Sialadenitis: Symptoms and Treatment
By sialadenitis is understood the inflammation of the salivary gland, which, as a rule, is caused by infection.Immediate causes of the development of the pathological process may be infectious agents of a bacterial or viral nature.With sialadenite, the iron becomes painful and increases in volume.Separation of saliva decreases, which causes a symptom such as dry mouth.The patient often complains of worsening of the general condition;It is possible to raise the total body temperature.
Complications of the disease can be the formation of an abscess, purulent melting of the gland and surrounding tissues, as well as the formation of concrements in the ducts.Conservative treatment involves rational antibiotic therapy or the use of antiviral drugs.If stones are present, remove them.Some complications require surgical intervention, including resection of the affected organ.Table of Contents: Classification Etiology and pathogenesis of salivary gland inflammation Risk factors for salivary gland inflammation Symptoms of salivary gland inflammation
All sialadenitis, like most inflammatory diseases, are divided into acute and chronic diseases according to the nature of the clinical course.
In turn, acute pathologies are divided by the nature of the infectious agent into:
Viruses that can cause the development of sialadenitis:
- influenza virus;
- of mumps;
- herpes simplex virus;
Among the bacteria that can lead to the development of sialadenitis are:
- of staphylococci;
- anaerobes( selected species);
Note : The share of sialadenitis according to statistics accounts for about half of all diseases of small and large salivary glands.The risk of developing sialadenitis is significantly higher in children, as well as in elderly patients( over 50).
The mechanism of occurrence of sialadenitis is divided into:
- is lymphatic;
- is hematogenous.
For the localization of inflammation within the same gland , chronic sialadenites are divided into:
- parenchymatous( the process affects the parenchyma of the organ);
- interstitial( inflammation of the stroma of the gland);
- sialodochitis( a pathological process affects the excretory ducts).
Etiology and pathogenesis of salivary gland inflammation
Infectious agents with non-specific sialadenitis can be representatives of the normal microflora of the oral cavity, as well as microorganisms entered with blood or lymph flow from distant foci.For example, the lymphogenous form is observed against the background of odontogenic diseases( in particular, with periodontitis), boils, conjunctivitis, and ARVI.
Important: is one of the causes of the pathology called benign lymphoreticulosis, known as "b cat scratch scratches" .
Contact sialadenitis is often the result of purulent inflammation of the tissues adjacent to the salivary gland.
Breast cancer can be associated with surgical interventions performed on adjacent tissues.
Specific varieties can be caused by pale treponema( against the background of syphilis), Koch's rod( mycobacterium - a causative agent of tuberculosis), and also actinomycetes.
In a number of cases, the cause of the pathology is blockage of the duct against the background of the formation of concrements( sialolithiasis) or foreign bodies( small solid food particles, toothbrush villi, etc.).
Infectious agents most often penetrate through the mouth of the gland duct.Less often they can penetrate by contact, as well as through the blood and lymphatic vessels.
Acute process can consistently go through several stages:
- serous inflammation;
- purulent inflammation;
- tissue necrosis.
Risk factors for inflammation of the salivary gland
Among the factors predisposing to the development of sialadenitis are:
- reduction of general and( or) local immunity;
- congestion of the secretion produced by the gland in its ducts;
- hyposalization against a background of severe common diseases;
- trauma to the salivary gland;
- rheumatoid arthritis;
- systemic lupus erythematosus;
- course of radiotherapy( for oncological diseases);
- dehydration( dehydration);
- hypercalcemia( increases the likelihood of formation of stones in the ducts).
Symptoms of salivary gland inflammation
The most commonly inflammatory process affects the parotid gland, which is due to the specific nature of the anatomy.The sialadenitis of the sublingual, submandibular, and so on is somewhat less common."Small" salivary glands.
Symptoms of acute sialadenitis
In acute disease, the affected gland increases in volume, and its consistency is significantly thickened.
Patients have the following clinical manifestations:
- local soft tissue swelling;
- pains of medium intensity, intensifying with the act of chewing, swallowing or turning the head;
- stuffiness of the ears( not always);
- decrease in secretion and( or) separation of saliva( less often - hypersalivation);
- inhomogeneity of saliva( presence of flakes or pus);
- hyperemia of the mucosa in the mouth of the duct.
Pain has the property of "giving" to the ear or temple.Quite often it is difficult for a patient to completely open his mouth.An acute process can be accompanied by a deterioration in overall well-being and a feverish reaction.
Important: if, in case of serous inflammation during palpation, the gland is compacted( infiltrate), then at the onset of purulent fusion, fluctuation takes place( fluid movement).
A characteristic feature of chronic sialodohitis( ductal lesions) is the retention of saliva during exacerbation.The symptom is manifested by the excretion of the mucosal consistency and the painful colic in the prostate of the affected gland.
Symptoms of chronic sialadenitis
The chronic process is characterized by alternation of periods of exacerbations and remissions( improvement of well-being).When the exacerbation is fixed swelling in the gland.The patient may complain of mild tenderness when chewing or palpating, dryness or an unpleasant taste in the mouth.
Diagnosis is based on patient complaints, data received by the dentist during the examination, as well as the results of additional studies.
Refinement of the diagnosis requires the following studies of :
- microscopy of a discharge from the gland ducts( bacteriological and cytological analysis);
- ultrasound examination of the gland;
- study of material taken during biopsy of the affected gland;
- enzyme immunoassay( for the presence of antibodies to a particular type of pathogen);
- PCR( polymerase chain reaction).
Important: One of the most common forms of this pathology is epidemic parotitis, also known as "mumps".Inflammation of the salivary glands can accompany certain systemic diseases, as well as tuberculosis and syphilis.
Depending on the form and specificity of the pathology, it can be detected not only by the dentist, but also by the therapist, infectious disease doctor, rheumatologist, phthisiatrist or venereologist.
Note : an important sign that allows diagnosing "acute sialadenitis, is the secretion of pus during palpation of the gland during the examination.
Differential diagnosis of sialadenitis with benign and malignant tumors, cysts, inflammation of the lymph glands( lymphadenitis), as well as infectious mononucleosis is required.
Treatment of inflammation of the salivary glands
Treatment of acute sialadenitis
Before prescribing drugs, the nature of the infectious agent should be established.In bacterial infection, antibiotics( in the form of instillations) and proteolytic enzymes are shown, and in viral - antiviral agents and irrigation with interferon.
The most effective in sialadenitis antibiotics penicillin series, as well as cephaloridine and erythromycin.Locally injectively inject streptomycin or penicillin at a dosage of 50,000 units( previously dissolved in 2 ml of 0.5% novocaine).To stimulate the functional activity of the glands, as well as to reduce inflammation, Galantamine( injected or used for electrophoresis), sodium nucleotide( orally) and Pyrogenal( injectively, IM) can be used.In the presence of infiltration, local applications with a solution of dimexide, as well as novocain blockades( "creeping infiltrate" according to Vishnevsky) are shown.
If an abscess is diagnosed, then surgery is indicated( opening with drainage of the abscess cavity).
Treatment of chronic sialadenitis
When choosing the drugs are guided by the same principles as in acute processes.
In addition to drug therapy, the patient is prescribed physiotherapeutic procedures:
- UHF therapy;
- application of the SOLLUX device.
It is also recommended for the treatment of sialadenitis regular massage of the gland.
The presence of strictures( narrowing) of the duct can be an indication for bougie( mechanical expansion by a special tool).When a stone is found( salivary salivolite stones), they are removed.For this, lithoextraction or lithotripsy can be used.
Note : concrements( stones) in the ducts are most often formed when the submaxillary salivary glands are affected.
In the event that the course of chronic sialadenitis is prolonged, relapsing, and the disease is practically not treatable, the question of extirpation( surgical removal) of the affected gland may be raised.
Indications for resection of the gland are also multiple concrements with sialadenitis.In the event that a single stone is found, it is often possible to eliminate it, keeping the secretory organ.
Emergency removal is performed with signs indicating the onset of purulent melting of the gland itself and nearby tissues.
Complications of sialadenitis
Acute inflammation of the salivary gland may cause foci of suppurative inflammations( abscesses), phlegmon in nearby areas, and infection of ducts.Severe clinical cases of acute sialadenitis lead to necrosis( necrosis of the tissues) of the gland or its scar deformation( replacement of glandular fibrous tissue).Structural changes lead to a disruption of the functional activity, ie, a decrease( or lack) of saliva secretion.Chronic dry mouth leads to xerostomia and secondary lesions of the mucous membranes of the oral cavity.
Please note : with timely initiated and adequate treatment, the process usually ends with complete recovery within a half to two weeks.
Prevention of sialadenitis
To prevent the development of inflammatory processes in the salivary glands, it is necessary to take measures to strengthen immunity, timely eliminate chronic foci of odontogenic infection( treat diseases of teeth and peri-toothed tissues), and maintain oral hygiene at a high level.
Against the backdrop of severe somatic diseases for the prevention of sialadenitis, patients are recommended to rinse the mouth with solutions with antiseptic effect.You can use 2% boric acid, as well as 1% acetic or lemon.
For more detailed information on the course and treatment of calculous sialadenitis, we recommend that you view this video review:
Plisov Vladimir, dentist