Stomatolog y

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9.3 Inflammations of Salivary Glands

Inflammations of salivary glands can be either primary, during whose the first disease modification is the inflammation of a salivary gland’s parenchyma; or secondary, where an inflammation is caused by a pathological process inside the gland’s duct or its surroundings. Among the latter, there are concretions of gland ducts, post-inflammatory strictures of ducts or obturation of ducts by a tumorous process. All these ailments result in decreasing the rate of secretion and flow of the saliva including a possibility of an ascendant gland’s infection. In cases of general infectious diseases, a salivary gland may become descendably infected by hematogenous or lymphogenous ways. Penetrating injuries of salivary glands or their neighboring areas can also cause their direct infection. Bacterial, viral and mycological infections, as well as aseptic inflammations play a role at the etiology of sialadenitis.

The major signs of salivary glands inflammations are swelling of a corresponding area, red and sometimes also stretched skin. Retention of saliva, pressure of an exudate and irritation of sensitive nerves by toxic products of microorganisms cause pain. A sharp, very intense pain that shoots into the teeth and tongue (salivary colic) is a result of sialolithiasis caused by a sudden duct’s entanglement and closure by a stone. Chronic inflammations of salivary glands cause less severe pain which can be induced by a deep palpation. An important diagnostic feature of salivary glands inflammations is redness of duct’s opening, absence of saliva production even after massaging, or milky colored saliva containing flakes of puss.

Inflammation of the parotid gland (Parotitis acuta or p. chronica). The inflammation is characteristic by swelling of the parotido-masseteric region in front of the ear, below and behind it, and by a typical elevation of the ear lobe. Swelling may be rigid, together with redness of skin, sometimes the skin is stretched and glossy. At the purulent form (parotitis purulenta), except parotids of infants, a fluctuation is not palpable since the parotid gland has a thick fibrous capsule. Both spontaneous and palpational pain is present, the Stenton’s duct opening is reddish, saliva is cloudy or purulent, its secretion is reduced or absent.

Therapy is based on administration of broad-range antibiotics and analgesic medications. Purulent forms are treated by the extra-oral incision and wide opening of the gland’s fibrous capsule followed by drainage.

Parotitis epidemica (mumps) although affecting mainly children of pre-school and school age, can appear at adults, too. The causative agent of the disease is Paramyxovirus parotitidis. The incubation period is 21 days. Swelling occurs at one side first and in about 60% of cases extends to the other side. It slowly diminishes after 2-3 days. Overall problems do not have to be too serious, fever lasts several days and may reach 38-39oC. Salivation is reduced and a patient has difficulties with opening the mouth. The disease induces a lifelong immunity. A substantial diagnostic tool is positive serological reaction with the V-antigen. Amylase concentrations are elevated in blood and urine. At adults the disease may be accompanied by complications, such as meningoencephalitis, pancreatitis, orchitis or mastitis, with permanent consequences (malfunctions). The disease is subject to mandatory reporting. It requires isolation of a patient and rest at home. Therapy is symptomatic and uses analgesic drugs and application of wet compressions. A sufficient supply of liquids and oral hygiene are other major parts of a therapy regimen. An inpatient care is required only if complications occur.

Recurrent child’s parotitis (morbus Payen) is a microbial infection of the salivary gland which appears at children several times a year. Antibiotics are used for therapy; in cases of repeated inflammations and a large damage of the gland’s parenchyma, the gland’s function elimination can be indicated by tying off the duct. The disease has a typical sialographic picture.

Parotitis of newborns (parotitis neonatorum) can occur already few hours after the birth after infection of mixed microbial flora. It represents a serious purulent inflammation of the gland that originates by a hematogenous way, characteristic by early fluctuation (in contrast to adults disease). Therapy is surgical and radical in order to prevent spreading the disease to the mandibular joint (and jaws deformation by damages of the growth center).

Parotitis postoperativa (postanesthetica) is an inflammation of the ascendant origin that appears at dehydrated, hypovolaemic or decrepit patients as a result of reduced salivation or bad oral hygiene. It may complicate serious abdominal or gynecologic surgeries and neurosurgeries. Its origin is facilitated by metabolic disorders. Therapy is based on administration of broad-spectrum antibiotics, supplying a patient with liquids, eventually a surgery (incision) in case of purulent forms. Prevention by consistent pre-operative preparation and good oral hygiene are important.

Odontogenous inflammation of the parotid gland (parotitis odontogenes) is a rare complication of inflammation around the jaws, it appears per continuitatem and it is extremely painful. After an incision, a malodorous pus comes out, similarly as in cases of odontogenous abscesses.

Sialadenitis submandibularis is a microbial inflammation originating ascendentally at sialolithiasis. It is manifested by swelling of the submandibular area and a reddish and stretched skin. A characteristic swelling of the mouth base mucosa around the Wharton’s duct opening and reduced production of saliva upon massaging are important for diagnostic differentiation of this disease from a submandibular lymphonoditis appearing at acute inflammations around the jaws. There are no X-ray findings on the lower jaw’s teeth roots. Therapy is directed towards removal of a sialolith, after which the pathological condition disappears.

Sialoadenitis sublingualis (acuta) appears during purulent processes at the mouth floor. Plica sublingualis is swollen, the mucosa is reddish. The condition is relieved after inflammatory changes inside the mouth are eliminated.

Acute inflammation of tiny salivary glands appears rarely as a single disease. A chronic inflammation may affect the lower lip glands - cheilitis glandularis simplex (morbus Puente Acevedo), or cheilitis suppurativa superficialis (Volkmann’s disease). The lower lip is swollen and its mucosa contains small papulae with grayish tips - gland ducts. Cryotherapy is used with success in treatment of this disease.

Specific inflammations of the salivary glands.

Tuberculosis affects the parotid glands more often (70%), than the submandibular glands (27%). An infection passes into the gland via hematogenous or lymphogenous ways. This disease occurs both in the disseminated (infiltrative) and delimited (nodular) forms. The latter form is characterized by formation of delimited lymphomas that can be found by palpation at various parts of the salivary gland. Reduction in saliva secretion may lead to a secondary gland super-infection of an ascendant origin, which obscures a diagnosis. Therapy lies in curing the basic tuberculosis disease.

Syphilis (lues) may affect salivary gland at its 2nd stage causing diffuse swelling at both sides, or at its 3rd stage when a single-sided gumma may occur in addition to double-sided damage of a salivary gland by infiltration. Diagnosis is confirmed serologically and finding of Treponema pallidum in saliva, at some cases. Therapy focuses on treatment of the basic illness. The disease is relatively rare, however, due to current increase of newly reported cases it is necessary to take into account also the luetic damage of salivary glands.

Actinomycosis affects preferably the parotid salivary gland either primarily or secondary ( by penetration from adjacent areas in case of cervico-facial actinomycosis). Diagnosis is supported by finding of a rigid, slab-like infiltrate at the parotido-massetheric region, accompanied by formation of numerous fistulas, from which a pus containing yellowish druses of actinomycetes flows out. Therapy is based on a combined antibiotic and surgical treatments, similar to those used for therapy of specific inflammations of the oro-facial region.

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