Stomatolog y

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9.7 Cysts of Salivary Glands

Retention cysts of salivary glands originate from widening of a duct either inside a gland or outside of it. The cause may be a post-inflammatory or after-injury stricture that gradually closes a gland’s duct. Saliva accumulates before a barrier and widens the duct by pressure (ductocele). Among retention cysts of the sublingual salivary gland, there is ranula, a cyst that appears on the floor of the mouth on the side of the tongue frenulum. It can grow into a size that obstructs the tongue’s movements. In some cases it may break open and get emptied spontaneously. This cyst often reappears if it was not removed surgically.

Retention cysts of small mucinous glands (mucocele) appear on the mucosa of the lower lip, cheeks, palate or tongue. These cysts on the lower lip of children can be traumatized by biting, causing them to break open. If even a small amount of mucinous saliva penetrates the lower lip tissue, a painful inflammation occurs - mucophagous granuloma.

Cystic widening of the parotid gland Stenon’s duct or Wharton’s duct of the submandibular gland appear scarcely, called ductocele and sialodochocele, respectively. It is presumed that these cysts are caused by an inborn atony of a salivary gland duct’s wall followed by dilatation. A causative factors include increased pressure inside the mouth of musicians playing brass instruments, or glass blowers.

9.8 Injuries of Salivary Glands

Traumatic injuries of the parotido-masseteric area cause affection of salivary gland more often than it is recorded. These injuries may be of various extent and severity. A frequent injury is bruise - contusion of a parotid gland caused by blunt blows at the gland area. It is manifested by bloody saliva at the Stenon’s duct opening only, and gets obscured by other more pronounced signs (pain, swelling, eventually fractures of the lower jawbone).

A gland may get damaged during open injuries of the parotido-massetheric region caused by traffic accidents or gunshot wounds. Injuries of this kind usually interrupt the facial nerve as well, followed by ailment of the mimic muscles function. Salivary fistulas can be formed upon an injury of the gland’s parenchyma, which require a surgical correction. The principle of a surgical treatment of the salivary skin fistulas is replacement of a fistula’s opening into the oral cavity and its suturing into the buccal mucosa.

10. Traumatology of the Facial Skeleton and the Teeth

Stomatology with all its branches covers a large area of medical sciences. In the field of maxillofacial surgery it deals with a complex area of the facial and oral traumatology. The face is a highly significant bodily part for everyone and correction of its damages restores mechanical functions that regulate physiological processes of breathing, alimentary tract, fonation, sensorial functions, as well as personal appearance which is important for a man’s communication with his environment. Efforts should therefore be put into returning life values and happiness to injured patients by means of qualified care.

10.1 Statistical Analysis of Causes of Facial Injuries

Numerous statistical analyses of facial injuries show both causes of these injuries and their locations.

  • the majority of injured people are males (86%)

  • the majority of patients are between 20 and 29 years old

  • the most common causes of isolated injuries of the lower jaw are criminal acts (batteries and fights), more than 40% of cases

  • the most common causes of isolated injuries of the middle facial third are traffic accidents (more than 49%)

  • the highest injury increase rate of all transportation vehicles was at bicycles (more than 24%)

  • the lower jaw gets hurt more frequently than the middle facial third during isolated injuries(2:1)

  • poly-traumatic injuries show the opposite ratio, the middle facial third gets injured more frequently

  • the lower jawbone’s body and angles get broken most often (64%)

  • for the middle facial third, the most common is a fracture of the zygomaticomaxillary complex (53%)

  • luxation or subluxation affects mostly the teeth of the upper jaw (72%)

  • soft tissues of the chin and cheeks get injured most often, followed by tissues of the upper lip and nose.

X-ray examination.

An X-ray examination belongs to the basic methods in diagnostics of fractures. It is employed at all cases. Both extra-oral imaging of the skull and intra-oral images are used to diagnose injuries of jawbones (the alveolar ridge) and the teeth. It is advantageous to use a panoramic imaging and ortho-pantomograms.

Native images of the skull are taken at the basic projections (anteroposterior, lateral and semiaxial) with the aim of clarifying the nature of an injury from more projections, perpendicular if possible.

To elucidate some types of injuries (hydraulic fractures of orbits), tomograms or other special projections onto the temporo-mandibular joint, zygomatic arch, orbits etc. are utilized.

For detailed observation of fracture lines at fractures of the middle third of the face and craniomaxillar fractures, the CT examination under various projections is often used, as well as a special 3D software.
Documentation and administrative activities.

A documentation has to be filed for all cases of injuries using obligatory forms (case history, daily records, the card of an outpatient treatment). Attention has to be paid to confession of a patient or an accompanying person about the causes of injury. It may influence both legal and expert examinations as well as patient’s compensation at later times. Injuries caused by other person(s) have to be announced to legal bodies and to health insurance companies. An eventual influence of alcohol should be recorded and the alcohol blood test should be performed upon request of competent organs.

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