Treatment of sialadenitis in children and adults. Sialoadenitis of the submandibular salivary gland - clinic, diagnosis and treatment Acute sialadenitis of the parotid salivary gland

Human digestion begins with the salivary glands. In the mouth, chewed food is moistened with saliva. It is produced by three large glands (parotid, sublingual, submandibular) and many small ones.

Inflammation of the salivary gland downstream proceeds as an acute or chronic disease. The disease is called sialadenitis. Local signs of inflammation can have unexpected consequences.

What you need to know about the structure and functions of the salivary glands?

The salivary glands are paired secreting organs. They have a different location and structure. Small or small glands are located deep in the mucous membrane of the oral cavity, nasopharynx and tonsils. According to localization, labial, palatine, buccal, gingival, lingual are distinguished. Among the major salivary glands, the parotid, sublingual, and submandibular glands are distinguished.

In the body of an adult, 1000-1500 ml of saliva is secreted per day. The total amount depends on the stimulating role of food, nervous and humoral effects. It is estimated that 69% of the volume is produced by the submandibular glands, 26% - parotid, 5% - sublingual.

Saliva contains:

• lysozyme, amylase, phosphatase and other enzymes;
• proteins;
• electrolytes (sodium, phosphorus, potassium, calcium, magnesium);
• parotin (an epithelial and nerve growth factor) and other substances with hormonal activity.

The parotid gland is located in the zone of masticatory muscles in the retromaxillary fossa. Above it lies the external auditory meatus and the zygomatic arch. It is covered in front and behind by strong neck muscles, so it is poorly palpated normally. This is the largest of all salivary glands, weighing up to 30 g. It is divided into superficial and deep lobes.

The dense capsule of the gland is fused with the muscles, but becomes thinner on the inner surface, there is no continuous coating here and there is communication with the peripharyngeal space. The processes of the capsule go inward, forming lobules.

Other glands are arranged according to the same principle. 60% of people have an additional share. The secret enters the salivary ducts, which merge to form a single excretory duct of the parotid gland (length up to 7 cm, width about 2.5 mm).

Nearby are such important structures as the carotid artery, facial and ear-temporal nerves, large veins, fibers of the sympathetic and parasympathetic plexuses, and lymph nodes. The path of the excretory duct can vary from straight to curving, rarely bifurcating. It opens on the buccal mucosa.

In old age, part of the tissue atrophies, its fatty degeneration is observed. According to the secretory composition, the parotid gland is considered purely serous.

The secretion in the lobules is produced by pyramidal cells, protection against infection, so that the gland does not become inflamed, provides mucus secreted by goblet cells

Submandibular gland - located in the submandibular fossa between the lower jaw and the digastric muscle. Back in contact with the sublingual gland. In the zone of the angle of the lower jaw, it is very close to the parotid. Weight is 8-10 g (decreases in old age). A dense capsule is surrounded by adipose tissue, lymph nodes.

The excretory duct is up to 7 cm long, the lumen is 2–4 mm, it opens in the floor of the oral cavity near the frenulum of the tongue. According to the composition of the secretion of iron, it belongs to the serous-mucous. The blood supply comes from the facial artery. The lingual nerve passes in close proximity.

The doctor in cases of surgical treatment of inflammation of the submandibular salivary gland has to take into account the possibility of the location of the lingual nerve in the surrounding adhesions. This also applies to the projection of the facial nerve. The need for removal (extirpation) of the gland requires caution in choosing the site of the incision. Otherwise, curing one disease can cause serious complications.

The sublingual gland is located at the bottom of the oral cavity in the area between the frenulum of the tongue with the wisdom tooth. Outside and below it is limited by dense muscles. Nearby are the lingual nerve and the endings of the hypoglossal nerve, the lingual vessels, the excretory duct of the submandibular gland.

The capsule is thin. Weight up to 5 g. The excretory duct flows into the mouth of the duct of the submandibular gland. Its length is up to 2 cm. It belongs to the mixed glands of the serous-mucous type.

Why does sialadenitis occur?

The cause of acute inflammation of the salivary gland is one of the infectious agents or a mixed infection. The most common viruses are mumps, influenza, cytomegalovirus, Epstein-Barr, herpes, Coxsackie. The route of infection is airborne with the saliva of a sick person.

The tissues of the salivary glands are particularly sensitive to the mumps virus. Getting on the mucous membrane of the respiratory tract, it goes deep into the parenchyma of the parotid gland, multiplies and forms an inflammatory response. In addition to local inflammation, the circulation of the mumps virus through the circulatory system is important.

Once in the testicles of boys, the microorganism causes irreversible changes that threaten infertility in the future.

Bacteria - come from the oral cavity with lymph or through the ducts. The source can be carious teeth, tonsillitis, purulent discharge from the nasopharynx with sinusitis, lack of proper hygiene measures for care. With the bloodstream, bacteria can enter the salivary glands with scarlet fever in children, typhoid fever (typhoid pneumonia).

With lymph, they are transmitted with boils on the face, in the throat, and purulent wounds. One of the factors contributing to infection with further inflammation of the salivary gland is mechanical obturation (lumen occlusion) of the ducts.

It comes as a result of:

• the formation of a stone inside the duct, the stagnation of the secret quickly becomes infected (such inflammation is called calculous);
• introduction of a foreign body;
• reactive obturation - reflex narrowing of the ducts and a decrease in saliva production occurs under the influence of stress, malnutrition, surgical interventions on the abdominal organs, exhaustion in chronic diseases, malignant neoplasms, and diabetes mellitus.

The accumulated saliva in the duct serves as a good medium for the growth of pathogenic microorganisms from the oral cavity.

Chronic inflammatory diseases rarely progress from the acute form of sialadenitis. They are characterized by independent development, which is caused by the predisposition of the gland tissue. This feature is explained by autoimmune processes, genetic disorders, various underlying diseases.

The provoking factors are:

• stress;
• hypothermia;
• pregnancy;
• past trauma;
• decreased immunity due to a serious illness, aging of the body.

Chronic inflammation occurs against the background of a deterioration in blood supply with widespread atherosclerosis in the elderly.

How does the disease manifest itself?

Symptoms of inflammation of the salivary glands depend on the location, form, have local and general signs.

Parotitis

The disease begins suddenly with an increase in temperature up to 40 degrees. Swelling in the parotid region is formed on both sides. Patients experience pain when moving the jaw, talking, chewing. Radiates to the ears. Puffiness makes the face round, so the popular name for the disease is “mumps”. In adults, inflammation of the submandibular salivary gland and sublingual gland occurs simultaneously.

In the photo, unilateral sialadenitis

There are stages of the disease:

• Serous - appears dry mouth, soreness and swelling of the face in the ear area (noticeably elevated position of the earlobe). The pain is moderate, felt when eating, salivation at the sight of food. The skin is not changed. The temperature is low. Pressure does not cause saliva, little painful.
• Purulent - the pains become sharp, do not give the opportunity to open the mouth, "shoot" in the ears, lead to insomnia. The temperature rises to 38 degrees and above. Puffiness extends to the temples, lower jaw. The pressure is very painful, pus is released into the mouth. The gland is of dense consistency, the skin in the area of ​​inflammation is reddened.
• Gangrenous - it is difficult, the temperature does not rise high due to the weakening of the protective forces. The skin is partially destroyed and necrotic tissues pass through it. Perhaps a septic course with a fatal outcome or acute bleeding from the arteries of the neck.

Inflammation in the submandibular gland

Sialoadenitis of the submandibular salivary gland is manifested by swelling in the submandibular region. The gland is palpated as an enlarged, dense, bumpy, painful formation.

As inflammation increases, swelling increases, pain appears when swallowing

When examining the mouth under the tongue, redness, swelling are visible, it is possible to detect the release of pus from the duct. Localization in the submandibular salivary gland is most often accompanied by the formation of a stone in the duct (calculous process). The reason is a high concentration of calcium in the blood, the introduction of a foreign body.

Signs of calculous inflammation are:

• in changing the nature of the pain to a sharp, stabbing, there remains an increase in eating;
• impaired salivation;
• constant feeling of dryness in the mouth;
• swelling of the skin;
• dense bumpy surface of the gland.

Massaging movements cause the release of pus under the tongue.

Sublingual sialadenitis

Inflammation of the sublingual salivary gland is very rare. It is detected by dentists in case of complicated course of periodontitis. Maximum soreness and swelling are detected under the tongue. It is felt when talking, eating.

Forms of chronic inflammation

Inflammatory diseases of the salivary glands in chronic course differ in forms. Interstitial sialadenitis - observed in 85% of patients with lesions of the parotid glands, more often in women and in the elderly. It is asymptomatic for a long time.

It progresses slowly, accompanied by a gradual narrowing of the ducts. The aggravation begins suddenly, the gland increases, is painful, but has a smooth surface. After treatment, the size does not return to normal.

Parenchymal - also affects almost always the parotid glands. Patients are of any age, women are more likely to get sick. The hidden current has been going on for many years. The clinic of exacerbation does not differ from acute sialadenitis. In the initial stage, patients note the appearance in the mouth of abundant brackish mucus when pressing on the parotid zone.

Then pain, induration, tuberosity of the gland, pus in saliva appear. Dryness, painful swallowing or chewing are not characteristic.

Sialodokhitis - this is the name of an isolated lesion of the ducts. It often develops in old age due to the anatomical expansion of the excretory tract. The main symptom is profuse salivation when eating and talking. This contributes to the formation of jam in the corners of the mouth.

How is the diagnosis made?

Diagnosis is based on clarifying the symptoms and examining the patient, palpation of the glands. In addition to the therapist, you may need to consult an otolaryngologist, dentist. Acute processes usually have a pronounced association with infection.

Palpation is carried out with soft massaging movements.

Chronic sialadenitis is detected by X-ray examination after the introduction of a contrast agent into the duct (sialography). Then the pictures reveal characteristic changes:

• in the interstitial form - narrowing of the ducts, against the background of a small introduction of Iodolipol (up to 0.8 ml instead of 2-3 is normal);
• with parenchymal - multiple small cavities, ducts and gland tissue are not determined, and up to 8 ml of solution is needed to completely fill the cavities.

If necessary, differential diagnosis is used: ultrasound of the salivary glands, biopsy with analysis for cytology, bacteriological culture of saliva, biochemical analysis of the composition of saliva, polymerase chain reaction technique to identify the pathogen.

Types of treatment for sialadenitis

Treatment of inflammation of the salivary gland necessarily takes into account the stage and form of the disease, the age of the patient. Acute sialadenitis in the serous stage can be treated on an outpatient basis, following all the orders of the doctor.

With viral mumps, including epidemic, it is useless to treat inflammation of the salivary gland with antibiotics. Interferon-based drugs, immunomodulators, symptomatic drugs for pain relief, fever reduction are shown. In order to reduce the concentration of the virus in the bloodstream, drinking plenty of water is recommended.

In bacterial acute inflammatory processes, a special salivary diet is prescribed. The food includes crackers, lemon, sauerkraut, cranberries. To stimulate the excretory ducts, a solution of Pilocarpine in drops is used.

Antibiotics are introduced into the ducts in stationary conditions. At home, it is recommended in intramuscular injections or capsules. To wash the ducts, solutions of antiseptics (Dioxydin) are used. With inflammation of the salivary gland under the tongue, it is recommended to rinse with a warm preparation with a slight delay in the mouth.

Treatment of sialoadenitis is not complete without compresses on the gland area (once a day for half an hour).

For the compress, diluted heated vodka, Dimexidine is used, the patient feels a decrease in pain

From physiotherapy, UHF is used for anti-inflammatory and analgesic effects. Against the background of severe edema and pains that make it difficult to eat, blockades are used with a solution of Penicillin with Novocain.

To prevent the formation of adhesions and impaired patency of the ducts, Trasilol and Kontrykal are used intravenously. Surgical treatment is indicated in severe cases requiring opening of the abscess from the outside. The operation is performed under anesthesia. At the same time, a stone in the duct is removed, if it has formed.

Chronic sialadenitis is treated during an exacerbation by the same methods as acute ones. But it is important to support salivation, the release of purulent plugs during periods without exacerbation. For this it is recommended:

• conduct a course of duct massage with internal administration of antibiotics;
• novocaine blockade and electrophoresis with Galantamine - stimulate the secretion of saliva;
• galvanization procedures;
• the introduction of Iodolipol into the gland once a quarter to prevent exacerbations;
• course intake of potassium iodide;
• surgical removal of the gland, if it causes frequent exacerbations.

Treatment with folk remedies suggests: rinsing your mouth with a salt solution, slowly sucking on a slice of lemon, adding herbal teas with anti-inflammatory effects (mint, chamomile, calendula) to your drink.

Prevention

Children at the age of one and a half years are vaccinated with a three-component vaccine against mumps, measles, rubella. The most available general protective measures: oral care (brushing teeth at least twice a day, rinsing after meals), treatment of carious teeth, tonsillitis, sinusitis.

It is important to wash hands after contact with different people, before eating, wearing a mask when caring for sick family members, dressing for the season, and avoiding hypothermia. Participation in flu shots helps adults protect themselves from sialadenitis. Prevention measures should be taught to children from preschool age.

Also called sialoadenitis, it progresses against a background of abnormal salivation.

The disease is a violation of the process of producing saliva. Its course can be both acute and chronic.

Usually 1 gland is involved in the pathological process, but sometimes there is a simultaneous lesion of 2 symmetrically located glands. In 85% of cases, inflammation affects the parotid salivary gland (mumps, mumps), a little less often - the sublingual and mandibular.

Here is how the disease looks in the photo:

Sialoadenitis is a polyetiological disease. The development of the pathological process is preceded by the penetration of an infectious agent - viruses, bacteria.

At risk are children, pregnant women, the elderly.

The causes are conditionally divided into 2 groups - bacterial (anaerobic bacteria, staphylococci and streptococci) and viral.

Factors provoking the acute form of the disease in adults:

• infectious focus located in the cavity of the ear and mouth;
• benign lymphoreticulosis and lymphadenitis developing against its background;
• carriage of pathogenic microorganisms;
• metabolic disorders;
• carriage of conditionally pathogenic microorganisms;
• immunodeficiency;
• infectious diseases (measles, rubella, scarlet fever);
• pneumonia;
• acute respiratory viral pathologies (against the background of SARS, influenza, cytomegalovirus);
• bronchopneumonia;
• injuries of the maxillofacial area;
• mycoses;
• syphilis;
• tuberculosis;
• allergy;
• oncology.

Children's sialadenitis progresses against the background of mumps.

The reasons for the development of a chronic form of pathology include:

• autoimmune processes;
• genetic predisposition;
• vascular atherosclerosis;
• hypothermia (local, general);
• stress;
• diseases of the internal organs.

With a running chronic process, the most dangerous form of this disease develops - calculous sialadenitis.

Inflammation of the parotid gland is dangerous and contagious. A possible route of transmission from a sick person is airborne.

Types of inflammation of the salivary glands

Sialoadenitis is classified by:

• etiology;
• localization;
• nature of the inflammatory process.

A detailed classification of the disease is presented in the table:

Speaking about the pathogenesis of acute sialadenitis, physicians distinguish focal and diffuse, rarely gangrenous types.

The chronic form is interstitial, productive. The acute form can also be nonspecific.

The submandibular gland is a steam room, so the following types of sialadenitis are diagnosed:

• left-sided;
• right hand;
• bilateral (double-sided).

Also revealed:

By the nature of inflammation, there are such types of disease:

• dystrophic reactive;
• fibroplastic;
• serous;
• destructive;
• granulomatous;
• hemorrhagic.

Symptoms of acute inflammation

Information about the glands and their ducts is presented in the table:

Serous form

Symptoms of the "classic" inflammatory process appear:

• an increase in temperature to febrile indicators (38-39 degrees);
• swelling in the affected area (usually on the left or right);
• pain;
• change in shade where the gland becomes inflamed.

Purulent and abscessing form

In acute purulent form, the patient complains of:

• shooting pain syndrome in the jaw (it hurts in the area of ​​the affected gland), radiating to the ear;
• temperature rise (it increases to 39 degrees);
• swelling (the affected gland can swell, the cheek, neck swell);
• difficulty swallowing;
• flushing of the skin over the affected area (with damage to the parotid gland - near the auricle);
• hearing loss;
• dry mouth.

The last 2 signs are due to a sharp decrease in salivation.

When palpated, an infiltrate is detected, which hurts a lot. When massaging the affected area, turbid and then purulent contents flow out of the mouth of the ducts.

Calculous form

The clinic of this form manifests itself as follows:

• "salivary colic;
• pain syndrome in the cheekbone (character - pulling), extending to the root of the tongue;
• significant deterioration in general condition.

Symptoms of chronic inflammation

The clinical picture is almost similar to the symptoms of the acute form. It doesn't appear as pronounced. The general temperature is not increased, soreness is not observed.

The affected area can swell and disturb only during exacerbations.

Symptoms disappear within 3-5 days.

Interstitial and parenchymal inflammation

The local status of the interstitial form is as follows: the rapid growth of connective tissues. Violation is observed in the parotid zone.

The clinic is expressed implicitly, there are no specific complaints. Pain and swelling appear against the background of exacerbation. It is provoked by an increase in the symptoms of the underlying disease.

The parenchymal form is characterized by a long course. There are infrequent but painful exacerbations.

Typical symptoms:

• pain in the affected area, radiating to the pillow area, lips, palate, root and tip of the tongue;
• discharge from the salivary ducts of pus;
• swelling of the glands;
• dry mouth;
• difficulty swallowing.

Symptoms persist during periods of remission.

Sialodochit

Sialodochitis is characterized by the expansion of the excretory ducts.

The severity of the clinical picture depends on the stage:

Possible Complications

During the course of chronic sialoadenitis, the following complications appear:

• sclerosis of the gland (accompanied by another dangerous consequence - atrophy of the acinar sections);
• stromal lipomatosis;
• gland cyst;
• gland abscess.

With systemic damage to the glands, a decrease or loss of their functions is observed. This leads to xerostomia.

Diagnostic methods

When the first symptoms appear, you should contact:

• dentist
• infectious disease specialist;
• maxillofacial surgeon (it is necessary to go to him in advanced cases).

The first stage of diagnosis is palpation.

Then the doctor directs the patient to:

• X-ray.

A differential diagnosis with Sjögren's syndrome is mandatory.

The clinical data of the cytogram and sialogram are taken into account (contrast sialography is recommended for chronic form).

If lymphadenopathy is suspected, the patient is referred for a biopsy followed by histology. After that, treatment is prescribed.

How is the treatment carried out?

In the initial stages, conservative means will help to cure the disease:

1. Dry heat (you can warm the affected area with sea salt).
2. Sollux.
3. Salivary diet (food includes crackers, lemon, sauerkraut, cranberries, and is supplemented with 1% solution of Pilocarpine hydrochloride (5-6 drops)).
4. Antibiotic therapy.

The patient undertakes to avoid hypothermia and new infection, to treat pharyngitis and tonsillitis in a timely manner. The duration of treatment depends on the form and stage of the pathological process. In advanced stages, therapy lasts a year.

With suppuration, the patient is hospitalized and surgical intervention is prescribed for him.

conservative ways

Drug treatment involves taking broad-spectrum antibiotics in combination with Metronidazole. With a mild degree, drugs are prescribed in tablets.

The child is prescribed "safe" drugs - cephalosporins, penicillins, macrolides:

• Zinacef.
• Zinnat.
• Aksetin.

In moderate cases, antibiotics are injected into the muscle. Penicillin-novocaine (40-50 ml of a 0.5% solution) blockade of the subcutaneous tissue of the parotid chewing area is carried out.

Desensitizing therapy is prescribed - droppers are placed with Loratadine or Suprastin.

In the chronic form, it is additionally allowed to treat the disease with local remedies. It is recommended to make ointment compresses with 30-50% Dimexide.

Surgery

The volume of surgical intervention depends on the stage of the pathological process:

The duration of rehabilitation depends on the type of operation. On average - up to 3 months.

Inflammation of the tissues of the salivary gland has an acute and chronic genesis, is both primary and complicates other inflammatory processes (periodontitis, furuncle, conjunctivitis).

Therefore, sialadenitis of the submandibular salivary gland requires diagnosis and timely treatment.

What is sialadenitis

Treatment Methods

Conservative therapy

It is the main way to treat the disease, includes the fight against an infectious agent, symptomatic and physiotherapy.

Etiotropic

With the established viral etiology of the pathology, antibiotic therapy is prescribed for a course of 5-10 days, depending on the severity of the course of the disease.

Antibiotics are used in standard therapeutic doses orally, intramuscularly and by injection into the excretory duct.

The groups of drugs used include:

• synthetic penicillins (Amoxiclav, Amoxicillin, Ampicillin);
• sulfonamides (Biseptol, Ftalazol, Sulfasalazine);
• III generation cephalosporins (Ceftriaxone, Cefosin, Cefotaxime).

For viral sialadenitis:

• interferon alpha preparations (Altevir, Viferon, Herpferon) by injection into the duct, rinsing the mouth, instillation into the nasal passages for up to 10 days;
• intraductal application of ribonuclease 5-10 mg, diluted in 3-5 ml of 0.9% saline, daily for 5-8 days;
• Oseltamivir 75 mg twice a day for 5 days.

pathogenetic

• Pilocarpine hydrochloride 5-6 drops 3-4 times a day to restore salivation, Prozerin, Neostigmine.
• Anti-inflammatory therapy with drugs from the NSAID group (Baralgin, Ibuklin, Indomethacin). In addition to stopping inflammation, they also have an antipyretic effect, which makes their use rational in the acute period of the disease. With long-term use of NSAIDs (more than 5 days), it is necessary to prescribe Omeprazole 40 mg / day for the prevention of gastropathy.
• Compresses with a 30% solution of dimexide on the area of ​​the submandibular gland for 20-30 minutes 1-2 times a day.
• Novocaine blockade according to Vishnevsky.

symptomatic

• Vitamin therapy with groups C, PP, A (Ascorbic acid, Askorutin, Rutin) has a general strengthening effect, reduces the symptoms of intoxication.
• Rinsing the mouth with antibacterial solutions (Furacilin, Miramistin, Chlorhexidine) 4-5 times a day moisturizes the mucous membranes, fights the growth of microorganisms, and also flushes out food particles that irritate inflamed tissues.
• Antipyretic therapy is carried out in the acute period to relieve fever: Acetylsalicylic acid 500 mg 2 times a day, Paracetamol, Baralgin.

Physiotherapy

Physiotherapy treatment is used for the serous nature of the pathology (viral etiology of the disease) and is aimed at eliminating symptoms, stopping the inflammatory process and restoring the normal outflow of salivary gland secretion into the oral cavity.

• electrophoresis with novocaine, heparin, iodine preparations is carried out daily with a course of 5 to 10 procedures.
• Galvanization– exposure to direct current of low voltage on the skin of the submandibular region, stimulates the restoration of secretory function.
• Fluctuating(exposure to alternating low-frequency currents) in the acute period helps to limit the inflammatory process, prevent the formation of abscesses. It is carried out in 2-3 days within two weeks from the onset of the disease.
• UHF therapy indicated in the chronic course of the disease. The duration of the session is 20-25 minutes, the course accounts for an average of 15 procedures performed every 1-2 days.

Folk methods of treatment

Includes:

• Rinsing the mouth with decoctions of peppermint leaves and lemon peel stimulates salivation, moisturizes the mucous membranes, and has an analgesic effect.
• Rinsing the mouth with a decoction of walnut leaves, sage, cinquefoil rhizomes and calendula flowers every 2 hours.
• Compresses from echinacea tincture: dilute 30 drops of a pharmacy form with water in different parts, moisten a gauze bandage in the resulting solution, apply to the skin of the submandibular region for 20-30 minutes 2 times a day.
• A decoction of eucalyptus leaves helps relieve inflammation, take half a glass of warm infusion 3 times a day.
• Massage of the lower jaw area to reduce pain and stimulate the outflow of saliva.

Surgery

• blockage of the duct by a foreign body (calculus, clot of pus, dead tissue or a foreign object that became the initial cause of inflammation);
• abscess localized in the parenchyma of the gland;
• salivary strictures;
• purulent fusion (phlegmon) of tissues;
• gangrenous sialadenitis.

Methods of surgical treatment:

• Bougienage of ducts. It is carried out with strictures and severe stenoses, when an independent restoration of the outflow of salivary secretion is impossible. It consists in introducing a special bougie of the appropriate diameter into the duct and mechanical expansion of the stenotic area. If necessary, the procedure is repeated.
• opening of an abscess localized in the stroma of the gland. It is carried out under intravenous anesthesia, the abscess is opened, the cavity is washed with disinfectants, drainage is installed in the form of a rubber strip and sutures are applied. To stimulate the outflow of exudate, a bandage moistened with hypertonic sodium chloride solution is applied.
• Removal of foreign bodies. It is usually performed under local anesthesia, takes from 5 to 20 minutes, after the procedure is completed, an antiseptic drug is injected into the salivary ducts, and broad-spectrum antibiotics (Ceftriaxone, Cefotaxime) are supported.
• Sialectomy - complete removal of the salivary gland involved in the pathological process. It is indicated for frequent relapses of the disease, purulent fusion and ineffectiveness of previous treatment.

The outcome of the disease is favorable: with timely treatment of submandibulitis, recovery is observed after 2 weeks.

With a late visit to the doctor, the lack of proper therapy and non-compliance with the recommendations, the risk of complications increases: the development of strictures, stenosis, and a persistent decrease in the production of salivary fluid.

Sialoadenitis is a disease of inflammatory etiology, which is localized in the salivary glands, manifested for one reason or another (developmental anomaly, traumatic impact, infection). In a situation where the substrate for the occurrence of sialadenitis is an infectious disease, then the diagnosis must indicate its secondary nature of origin.

There are also primary sialadenitis, they are usually noted in pediatric practice and occur due to a violation of the embryogenesis of the salivary glands. Usually, the process of pathology during sialadenitis has an asymmetric unilateral character, however, in world practice there is information about multiple lesions.

The main causes of the disease

In the general structure of this disease, the most common etiopathogenetic method is sialoadenitis of the parotid gland. All the factors why sialadenitis of the salivary gland appears belong to one of two etiological groups (non-epidemic and epidemic group). The main reason for the appearance of the epidemic form of sialoadenitis is the penetration into the body of bacterial or viral particles that cause a general and local inflammatory reaction.

The appearance of inflammatory changes in the salivary glands, which is always noted during sialoadenitis, is facilitated by the presence in the oral cavity of infectious chronic foci in the form of dental caries. In addition, sialadenitis of the parotid gland of a non-epidemic form may appear as a complication of surgical interventions or other diseases of an infectious nature.

Signs and symptoms of the disease

Acute sialadenitis of the salivary gland is characterized by:

• infiltration;
• the appearance of puffiness;
• necrosis of glandular tissue with replacement by connective tissue and the appearance of a scar;
• purulent fusion.

Not in all cases, the result of an acute process is necrosis and suppuration, as a rule, inflammatory changes subside at earlier stages. If a person has sialadenitis of the parotid gland, then the pathognomonic symptom is the development of a pronounced pain sensation during head movements, as well as opening the mouth. After a while, soft tissue edema passes to adjacent areas:

• submandibular;
• buccal;
• upper part of the cervical region;
• posterior region.

During deep palpation, which is complicated due to severe pain, an infiltrate of a dense consistency is felt in the projection of the presumed location of the parotid gland. When if a person has a complication in the form of purulent fusion is connected, then a positive sign of fluctuation is noted above the lesion.

A specific symptom of sialoadenitis is hyper- or hyposalivation, with changes in the qualitative composition of saliva (desquamated epithelium, an admixture of pus and flakes of mucus are noted in saliva). Submandibular sialadenitis It is expressed by such signs as pain during swallowing movements, swelling of the sublingual and submandibular region with spread to the cervical part.

In addition to clinical symptoms, a cytological examination of the secretion of the salivary gland is a good help for the correct diagnosis. During sialadenitis, which is provoked by blockage of the salivary ducts by a foreign body, a person may experience different clinical symptoms.

In certain cases, this disease is expressed only by a small increase in the gland, and in others there is extensive inflammation in the form of phlegmon and abscess. The foreign body briefly begins to provoke a slight swelling of the submandibular and parotid glands, as well as a delay in salivation. For this form of sialadenitis pain syndrome is not typical.

Purulent inflammation of the salivary gland, in the absence of proper treatment, inevitably provokes the melting of the iron capsule and the spread of the pathology process to adjacent tissues. In certain cases, there is an independent opening of the abscess with the release of a foreign body.

Acute sialadenitis

Most often, the acute form of the disease appears against the background of a deterioration in oral hygiene, impaired salivation, with neurovegetative reactions, as well as dehydration. parotid gland in this case is the predominant localization of the process of inflammation. Among the local causes of acute sialoadenitis, it is also necessary to consider a malfunction of the gland during a traumatic effect on it, as well as during inflammatory changes in periodontal tissue.

The pathognomonicity and intensity of clinical symptoms during acute sialoadenitis correlate with the localization and inflammation of the pathology process. Serous acute sialadenitis is expressed sharp pain sensations in the projection of the parotid region, which increase during chewing food. The deterioration of a person's condition in this disease develops very quickly and is expressed by pain, a feeling of dry mouth and the appearance of febrile fever.

During the examination of a patient with acute sialoadenitis, all the symptoms of inflammation are visualized in the form of pain on palpation, a strong increase in soft tissues at the affected area. During the accession of the purulent nature of the inflammatory process, both clinical symptoms and laboratory tests worsen.

Chronic sialadenitis

Chronic passage of sialoadenitis is a very common phenomenon and in pediatric practice it has at least 15% in the structure of diseases of maxillofacial surgery. Most often noted chronic sialadenitis, which has nothing to do with mumps. Given the prevalence of the pathology process in the salivary gland, it is customary to classify parenchymal (usually prevalent in children) and interstitial sialadenitis.

Many doctors in the field of maxillofacial surgery believe that the appearance of chronic sialoadenitis is due to congenital failure of the glandular tissue. The exacerbation of the disease is steady decline indicators of the protection of the human body, which are not restored even during clinical remission, this causes the primary chronic process of inflammation. The specificity of chronic sialoadenitis is its tendency to cyclic passage.

Chronic interstitial submandibular sialoadenitis may be accompanied by narrowing of the ducts, therefore, during radiation imaging methods, a decrease in the intensity of the parenchyma can be observed without any violations of its structure. The use of contrast methods of X-ray examination is possible only during complete remission.

Treatment of a patient with symptoms of chronic sialoadenitis depends directly on the stage of the disease. Thus, during an exacerbation, it is mandatory to use desensitizing agents(Cetrin one tablet once a day), antibacterial drugs (Ampiox at a daily dosage of 2 grams orally). During the onset of symptoms of purulent inflammation, the use of daily instillation of the infected gland is prescribed until saliva analysis for the presence of pus is restored.

Instillation is used with the help of proteolytic enzymes and antiseptics, which promote dehydration and anti-inflammatory effects, as well as lysis of necrotic tissues. For local treatment the use of compresses is prescribed with 40-55% dimexide and ointment compresses. In the role of preventive measures during chronic sialoadenitis, salivation stimulation is used, which can be provided by introducing 1.6 ml of 10% xanthinol nicotinate into the salivary passage. Patients with symptoms of chronic sialoadenitis require medical examination, and the implementation of preventive measures that are aimed at preventing the occurrence of exacerbations.

Sialadenitis: Treatment of the disease

Salivary gland sialadenitis responds well to treatment at the acute stage of the disease, while chronic treatment is difficult to treat. The pathogenetic treatment of sialadenitis is based on medicines, which enhance the secretion of saliva and its passage through the salivary canal (2% composition of Pilocarpine). In addition, physiotherapeutic methods of treatment in the form of UHF at the site of infection, as well as the use of alcohol-camphor compresses, have an excellent therapeutic property during sialoadenitis.

Non-specific treatment options for the disease include compliance with the rules of oral hygiene by the patient, which implies regular brushing of the tongue and teeth. after every meal using dental floss and brush. Patients should also stop smoking. The organization of food intake, which involves grinding products, increasing the drinking regimen, which helps prevent the transition of the inflammatory process to nearby tissues.

A pronounced reaction of the inflammatory process can provoke a fever, it must be stopped with the help of antipyretic drugs (Nimide in a single dose of 100 mg). For relief of feelings of pain, which often accompanies submandibular sialadenitis, you need to use different massage techniques for the affected area. Chronic sialoadenitis is difficult to treat, and the percentage of full recovery in this case is not more than 25%.

All the methods of treatment used during the chronic passage of sialadenitis are mostly used to prevent the occurrence of complications. The time of exacerbations in chronic sialoadenitis is also due to the appearance inflammatory process in the salivary gland, this makes it advisable to use antibacterial drugs. During remission of this category of patients, a course of galvanization of the salivary glands is indicated. If a person has calculous sialoadenitis, then the use of surgical intervention is justified.

Also, surgical intervention is prescribed in cases where there is parenchymal purulent sialadenitis with symptoms of melting. Operational allowance and scope surgical intervention will directly depend on the degree of damage to the salivary gland and is most often limited to drainage or opening of the gland with the concomitant administration of an antibiotic to the affected area.

Which doctor can help with sialadenitis? If you suspect or have the appearance of sialoadenitis, you should seek help from doctors such as a surgeon and an infectious disease specialist as soon as possible.

Prevention and prognosis of sialadenitis

Most often, the outcome of sialoadenitis is favorable. In acute sialoadenitis, recovery usually occurs within 14 days. In advanced or severe situations, sialadenitis accompanied by congestion of the ducts or cicatricial deformity, necrosis of the gland, persistent violation of salivation. Prevention of the disease consists in maintaining oral hygiene, strengthening immunity, eliminating somatogenic foci of chronic infection, and treating concomitant diseases.

Anatomical and physiological features of OSZh

OSJ are localized in the parotid-chewing part of the face, under the skin, below and in front of the auricles. From above, the formations approach the zygomatic arches, from below they come into contact with the angle of the lower jaw, from behind - with the anterior edge of the sternocleidomastoid muscle. The parotid salivary gland is surrounded by a capsule (fascia).

In its structure, it is uneven, most of the formation is dense, but there are also loosened areas. The fascia protrudes into the OSJ and divides it into lobules. Thus, we can say that the OSJ is distinguished by a lobed structure. The parotid glands are well supplied with blood, penetrated by a large number of large and small vessels, nerves, and lymph nodes.

Important! The main function of the OSJ is the secretion of saliva. The parotid glands produce a secretion of a liquid consistency with a high concentration of sodium and potassium salts, as well as significant amylase (enzyme) activity. During the day, both OSJs secrete approximately 0.2–0.7 liters of saliva (this is almost a third of the total volume of secretion produced over a given period by all the salivary glands of the human body).

Inflammatory processes

Sialoadenitis, an inflammation of the parotid salivary glands, is the most common problem that occurs in this area. The inflammatory process, as a rule, is one-sided, has a viral or bacterial origin. Sialoadenitis of the parotid SF occurs in both acute and chronic forms.

The parotid glands have a lobular structure, are well supplied with blood, produce a third of the total daily secretion volume.

Reasons for the development of the inflammatory process in the OSZh:

• transferred infectious diseases;
• playing wind instruments (increased load on the masticatory muscles of the face adjacent to the OSJ);
• transferred operations;
• stenosis of the OSJ duct;
• increased blood pressure.

Types of inflammation

Sialadenitis is of several types (depending on the cause):

• acute contact (develops as a complication of an abscess (furuncle) localized next to the OSJ, secondary infection);
• blockage and inflammation of the duct of the gland with food particles, toothbrush villi or other foreign body;
• epidemic parotitis (you can recognize this disease by the characteristic swelling of the cheeks and neck);
• acute lymphogenous (not only the parotid glands themselves become inflamed, but also the lymph nodes, as well as subcutaneous fatty tissue);
• chronic interstitial (complication of surgery or past infections);
• parenchymal (occurs in a chronic form, the cause is a cyst in the OSJ).

Mumps

The symptoms of this type of inflammation are the most striking. The pathological process affects one or both OSZh at once, leads to a decrease in the amount of secretion synthesized, dry mouth and digestive problems. Risk group - children 3-10 years old with reduced immunity. Mumps most often get sick in the cold season (especially after suffering infectious or viral illnesses).

Parotitis is most common in children between the ages of 3 and 10.

Classic signs of parotitis:

• intense pain in one (both) parotid salivary glands;
• feverish state (chills, a sharp jump in body temperature);
• swelling of the face;
• dry mouth;
• saliva becomes cloudy and thick;
• an unpleasant putrid taste appears in the mouth, pus may be released;
• chewing, swallowing is difficult and painful;
• loss of appetite;
• the neck muscles are tense, painful on palpation, the pain radiates to the ear, temple, nose.

A mild form of mumps can be almost asymptomatic. The affected gland slightly increases in size, may be painful on palpation. Inflammation of moderate severity begins with an increase in body temperature, which is accompanied by general weakness, severe headaches. This form of the disease, as a rule, affects both glands - they swell, become large, extremely painful.

Salivation is sharply reduced, the oral mucosa is hyperemic. Pressing on the gland most often leads to the release of pus. Loss of appetite, chills, and fever are classic signs of severe mumps. The area of ​​the glands, the whole neck, face are swollen. The ear canal narrows, swallowing function is impaired.

An increase in size, swelling, pain when pressed are the main signs of inflammation of the OSJ (sialadenitis)

Important! An alarming signal is the appearance of an erosion site on the skin above the gland, through which dead cells of the OSJ and purulent exudate are released. Gangrenous (severe) form of mumps, if left untreated, can result in sepsis (blood poisoning). Tactics treatment of parotitis depends on the severity of the disease and the age of the patient. As a rule, the patient is shown bed rest, systemic and local drug therapy.

Sjögren's syndrome

It is noteworthy that sialadenitis of the parotid salivary gland can also have an autoimmune origin - to develop as a result of the pathological production of antibody cells by the body itself. Autoimmune inflammation of the OSJ is called Sjögren's syndrome. The main provocateurs of the development of this pathology are genetic predisposition and viral infections. When the virus enters the glandular tissue, "local" cells are destroyed due to increased synthesis of lymphoid cells.

Treatment of autoimmune inflammation is exclusively symptomatic.

Principles of treatment of sialadenitis

Mild and moderate forms of the inflammatory process are indications for bed rest. Symptomatic treatment of sialadenitis involves the use of antipyretics, painkillers, and dry warm compresses (the latter measure, provided that the patient's body temperature has not risen above 37.2 degrees). Pleomorphic adenoma is a common benign formation of OSJ and is an indication for surgical intervention.

It is very important to observe the drinking regimen (at least 2.5 liters of water per day), since the inflammatory process in the OSJ leads to a decrease in secretion production, dry mouth and digestive problems. In addition, a patient with sialoadenitis must follow the so-called salivary diet - eat fermented milk products, fiber (vegetables, fruits). To reduce the load on the chewing muscles and facilitate digestion, it is recommended to grind all food in a blender (food processor).

Careful oral hygiene is an important condition for the speedy recovery of patients with sialadenitis. In addition to the usual two-time brushing, it is recommended to rinse your mouth with a soda solution (1 teaspoon of powder in a glass of warm boiled water) after each meal. Based on the cause of the development of inflammation, the patient is shown antibiotic therapy or taking antiviral drugs. Severe forms of sialadenitis are treated exclusively in a hospital setting (including by surgery).

The treatment of sialoadenitis is complex, it involves the use of antipyretic, analgesic drugs, antibiotic therapy, the use of dry compresses

Possible complications of OSZh inflammation

In the absence of timely treatment of sialoadenitis, the disease can turn into:

• a breakthrough of the abscess into the ear canal (with a purulent form of inflammation);
• melting of the walls of large vessels with subsequent bleeding;
• parotid hyperhidrosis (increased work of "local" sweat glands);
• suppuration, swelling of the surrounding soft tissues;
• blockage of the salivary duct, the formation of fistulas.

It is noteworthy that parotitis can result in testicular atrophy in men (that is, infertility).

Other OSZh diseases

Stones can form and deposit in the ducts of the salivary glands - this leads to the development of the so-called salivary stone disease of OSJ. Such formations also cause the development of a local inflammatory process (reactive).

Stones impede the natural outflow of secretions, the gland becomes inflamed, and the amount of saliva produced decreases. Without surgery and symptomatic drug treatment, all this can lead to the appearance of a retention cyst of the OSJ (it is also removed surgically).

Pleomorphic adenoma of the OSJ is a benign neoplasm that grows slowly, does not cause pain, and usually affects elderly patients. Pleomorphic adenoma should be treated exclusively promptly - it can grow to a significant size and become malignant.

Mucoepidermoid carcinoma is a malignant tumor of OSJ (the most common). It most often occurs in women between 50 and 60 years of age. It is treated surgically, the depth of intervention depends on the extent of the pathological process.

Mucoepidermoid carcinoma involves partial or complete excision of the BSF

Prevention

To prevent any pathological processes in the OSZH, it is recommended:

• visit the dentist regularly;
• follow all the rules of daily oral care;
• strengthen immunity;
• timely treat all viral and infectious diseases;
• eat sour vegetables fruits (to stimulate saliva production).

So, OSJ are the largest salivary glands in the human body, producing about a third of the total volume of the secret. These formations are susceptible to inflammatory processes of infectious and autoimmune origin, can become foci of the formation of benign and malignant tumors, and salivary stone disease also develops in the OSJ. Careful care of the oral cavity, rational nutrition and timely medical care at the first symptoms of "local" problems will help to avoid complications of the most common diseases of the salivary glands (from dysfunction to sepsis).