Inflammation of the parotid, submandibular and sublingual salivary glands. How to treat inflammation of the parotid salivary glands

Inflammation of the parotid salivary gland is the most common manifestation of a viral disease called mumps or mumps. The pathogen can affect the nervous tissue and various glandular organs: the pancreas, testicles and ovaries.

In the oral cavity, the ducts of three pairs of large salivary glands open:

submandibular;
parotid;
sublingual.

The parotid salivary gland is a paired organ that is located under the skin in front and below the auricle. It secretes a liquid protein secretion from the salivary duct into the oral cavity. The parotid salivary gland has the shape of an indistinct trihedral pyramid, consisting of small lobules and covered with a fascial capsule.

When the salivary glands become inflamed, the production of the required amount of mucous secretion is disrupted, and pain is felt when swallowing. Due to the penetration of the virus into the tissues of the gland, its normal functioning is disrupted. Symptoms of the inflammatory process appear: swelling, pain, redness, fever.

Causes of inflammation

With parotitis, the ear salivary glands are most often inflamed. Children are usually affected. Adults get sick much less frequently. They usually have erased forms, reminiscent of the common cold. The infection enters the body through airborne droplets. The virus multiplies in the epithelium of the mucous membranes of the respiratory tract, and then enters the bloodstream and spreads throughout the body.

The causative agent of mumps was discovered in 1934. It has a rounded shape and a size of about 150–200 nm. The virus is unstable in the external environment. People who have been ill have lifelong immunity.

Clinical manifestations

The incubation period of mumps lasts a minimum of 11 days, a maximum of 23 days. During inflammation, the ear salivary gland enlarges, becomes dense to the touch, reddening of the skin is possible.

Inflammation develops both on one and on both sides. But the sublingual and and can also increase. It becomes painful for the child to open his mouth, chew.

The salivary gland increases significantly in size due to a decrease in secretion production. It also reduces the flow of saliva into the oral cavity due to blockage of the ducts through which it passes there.

To diagnose mumps, there is no need to conduct virological studies, since the clinical picture is very bright and characteristic.

Mild form of inflammation

The patient's condition worsens slightly. He experiences the following symptoms:

slight malaise, weakness;
a slight increase in temperature;
the affected area has slight swelling.

When pressing on the gland, pain does not occur. Recovery occurs in 7-10 days, does not cause complications and does not require hospitalization.

moderate form of inflammation

With this form, signs of parotitis begin to actively develop. During an illness of moderate severity, there is:

an increase in febrile temperature to 38–39.5 ° C;
general intoxication (chills, headaches, sleep disturbance);
a noticeable, usually bilateral, increase in the auricle;
soreness of the affected area when pressed;
salivation is reduced.

This condition can be within 5-7 days, then the symptoms gradually subside. Feeling normalized.

Severe inflammation

Symptoms of a severe form of the disease have a pronounced picture:

intoxication manifests itself in severe headaches, vomiting, convulsions, the temperature reaches 40 ° C;
the swelling of the glands increases greatly, pressure on them causes a sharp pain;
swelling of the subcutaneous tissue of the neck.

During this period, pain appears in the oral cavity and in the neck, which radiates to the ear and temple. There is a feeling of pressure, tension and bursting in the affected area.

The temperature can last for seven days.

In a severe course of the disease, the possibility of damage to other organs is high.

Possible Complications

The mumps virus also infects other organs. The most common complication of mumps is the defeat of the male genital organs, which often causes infertility.

Inflammation of the testicle (orchitis) is diagnosed on the seventh day of the disease. After the first manifestations subside, the patient again has a feverish state with a temperature of up to 40 ° C, pain in the scrotum and testicle, which radiate to the lower abdomen.

The inflamed testicle significantly increases in size. After 7-8 days, the symptoms subside. A complication of orchitis is testicular atrophy, which is observed in half of the patients, regardless of age.

The mumps virus can also infect the ovaries. The disease proceeds with high fever and abdominal pain, but does not lead to female infertility.

With pancreatitis, inflammation of the pancreas, the patient experiences abdominal pain, vomiting and nausea appear.

The most severe complications of mumps are serous meningitis and encephalitis. The defeat of the membranes of the brain is expressed in severe and persistent headaches, nausea, increased tone of the muscles of the back of the head. With inflammation of the brain, the patient's consciousness is disturbed, severe weakness, constant drowsiness appear, paresis and paralysis of the facial muscles are observed.

Principles of treatment

With an uncomplicated course of the disease, treatment is carried out at home. Hospitalization is provided only for severe forms of mumps and complications. Since there is no specific treatment for parotitis, the main task of therapy is to prevent complications that may occur with this disease.

In severe cases of the disease, antiviral drugs, agents to enhance salivation, vitamin complexes, and antipyretics are used. The complex treatment includes physiotherapy procedures. During treatment, the patient must comply with bed rest. Plentiful warm drink is necessary.

Complicated forms of parotitis are treated in a hospital, the length of stay in the hospital is determined by the patient's condition.

Folk methods at home

Treatment of parotitis with infusions of medicinal herbs can reduce the manifestation of the disease, improve salivation.

An infusion of lime blossom is given to drink at a high temperature. Dry flowers are poured with hot water, insisted for several minutes.
An infusion of dried sage is prepared in the same way, the patient is allowed to drink warm three or four times a day.
Rosehip infusion strengthens the immune system and promotes a quick recovery. It is brewed in a thermos and drunk instead of tea.

For disinfection of the oral cavity, rinses from a decoction of chamomile and sage are used. A mixture of dry herbs is infused for about half an hour. Rinse your mouth every time after eating.

Prevention

Parotitis is caused by a viral infection. There is no specific treatment; prevention of infection is very important. At home, it is advisable to isolate the patient in a separate room if possible. It is necessary to minimize contact with the patient and carefully observe the rules of personal hygiene.

The most effective vaccination. Vaccination against mumps is included in the national vaccination calendar and is given to all children in the absence of medical contraindications.

Inflammation of the salivary glands is called sialadenitis. This is a dangerous disease that can cause dangerous complications.

Many people believe that inflammation of the salivary glands develops as a result of hypothermia. This is not entirely true. There are a lot of factors that provoke this pathology.

Inflammation of the salivary glands can be very dangerous for men, because it can lead to a complication that hits the gonads.

This article will be useful to all people who want to know about the nature of inflammation of the salivary glands, symptoms, treatment and prevention of the disease.

The role of the salivary glands

The salivary glands are very important for the body.. Any changes in the composition of the saliva produced by them quickly affect the general condition of a person. In particular, the enzyme lysozyme, which is part of saliva, is of great importance for immunity. The hormone-like substance parotin, produced by the salivary glands, affects protein metabolism.

If the salivary glands become inflamed, then the infection spreads very quickly throughout the body. The consequences of such a spread, as a rule, are very severe: many organs and systems are affected.

There are several types of salivary glands:

All salivary glands are paired.

The main causes of inflammation of the salivary glands

These glands always become inflamed after an infectious agent enters them. Depending on the type of agent, sialadenitis is viral and bacterial.

Viral inflammation of the parotid salivary gland

We are talking about the defeat of the body by the mumps virus. In folk speech, this disease is called "mumps." The parotid salivary glands are very sensitive to this pathogen. And anyone can get sick, as the virus is airborne.

After infection of the gland tissues the virus begins to multiply very quickly, causing an inflammatory process. When the infection becomes generalized, then it can enter the testicles of men through the bloodstream and cause infertility.

Bacterial inflammation of the parotid salivary gland

It is often referred to as non-specific. The fact is that the inflammatory process occurs when the infection penetrates through the ducts of the glands. The bacterial agent can be anything. Moreover, the habitual microflora of the oral cavity under certain conditions can also provoke inflammation of the parotid gland. . These conditions include:

Inflammation of the parotid gland can occur due to bacteria entering it with the blood stream. This happens in patients with scarlet fever and typhoid.

The salivary glands become infected through the lymph with furunculosis, purulent lesions of the face, tonsillitis and periodontitis.

It is noteworthy that in the vast majority of cases, chronic sialadenitis develops, bypassing the acute stage. That is, the disease is initially chronic. Most often, the chronic form of pathology develops in people with altered tissues of the salivary gland. Such changes are most often caused by genetics or are the result of pathological immune processes in the body.

Chronic form of sialadenitis It can also be triggered by prolonged stress, hypothermia, trauma, and decreased immunity.

Often, inflammation of the salivary glands is detected in the elderly. This is due to a lack of nutrition of the glands due to sclerosed vessels.

Symptoms of inflammation of the parotid salivary gland

The first symptoms of the disease appear a couple of weeks after infection. Mumps can be mild, moderate or severe.

Gangrenous parotitis can cause such a serious complication as sepsis (colloquially called blood poisoning). It usually ends in the death of the patient.

Symptoms of inflammation of the sublingual and submandibular glands

With inflammation of the submandibular salivary gland tissue compaction is formed in the submandibular region. The inflamed gland can be easily felt with the fingers. Its surface becomes bumpy. On palpation, the patient complains of pain.

With an increase in the inflammatory process, swelling of the tissues increases. It becomes difficult for the patient to swallow. The mucous membranes of the mouth become red and swollen. In some cases, there is a discharge of pus through the ducts of the gland.

With calculous inflammation of the submandibular salivary gland caused by blockage of the ducts by calcium deposits, the following symptoms appear:

Severe pain, aggravated during eating.
Saliva is poorly secreted.
The patient feels dry mouth.
The submandibular gland swells up. Its surface becomes bumpy.

If you try to massage the gland, then purulent contents will begin to be released from it under the tongue.

The sublingual gland becomes inflamed quite rarely. Most often, this pathology develops as complications of diseases such as phlegmon and abscess. It is expressed in swelling and soreness of the soft tissues under the tongue. In severe cases, suppuration may occur.

Types of chronic inflammation of the salivary gland

Doctors distinguish 3 forms of chronic inflammation of this organ:

Inflammation of the salivary gland: treatment

In most cases, patients with salivary gland disease forced to be hospitalized. At the same time, doctors try to use conservative therapy to stabilize the patient's condition. Surgical treatment is resorted to only if the patient begins to suppurate the gland.

Viral inflammation of the parotid salivary glands is treated with interferon preparations. The most effective is considered such a medicine as Leukinferen. In addition, patients are prescribed drugs to relieve symptoms of the disease.

In acute nonspecific saialadenitis, the following therapy is prescribed:

Surgery in acute inflammation of the salivary glands, it consists in opening the abscess from the outside in order to divert its purulent contents. The procedure is performed under local anesthesia. After it, drainage can be installed in the incision.

If suppuration begins with calculous inflammation, the operation is performed under general anesthesia. During it, the stone that clogs the duct is removed.

With exacerbation of a chronic form of inflammation of the salivary gland slightly different therapy is prescribed:

The doctor massages the ducts of the gland with the simultaneous introduction of an antibiotic solution into it.
Do novocaine blockade of subcutaneous tissue. This allows you to stimulate the secretion of the gland.
Within a month, a galvanization procedure is carried out daily.
Once every few months, 5 ml of iodolipol is injected into the gland. This procedure helps to prevent exacerbations.

If necessary, doctors resort to removing the problematic salivary gland.

Treatment with folk methods

Can be used for mumps to reduce symptoms the following traditional medicine recipes:

Prevention

It is impossible to completely protect against inflammation of the salivary glands, but it is possible to minimize the likelihood of infection. through the following preventive measures:

Balance your diet.
Drink vitamin and mineral complexes.
Be outdoors more often.
Show physical activity. You don't have to be an athlete. Enough morning exercises.
Observe personal hygiene.

Conclusion

Inflammation of the salivary glands- a dangerous disease that can cause severe harm to the general health of a person. But if you turn to the doctors in time, you can avoid many complications. The main thing is to start treatment immediately after the first symptoms appear. If you postpone a visit to the doctors, you can wait until the moment when the changes in the body caused by the pathology become irreversible.

Human salivary glands are paired organs that play a significant role in the initial stages of food digestion, and also affect the mineral and protein metabolism in the body.

Salivary glands of man

There are three pairs of salivary glands:

parotid;
sublingual;
submandibular.

These glands produce up to two liters of oral fluid per day. It is very important for moisturizing the oral cavity and protecting against the introduction of pathogenic microorganisms into the mucous membrane, the breakdown of complex carbohydrates into simpler forms, and the removal of certain medicinal substances.

Also, the parotid glands play the role of endocrine glands and affect the mineral and protein metabolism, due to the presence of a hormone-like substance, parotinin, in their secretions.

Saliva helps with proper articulation, unhindered passage of the food bolus into the throat, improves the taste perception of food and increases the body's resistance to infections with the help of lysozyme.

A bit of anatomy: the glands of the oral cavity.

The oral fluid contains proteins, more than 60 enzymes - amylase, mucin, glycoproteins, and immunoglobulins. In addition, the salivary fluid contains phosphatase, which is actively involved in calcium-phosphorus metabolism and helps the mineralization of bones and teeth.

For the state of health, not only the qualitative, but also the quantitative composition of saliva is very important. A small secretion of saliva can cause various inflammatory diseases of the oral cavity, demineralization of tooth enamel, and its excessive production leads to dehydration and exhaustion of the body.

In addition to the large glands in the mouth, a person has many small salivary glands, which are grouped on the tongue, lips, cheeks, hard and soft palate. With inflammation of any of the salivary glands, the disease sialadenitis occurs.

Inflammation of the salivary glands

The most common etiological factors in the development of inflammation in the salivary glands is the penetration of an infectious agent through the ducts or by the hematogenous route. Most often, the parotid salivary gland is inflamed, and then the disease is called parotitis. Its infection occurs when the infection is introduced through the oral cavity, blood or lymph. Sometimes the cause of parotitis can be a foreign body in the ducts of the gland, such as stones. Let us consider in more detail the causes and symptoms of the development of epidparotitis.

Causes of inflammation of the parotid gland

The cause, as a rule, is an acute viral infection, which in most cases affects the parotid gland, the submandibular and sublingual glands rarely become inflamed.

This disease belongs to the group of childhood diseases and often occurs in the form of epidemic outbreaks among preschool groups. Most often it is transmitted by airborne droplets, but there are cases of household infection with the virus. The main age of patients is 5-10 years.

A timely visit to the doctor can save you from many problems.

It rarely happens in adults, but it is more difficult for them to tolerate and more often gives complications to various organs and systems. First of all, men fall into the risk zone, since the disease leads to infertility and testicular atrophy.

Clinical picture

From the moment of infection to a detailed clinical picture, about 2.5 weeks pass.

The disease can manifest itself in mild, moderate and severe forms. There are also complicated and uncomplicated forms. During the first 9 days, the person remains contagious.

The mild form of the disease is characterized by:

minor violation of the general condition;
often the process is one-sided;
the gland is not greatly enlarged, a transparent secret is secreted from it, it is almost painless on palpation;
on the side of the lesion, swelling is observed, which is almost imperceptible from the side.

All manifestations usually disappear within a week and do not give any complications.

The average form of parotitis

After the incubation period, a period of precursors begins, which lasts several days. During this period, a headache, malaise gradually develops, the temperature rises to subfebrile figures. There is weakness, aching joints, muscle pain. There is dryness in the mouth.

Mumps, although it is not considered fatal, but still you should not neglect the disease, lethal cases are known.

The inflammatory process affects both parotid glands, they swell, become painful to the touch, swelling of the neck appears, and one side is enlarged more. Due to swelling of the neck and glands, the patient's ears rise and resemble the ears of a pig. That is why the people call the disease "mumps":

as the process develops, the body temperature rises, but it does not reach high numbers, but is limited to 38 ° C;
the oral cavity may be hyperemic, salivation is reduced;
after 4-5 days, the clinical picture begins to subside and a recession begins.

Severe form

The period of precursors has pronounced symptoms of a violation of the general condition: headaches, chills, weakness, loss of appetite, fever above 38 ° C, intoxication phenomena. The inflammatory process involves not only the area to which the parotid glands are located, but the entire neck. In some cases, the swelling can reach the collarbones.

The parotid gland is very enlarged, painful on palpation. It strongly pushes the earlobe up and forward, due to which the external auditory meatus narrows. Swallowing and opening the mouth becomes difficult and painful.

With the involvement of the other major salivary glands, the swelling greatly increases the size of the neck. Against the background of these changes, phenomena often join. The salivary duct of the parotid gland is well palpated in the form of a large cord. The separation of saliva in the oral cavity is significantly reduced or completely stops.

With the development of purulent-necrotic processes in the lobules of the gland, pus can be released from the duct, and there is a high probability of developing an abscess. Severe parotitis very often leads to serious complications. The most formidable of them are:

meningitis;
encephalitis;
damage to the cranial and spinal nerves;
damage to the auditory nerve;
various mental disorders;
infertility;
orchitis;
mastitis;
damage to the renal apparatus.

Most often epidparotitis ends with complete recovery, however, with insufficient or inadequate therapy, there may be fatal cases. In addition, inflammation of the salivary glands may be due to influenza infection - the parotid gland is more often affected, but other salivary glands can also be involved in the process. Very often the process is bilateral, sometimes the parotid and submandibular gland can be affected only on one side. In addition to the main clinical picture, there may be pain when moving the tongue, as well as an increase in the number of sublingual folds.

Postoperative and postinfectious sialadenitis most often affects the parotid glands. It can develop in any severe disease due to hematogenous or lymphogenous transfer. The cause of the development of inflammation in the gland, as a rule, are bacteria, E. coli. This form of the disease is dangerous because, in its extreme manifestation, it can lead to the development of necrosis of the salivary gland or an abscess of the pharyngeal space. Also, occasionally, purulent fusion of the walls of blood vessels occurs and bleeding develops.

The presence of a foreign body that has penetrated into the ducts of the salivary glands can lead to inflammation. May disturb the periodic increase in the salivary gland, a decrease in the separation of saliva. Gradually, the signs of inflammation subside and may not appear for a long time, then they appear again. Such a periodic course can last until a complete picture of acute sialadenitis develops with purulent-inflammatory phenomena in the lobules of the gland. The inflammatory process often moves to nearby soft tissues, to other parotid glands. Often there is a spontaneous removal of the interfering foreign body. However, most often, to eliminate the cause of the disease, one has to resort to surgical methods.

General principles for the treatment of inflammation of the salivary glands

In uncomplicated cases with mild and moderate forms, treatment is usually symptomatic and is aimed at preventing the development of complications. As mandatory measures, it is necessary to include daily wet cleaning of the premises with disinfectant solutions, airing.

The proverb “Cleanliness is the key to health” is especially relevant for diseases of the salivary glands.

It is recommended to rinse the mouth with soda solutions, citric acid, which helps to increase salivation and flush out stagnant contents from the salivary glands. Peppermint also enhances salivation. The diet should include foods that increase saliva production.

bed rest for a period of elevated temperature, especially this item applies to adult patients;
it is necessary to apply warming saline or alcohol compresses, ointment dressings to the area of the inflamed gland;
warming physiotherapeutic procedures are also shown: UHF, solux;
it is recommended to rinse the mouth and irrigate with various antiseptics - Furacilin, eucalyptus, Chlorophyllipt, Chlorhexidine.

In severe complicated forms of sialadenitis, antibiotic therapy is necessary. Its goal is to eliminate inflammation and restore the normal functioning of the gland. Through the duct, 50 thousand units of benzylpenicillin and 100 thousand units of streptomycin with 0.5% procaine are injected into the salivary gland. Besides:

for analgesia, relieving inflammation and improving microcirculation, compresses with Dimexide are prescribed;
physiotherapeutic procedures are also needed: warming compresses, heating pads, UHF;
if the symptoms do not subside, prescribe intramuscular injections of antibiotics, sulfa drugs and hyposensitizing agents;
sometimes they resort to active drainage of the salivary glands, which allows you to pump out stagnant contents and relieve signs of inflammation.

With a necrotic course of the process, surgical intervention is indicated to open the capsule of the affected salivary gland and eliminate destructive processes. The prognosis of the disease is generally favorable.
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With regard to chronic inflammation of the parotid salivary gland, many unclear questions still remain to date. There is no single generally accepted classification, there are no clear recommendations for the treatment of chronic parotitis.
We divide chronic inflammation of the parotid salivary glands into two main groups: parenchymal inflammation of the parotid salivary glands and interstitial inflammation, and in each of these forms periods of exacerbation can be observed.
Parenchymal inflammation of the parathyroid gland. For the differential diagnosis of the form of chronic inflammation of the parotid gland, sialography is of decisive importance (GA Zedgenidze, 1953;

V. Y. Zausaev, 1959; Sazama, 1960, 1971, etc.). In chronic inflammation of the parotid gland, sialography gives a complete picture of the changes that have occurred in the gland in a given form and stage of the disease.
The disease lasts for years, giving periodic exacerbations. More often one gland is affected, but the disease of both parotid glands is not uncommon. Complaints of patients are very diverse and depend on the stage of the inflammatory process. In the initial period, patients complain of swelling in the parotid region, which increases during meals, sometimes an increase in body temperature.
With a long course of the disease, patients begin to notice unpleasant discharge from the excretory duct of the gland and a taste of pus. The swelling in the parotid region increases and sometimes reaches a significant size, its boundaries can be clear, resembling a tumor outwardly (Fig. 3). The skin over the gland in color is usually not changed and is not soldered to the gland. Palpation reveals an enlarged, painless, firm, lumpy gland. When massaging the area of the parotid gland, saliva is released from the excretory duct with an admixture of pus or fibrous clots. The amount of saliva released during massaging is sometimes significant.
Chronic inflammation of the parenchyma of the gland can be complicated by the occurrence of multiple small abscesses, followed by scarring and replacement of the parenchyma with connective tissue, and then characteristic cavities are visible on the sialograms, in the form of rounded foci of accumulation of a contrast agent in the gland

(Fig. 4). With a long course of chronic inflammation, the lesion of the parenchyma progresses and the clarity of individual foci is lost on the sialograms, they eat: grow, their number increases significantly. If chronic inflammation lasts for years, then a complete lesion of the parenchyma may occur with the replacement of the glandular tissue with fibrous tissue, while the main excretory ducts lose their tone, expand and take on a flask shape (Fig. 5).
In patients with chronic parenchymal inflammation of the parotid gland, periodic exacerbations are observed, especially during the cold periods of the year. At the same time, tissue tension in the parotid region is noted, palpation of the gland is painful. The opening of the mouth is somewhat limited. Against the background of the edematous mucous membrane of the cheek, a gaping mouth of the excretory duct of the parotid gland is visible. If you press on the gland, then a small amount of viscous saliva mixed with pus or fibrinous clots is released from the excretory duct. The excretory duct under the mucous membrane of the cheek is palpable in the form of a dense painful cord. Body temperature can rise to 38 ° C and above. As a complication during exacerbation of chronic inflammation, a phlegmonous process may develop, requiring surgical intervention.
Treatment of chronic parenchymal inflammation of the parotid gland is very difficult and depends on the stage of the disease. The prognosis of parenchymal inflammation is unfavorable in the sense that the reverse development of the process is usually not observed, the disease progresses, and during exacerbations it often deprives patients of working capacity and forces them to constantly seek medical help.
In the chronic course of the process, after sowing discharge from the duct for sensitivity to antibiotics, bougienage of the excretory duct and washing with appropriate solutions of antibiotics is indicated. The solution is injected into the excretory duct with a blunt needle, as with sialography, in an amount until a feeling of fullness appears in the gland. In addition to antibiotics, washing can be done with a solution of furacilin or chymotrypsin. At the same time, it is possible to recommend the use of X-ray therapy in doses up to 100 R per session, with

Rice. 4. Sialogram for chronic parenchymal inflammation of the parotid salivary gland, complicated by the formation of abscesses.

Rice. 5. Sialogram with a long course of chronic parenchymal inflammation of the parotid salivary gland.

2 A. V. Klementov

at intervals of 2-3 days, in total 400-800 R per gland. M. V. Olkhovskaya and E. Ya. Bril (1937), Georgiev (1961) and others also point to the favorable effect of X-ray therapy. In chronic parenchymal inflammation of the parotid gland, we used X-ray therapy in anti-inflammatory doses in 72 people.
When prescribing X-ray therapy, the majority of patients showed improvement, inflammation decreased, and sometimes disappeared completely for several years. An example is our following observation.
Patient G., aged 33, was referred for a consultation on January 15, 1963. From the anamnesis it was found that in 1959 a swelling appeared under the lobe of the left ear, which periodically increased. In 1960, during the period of exacerbation, he turned to the clinic, where he was treated with a diagnosis of mumps. At the end of 1960, a swelling also appeared in the right parotid region. Periodically, exacerbations with an increase in body temperature were noted.
On examination, asymmetry of the face was noted due to swelling of the parotid areas, the skin integuments were not changed in color, they fold well. The opening of the mouth is free, thick saliva is secreted from the excretory ducts of the parotid glands in a small amount. The patient underwent sialography. Sialograms show a typical picture of parenchymal inflammation. After sialography, the patient noted improvement and complete disappearance of swelling. Felt good throughout the year.
On January 17, 1964, the enlargement of the left parotid gland appeared again, a feeling of fullness, the body temperature rose to 39 ° C. On examination, a pronounced asymmetry of the face is noted (Fig. 6, a) and on January 20, a course of X-ray therapy was started, which was completed on February 8 (total dose 600 R), inflammation was completely eliminated (Fig. 6, b).
On March 18, 1965, swelling of the left gland reappeared, body temperature up to 38°C. On examination on March 20, the presence of a dense infiltrate in the region of the left parotid gland, raising the earlobe, was noted. The patient underwent the second course of X-ray therapy, which was completed on April 16 (total dose 558 R).
May 29, 1965 there was swelling in the right parotid region, pain, limited mouth opening, fever. X-ray therapy was prescribed. From May 31 to June 21, the patient received 556 R, the inflammation was completely eliminated.
At the control examination on May 30, 1966, he did not complain. There were no exacerbations of inflammation during the year.
With an exacerbation of chronic inflammation, all therapeutic measures should be aimed at eliminating acute manifestations of inflammation. Physiotherapeutic procedures are recommended - UHF electric field, electrophoresis with potassium iodide. Intramuscular
but - injections of antibiotics. Mandatory crops separated from the excretory ducts on the microflora in order to determine its sensitivity to antibiotics. Inside-urosal, 2% solution of potassium iodide or other iodine preparations. However, many observations, especially with significant changes in the gland, convince us of the frequent absence of a lasting effect from conservative therapy, patients have been treated for years, do not get good results from treatment, and experience the failure of treatment hard.
A radical method of treatment in the absence of the effect of conservative therapy can be considered a surgical method - removal of the gland. At the same time, it must be said that if this is quite acceptable for the submandibular gland, then for the parotid, its surgical removal is associated with possible damage to the branches of the facial nerve. Until recently, such surgery was generally considered unfeasible.
The development of methods of operations on the parotid gland for tumors with preservation of the branches of the facial nerve made it possible to transfer these methods to the treatment of chronic inflammation of the parotid gland, when in advanced cases conservative treatment remains unsuccessful, and the patient's suffering requires radical measures from the doctor.
Based on the analysis of our observations, we can recommend surgical removal of the parotid glands if conservative treatment fails. This surgical method of treatment is the most effective, but requires good knowledge of the anatomy of the facial nerve and the precise execution of all the details of the operation. The operation is best performed under general anesthesia. In our clinic, the removal of the parotid glands or part of them in chronic inflammation was performed in 24 people, and in 3 patients with bilateral inflammation, both glands were removed. Our following observation serves as an illustration.
Patient R., aged 53, was admitted to the clinic on 29/11, 1960 again because of bilateral chronic parenchymal inflammation of the parotid glands. The patient considers himself since 1958. For two years, frequent exacerbations of inflammation were observed, accompanied by high body temperature, severe pain, increased

Rice. 6. Patient G. Chronic parenchymal inflammation of the parotid salivary glands. a - before treatment; b - after the first course of radiation therapy.

Rice. 7. Patient R. Chronic parenchymal inflammation of both parotid salivary glands, c - upon admission to the clinic; b - 7 months after the operation.

parotid glands. During this time, she was hospitalized 6 times in one of the Leningrad hospitals and once in our clinic. The applied conservative treatment, including radiotherapy (556 R for the right gland and 544 R for the left), had no effect.
Upon admission to the clinic, the patient had facial asymmetry due to uneven enlargement of the parotid glands; glands are dense, tuberous. The right gland is enlarged more than the left. In the region of the angles of the lower jaw on both sides, there are retracted postoperative scars (incisions were made in the hospital during the period of exacerbation). The opening of the mouth is free, thick saliva with flakes and an admixture of pus is released from the excretory ducts of the parotid glands (Fig. 7, a). The patient underwent sialography of the parotid glands. On sialograms, a characteristic picture of parenchymal chronic inflammation is determined - a sharp expansion of the excretory duct, there is no clear pattern of ducts of I-V orders, there are many different sizes and shapes of accumulations of a contrast agent.
Considering the duration of the disease, the failure of conservative treatment, the patient's urgent request to save her from excruciating suffering, since the slightest cooling of the body led to an exacerbation of inflammation and made her unable to work, the patient was asked to remove both parotid glands. The patient was warned. 8. An incision of skin veins about the possibility of trauma to the faces during removal of the parotid nerve, however, the fear of new glands,
exacerbations forced her to agree to surgery.
On March 23, 1960, the right parotid gland was removed under endotracheal anesthesia. An incision directly in front of the auricle, undercutting the earlobe and bordering the angle of the lower jaw, with an additional incision under the zygomatic arch (Fig. 8). The skin flap is folded anteriorly until the entire surface of the gland is exposed. Excretory duct detected. Orienting along it, the middle branch of the facial nerve was found, dissecting which to the center, a branching of the facial nerve was found, and then all its branches were identified. Then the iron is removed in parts. The excretory duct is ligated. The skin flap is laid in place, excess skin is excised. During the operation, due to heavy blood loss, a single-group blood transfusion was performed. The postoperative course is smooth. A slight paresis of the marginal branch of the facial nerve was noted. On April 13, the left parotid gland was removed. Histological examination of the removed glands confirmed the presence of chronic
cal inflammation with abundant growth of fibrous tissue between the lobules. Paresis of the marginal branch of the right facial nerve disappeared a month after the operation. At the control examination in September 1960, the patient had no complaints (see Fig. 7.6).
Interstitial inflammation of the parotid glands. We observed interstitial inflammation only in the parotid glands. The disease is characterized by a progressive proliferation of interlobular tissue, which leads to a gradual narrowing of the lumen of the ducts and with a long course of the disease

Rice. 9. Sialogram in chronic interstitial inflammation of the parotid gland.

to atrophy of the parenchyma of the gland. The disease is often bilateral and manifests itself in the form of a symmetrical enlargement of the parotid glands. The skin over the glands is not changed. By palpation, enlarged, painless, soft salivary glands are determined. When massaging the parotid glands, pure saliva is released from their excretory ducts. The mouth of the excretory ducts is often very narrow, which often makes it difficult to perform sialography. Patients are mainly concerned about the cosmetic side. Many patients note that in the cold season and with hypothermia, there is an increase in swelling of the glands,
per

Sialography is crucial for the differential diagnosis of interstitial inflammation. On the sialograms, the narrowing of the excretory ducts is determined, but all the ducts, as a rule, are filled with a contrast mass (Fig. 9). On the basis of radiosialography data, L. A. Yudin and U. A. Saidkarimova (1972) found that in chronic interstitial parotitis, there is a violation of the function of the salivary glands, which is expressed in a mild decrease in the amount of secretion.
A good therapeutic effect in interstitial inflammation of the parotid glands is obtained from the use of X-ray therapy in anti-inflammatory doses, i.e. within 70-100 R with a single exposure, a total of 600-700 R. Interstitial inflammation is observed relatively rarely, according to our data, among chronic parotitis interstitial inflammation occurs in less than 10%.

The parotid or salivary gland belongs to the digestive system and is responsible for the secretion of saliva. Man has large salivary glands, as well as several hundred small glands scattered throughout the oral mucosa, as well as in the throat, larynx, and nose.

The largest is located in the parotid region on the lateral surface of the faces, accessible for palpation between the mastoid process and the lower jaw. The second largest is the submandibular gland, in third place is the sublingual gland.

Mumps, as mumps is colloquially called, is an inflammation of the parotid gland. This disease is predominantly a childhood period, but can also affect adults and cause formidable complications.

Cause and development of mumps

The reason for the pig is mumps virus infection, which belongs to the Paramyxoviridae group. The source of infection, as a rule, is a sick person. The infection is transmitted by airborne droplets, through direct contact with a sick person, and also through contact with virus-infected material such as blood, saliva, urine, cerebrospinal fluid, or contaminated objects.

The main symptom of parotitis ...

The virus enters the body, where it continues to multiply in the epithelial cells of the respiratory tract, and then, together with the blood, spreads to many organs and tissues. The period that passes from infection to the appearance of clinical symptoms (the so-called incubation period) is 14-21 days.

A person who has not yet shown symptoms is a source of infection for his environment seven days before the onset of symptoms and up to nine days after the disappearance of the parotid tumor. The virus is present in the urine for up to two weeks after illness.

Symptoms of inflammation of the salivary glands

The process of inflammation of the parotid gland proceeds in different ways. Approximately 20-30% of patients do not develop symptoms at all. In other patients, the disease has a very and pronounced rapid process.

Some patients may experience periods of flu-like symptoms, namely: weakness, musculoskeletal pain, fever, apathy, etc. In most cases, inflammation spreads to both sides.

Typical complaints for mumps are:

pain and swelling of the salivary glands, the consistency of the parotid gland changes, the skin above it is tense, of the correct type. Gradually, the tumor spreads to the surrounding tissues, moves to the area of the zygomatic arch, to the temples, goes beyond the auricle. The greatest exacerbation of symptoms occurs approximately on the 2nd-3rd day of illness and decreases after 3-4 days;
redness around the excretory ducts of the salivary glands, swelling in the oral mucosa;
decreased secretion of saliva, which causes a feeling of dry mouth ;
pain in the parotid region is aggravated during meals, especially sour ones, which increase the production of saliva;
difficulties chewing, swallowing and opening the mouth;
elevated temperature up to 38-39°C, which appeared along with swelling of the parotid gland and recedes after 3-4 days. In case of infection of subsequent salivary glands, the temperature increase appears again;
other symptoms: feeling unwell, weakness, headaches, lack of appetite or abdominal pain.

There is a possibility of infection mumps virus nervous system. It occurs in 60-70% of patients, but is usually asymptomatic or with mild symptoms. There are typical for viral hepatitis changes in the cerebrospinal fluid.

Meningeal symptoms are rare and occur in 5-10% of those infected with the virus, more commonly in adults, usually between days 4 and 8 of illness. Their severity is small and pass within a week.

Diagnosis of mumps

Usually, diagnosis of endemic parotitis put on the basis of data from the medical history and physical examination of the patient, additional studies, in most cases, are not needed.

Confirmation can be provided by the results of virological studies. The virus is isolated mainly from blood, saliva or urine. It is also possible to perform a lumbar puncture and collect samples of cerebrospinal fluid for neurological symptoms.

Also useful in the diagnosis of mumps are serological tests. They consist in obtaining blood serum and identifying antibodies in it that the patient's body produces to fight the virus.

The presence of IgM antibodies indicates fresh infection and the acute phase of the disease. IgG antibodies indicate long-term illness. The concentration of both types of antibodies increases over time, and then their level falls. This is fast for IgM and slower for IgG.

IgG antibodies are a form of the body's immune memory and allow you to quickly "turn on" the defense upon repeated contact with the virus.

Among biochemical studies, measurement of the activity of the enzyme amylase in urine and blood is sometimes used, which indicates dysfunction of the salivary glands. However, this is not a specific study.

When making a diagnosis, differential diagnosis is very important. The possibility of the existence of other diseases should be taken into account:

infectious inflammation of the salivary glands of a different viral origin (parainfluenza, influenza, cytomegalovirus, lymphocytic ECHO or meningoencephalitis);
toxoplasmosis;
non-infectious causes: stones in the salivary ducts, narrowing of the outlet ducts, cyst or cancer of the parotid gland, Mikulich's syndrome, allergic reactions to drugs;
injury;
cystic fibrosis;
diseases of the surrounding tissues: lymph nodes, bone tumors, arthritis of the temporomandibular joint, muscle growth.

Treatment and complications of endemic parotitis

Mumps are not cured can only alleviate the symptoms. You should lie in bed, save energy. When the temperature rises, reduce it with cold compresses or antipyretic drugs. Use warm compresses on swollen areas.

For nutrition, choose those foods that will not irritate the mucous membrane of the mouth. Better liquid food and easy to digest. During the entire illness, it is necessary to drink plenty of fluids, preferably through a straw.

Antipyretics and pain relievers such as acetaminophen or non-steroidal anti-inflammatory drugs are used to relieve symptoms.

Complications of mumps more often affect adult patients. May occur during an acute illness, during convalescence, or later. Symptoms that should concern the patient are repeated fever and vomiting during illness.

Complications can be:

inflammation of the testicles and epididymis- occurs in 30-40% of boys during puberty and young men. It is manifested by the sudden onset of fever, pain with irradiation in the perineum, swelling, redness and warming of this area, abdominal pain and chills, nausea, and vomiting. Treatment consists of the use of painkillers, a bandage and bed rest. This inflammation is so dangerous that it can cause impaired seminal function and, in rare cases, infertility.
inflammation of the ovaries occurs in 5-7% of girls. Symptoms are less severe than testicular inflammation and resemble those of appendicitis. Does not affect fertility.
pancreatitis- manifests itself, as a rule, in the later stages of the disease with acute pain in the upper abdomen with irradiation to the back, nausea, vomiting, fever, chills, diarrhea. In laboratory studies, increased activity of lipase in the blood is observed. The inflammation usually resolves spontaneously within a week.
meningitis rarely occurs with a severe course. Inflammation of the meninges caused by mumps virus without coexisting inflammation of the salivary glands in clinical practice is indistinguishable from that caused by other viruses. Meningitis during mumps is most often limited. This means that the inflammatory process does not spread to other structures of the nervous system, and that the patient's immune system fights the viral infection on its own, even without specific treatment. In some cases, it comes to damage to the cranial nerves, which leads to long-term complications. Less commonly, the mumps virus can cause inflammation of the brain in the form of high fever, with significant impairment of consciousness, which often leads to serious consequences. Other complications from the central nervous system include: brain disorders, facial paralysis, transverse inflammation of the spinal cord, Guillain-Barré syndrome and narrowing of the cerebral ducts, leading to hydrocephalus.
other rare complications: Guillain-Barré syndrome, transverse inflammation of the spinal cord, polyneuropathy, inflammation of the labyrinth, facial paralysis, inflammation of the conjunctiva, lacrimal gland, sclera, choroid, cornea and iris, facial nerve, thrombocytopenia, paroxysmal hemoglobinuria, teroiditis, inflammation of the joints, myocardium, liver, mammary gland, kidneys.

Prognosis for mumps, as a rule, good and depends on the kind of complication. The transferred disease “leaves” strong immunity, repeated diseases occur sporadically. Infection during pregnancy does not increase the risk of birth defects.

Prevention of mumps

The only way mumps prevention- it's triple measles, mumps and rubella vaccine. The vaccine is called MMR, from the first letters of the English names of these diseases. The vaccine contains a weakened live virus. Its efficiency is about 97%. It refers to compulsory vaccination. It is performed for the first time between 13 and 14 months of age and is free.

Unfortunately, the vaccine does not provide lifelong protection; works only up to school age. At school age, re-vaccination is carried out. It is important that even the vaccine does not fully protect the child from parotitis, significantly softens the course of the disease, and the risk of complications is also significantly reduced. It must be remembered that sick children should not be vaccinated.

Vaccinations against mumps are not practiced in pregnant women, patients treated with glucocorticoid drugs and other immunocompromised patients. However, there are no contraindications to vaccination of children infected with the HIV virus.

Shortly after vaccination against mumps, in rare cases, adverse reactions are observed, such as fever, mild inflammation of the parotid salivary glands.

Allergic reactions, such as rash, itching, rarely occur after vaccination and are usually minor and disappear spontaneously. It has also been shown that in vaccinated children, the risk of inflammation of the brain increases over the next month.