Inflammation of the salivary gland( sialoadenitis)

With salivary glands digestion in humans begins. In the mouth, the chewed food is wetted with saliva. It produces three large glands( parotid, sublingual, submandibular) and many small ones.

Inflammation of the salivary gland along the course 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?

Salivary glands belong to the secreting pair organs. They have different location and structure. Small or small glands are located deep in the mucous membrane of the oral cavity, nasopharynx and tonsils. By the localization of the allocated labial, palatine, buccal, gingival, lingual. Among the large salivary glands, the parotid, sublingual and submandibular are distinguished.

In the adult body, 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 produces submandibular glands, 26% are parotid, 5% sublingual.

Saliva contains:

• lysozyme, amylase, phosphatase and other enzymes;
• proteins;
• electrolytes( sodium, phosphorus, potassium, calcium, magnesium);
• parotin( growth factor of the epithelium and nerves) and other substances with hormonal activity.

The parotid gland is located in the area of ​​the chewing muscles in the mandibular fossa. Above it lies the external auditory canal and the zygomatic arch. Front and back it is covered with strong muscles of the neck, so it is poorly palpable in normal. This is the largest of all the salivary glands, the weight reaches 30 g. It is divided into superficial and deep lobes.

A dense capsule of the gland is fused to the muscles, but is thinned on the inner surface, there is no continuous coating and there is a communication with the peripheral space. The processes of the capsule go inward, forming lobules.

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

Nearby there are such important structures as the carotid artery, facial and anemia nerves, large veins, sympathetic and parasympathetic plexus fibers, lymph nodes. The path of the excretory duct can vary from straight to curving, rarely bifurcating. It opens on the mucous cheeks.

Secretion in lobules is occupied by pyramidal cells, protection against infection, so as not to inflame the gland, provides mucus secreted by goblet cells

. Podmihnezhelustnaya gland - located in the submandibular fossa between the lower jaw and the digastric muscle. Behind it comes into contact with the hyoid gland. In the area of ​​the angle of the lower jaw is very close to the parotid. Weight is 8-10 g( in old age decreases).A tight capsule is surrounded by fat tissue, lymph nodes.

The outlet duct has a length of up to 7 cm, a lumen of 2-4 mm, opens in the bottom of the mouth near the frenum of the tongue. The composition of the secretion of iron refers to serous-mucous. Blood supply is carried out from the facial artery. In the immediate vicinity there is a lingual nerve.

The doctor in cases of surgical treatment of inflammation of the submandibular salivary gland must take into account the possibility of locating 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 hyoid gland is located at the bottom of the mouth in the area between the bridle of the tongue with a tooth of wisdom. Outside and below is bounded by dense muscles. Nearby are the lingual nerve and the end of the sublingual nerve, lingual vessels, the excretory duct of the submandibular gland.

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

Why does sialoadenitis occur?

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

The tissues of the salivary glands have a particular sensitivity to the mumps virus. Getting on the mucous membrane of the respiratory tract, it deepens into the parenchyma of the parotid gland, multiplies and forms a reciprocal inflammatory reaction. 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 in the future threaten with infertility

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 hygienic care. With the bloodstream, bacteria can enter the salivary glands with scarlet fever in children, typhoid fever( typhoid pneumonia).

With lymphomas are transmitted with boils on the face, in the throat, purulent wounds. One of the factors contributing to infection with further inflammation of the salivary gland is mechanical obstruction( overlapping of the lumen) of the ducts.

It occurs as a result:

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

Chronic inflammatory diseases rarely pass 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;
• supercooling;
• pregnancy;
• suffered trauma;
• decreased immunity due to severe disease, aging of the body.

Chronic inflammation occurs against the background of worsening blood supply in the prevalent atherosclerosis in elderly people.

How does the disease manifest itself?

Symptoms of inflammation of the salivary glands depend on localization, form, have local and general symptoms.

Epidemic parotitis

The disease begins suddenly with a temperature increase of 40 degrees. Swelling in the parotid region is formed on both sides. Patients experience pain during movement of the jaw, in conversation, during chewing. Irradiates in the ears. Puffiness makes the face round, so the common name for the disease is "mumps".In adults, inflammation of the submaxillary gland and sublingual fluid occurs simultaneously.

In the picture, unilateral sialoadenitis

There are stages of the disease:

• Serous - appears dryness in the mouth, tenderness and swelling of the face in the ear area( noticeably elevated position of the earlobe).The pain is moderate, it is felt when eating, salivating to the appearance of food. Skin is not changed. The temperature is low. Pressing does not cause salivation, a little painful.
• Purulent - the pains become sharp, do not allow opening the mouth, "shoot" in the ears, lead to insomnia. The temperature rises to 38 degrees and above. Puffiness extends to the temples, the lower jaw. Pressing is very painful, pus appears in the mouth. The gland is of dense consistency, the skin in the zone of inflammation is reddened.
• Gangrenous - leaking heavily, the temperature does not rise high due to a weakening of the protective forces. The skin is partially destroyed and necrotic tissues pass through it. Perhaps septic flow with a fatal outcome or acute bleeding from the arteries of the neck.

Inflammation in the submaxillary gland

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

As the inflammation increases, swelling increases, pain occurs when swallowing

When examining the mouth under the tongue you can see redness, swelling, possibly detecting the discharge 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.

Symptoms of calculous inflammation are:

• in changing the nature of pain to sharp, stitching, there remains reinforcement in eating;
• impaired saliva secretion;
• a constant sensation of dryness in the mouth;
• skin swelling;
• dense knobby surface of the gland.

Massaging movements cause the excretion of pus under the tongue.

Sublingual sialoadenitis

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

Forms of chronic inflammation

Inflammatory diseases of the salivary glands in chronic course vary in form. Interstitial sialadenitis is observed in 85% of patients with parotid gland disease, more often in women and in old age. Continuously asymptomatic.

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

Parenchymal - also almost always parotid glands. The age of patients is any more often women fall ill. The latent current lasts many years. Clinic of exacerbation does not differ from acute sialadenitis. In the initial stage, patients notice the appearance in the mouth of abundant brackish mucus when pressing on the parotid zone.

Sialodochitis - this is the name for the isolated lesion of the ducts. It often develops in the elderly due to the anatomical extension of the outflow tract. The main sign - abundant salivation during eating and talking. This contributes to the formation of zaed at the corners of the mouth.

How is the diagnosis made?

Diagnosis is based on clarifying the symptoms and examining the patient, palpating the glands. In addition to the therapist, consultation of the otolaryngologist, dentist may be necessary. Acute processes usually have a strong association with infection.

Palpation is carried out by soft massaging movements

Chronic sialadenitis is detected by X-ray examination after the introduction of contrast material into the duct( sialografii).Then the images show characteristic changes:

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

If necessary, differential diagnosis is used: ultrasound of salivary glands, biopsy with analysis for cytology, bacteriological saliva, biochemical analysis of saliva composition, polymerase chain reaction technique for detecting pathogens.

Treatment of sialoadenitis

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, carrying out all the doctor's orders.

In viral mumps, including epidemic, it is useless to treat the inflammation of the salivary gland with antibiotics. Interferon-based drugs, immunomodulators, symptomatic agents for anesthetizing, lowering of temperature are shown. In order to reduce the concentration of the virus in the blood stream, a generous drink is recommended.

In case of bacterial acute inflammatory processes, a special salivary diet is prescribed. In the food include croutons, lemon, sauerkraut, cranberries. To stimulate the outflow ducts, a solution of Pilocarpine in drops is used.

Antibiotics are introduced into the ducts under steady-state conditions. Homes are recommended in intramuscular injections or capsules. To wash the ducts, solutions of antiseptics( Dioxydin) are used. When inflammation of the salivary gland under the tongue is recommended rinsing with a warm preparation with a slight delay in the mouth.

For the compress used diluted warmed vodka, Dimexidine, the patient feels reduced pain

Of physiotherapy, UHF is used for anti-inflammatory and analgesic effects. Against the backdrop of severe swelling and pain, making it difficult to eat, blockades are applied with a solution of Penicillin and Novocain.

To prevent the formation of adhesions and the violation of the patency of the ducts, use Trasilol and Contrikal intravenously. Surgical treatment is indicated in severe cases requiring the dissection of the abscess from the outside. The operation is performed under anesthesia. Simultaneously, the stone in the duct is removed, if it was formed.

Chronic sialadenitis is treated during an exacerbation by the same methods as acute ones. But it is important to support the salivation, the release of festering plugs during periods outside the exacerbation. For this it is recommended:

• to conduct a course of massage of the ducts with the internal administration of antibiotics;
• Novocain blockades and electrophoresis with Galantamine - stimulate saliva secretion;
• galvanization procedures;
• introduction to the iodolipol gland once a quarter to prevent exacerbations;
• course intake of potassium iodide;
• prompt removal of the gland, if it causes frequent exacerbations.

Treatment with folk remedies offers: rinse your mouth with salt solution, slowly suck a slice of lemon, add herbal teas with anti-inflammatory effect( mint, chamomile, calendula) in the drink.

Prevention

Children in a year and a half are vaccinated with a three-component vaccine against mumps, measles and rubella. The most common protective measures are: oral care( cleaning the teeth at least twice a day, rinsing after eating), treatment of carious teeth, angina, 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, avoiding hypothermia. Participation in influenza vaccinations helps adults protect themselves from sialadenitis. Measures of prevention should be taught to children from preschool age.