SIALADENITIS (sialoadenitis; Greek sialon saliva + aden of iron + - itis) — an inflammation of a sialaden.
In S.'s etiology the large role is played by an infection. At S. in channels sialadens (see) find the mixed flora consisting of stafilokokk, pneumococci, streptococci, and also activators of an actinomycosis, tuberculosis, syphilis. Viruses of epidemic parotitis, a cytomegaly can be one of the reasons of S.
Contagiums get to a sialaden through the mouth of an output channel, sometimes it is promoted by hit to the canal of a foreign body (a fiber from a toothbrush, a peel from apples, etc.). and also lymphogenous or hematogenous way. S.'s emergence is promoted inf. diseases, operative measures, especially on abdominal organs, stagnation of a secret in channels of a sialaden.
Distinguish acute and chronic S.
the Acute sialadenitis
the Acute sialadenitis can proceed in catarral (serous), purulent or gangrenous forms. At catarral S. note hypostasis and leukocytic infiltration of fabric of gland, exfoliating of an epithelium of channels. Purulent S. can be followed by fusion of fabric of gland with the subsequent its scarring. The gangrenous form C. quite often comes to an end with death of all gland.
The main wedge. acute S.'s signs are morbidity of gland, its increase, deterioration in health of the patient, fervescence can be noted. At acute S. the sialaden at the beginning of a disease soft, painful, during the progressing of process is formed dense infiltrate, at purulent fusion of fabric of gland over this area fluctuation is defined.
A characteristic sign of S. is dysfunction of gland in the form of hypo - or hypersalivations, and also emergence in to saliva (see) flakes of slime, pus, a large number of cells from the husked epithelium.
Acute S. can be complicated by abscesses and phlegmon of surrounding soft tissues, a stenosis of salivary channels, education sialosyrinxes (see), depression of function of gland.
The diagnosis is established on the basis of the anamnesis and characteristic by a wedge, pictures.
Treatment includes a complex of the anti-inflammatory, antibacterial, hyposensibilizing drugs, and also means increasing resistance of an organism (vitamins, nucleinate of sodium, etc.). Introduction to channels of sialadens of antibiotics is reasonable in the presence of the purulent channel separated from the mouth. At the created infiltrate of a sialaden has good effect novocainic blockade (see), applications of solution of Dimexidum.
The forecast at timely begun treatment favorable. Acute S. can sometimes give repeated flashes of inflammatory process and pass into a chronic sialadenitis.
Acute S.'s prevention consists in observance of rules of hygiene of an oral cavity, especially at inf. diseases and after operative measures (see. Roth, oral cavity, hygiene of an oral cavity ).
The chronic sialadenitis
the Chronic sialadenitis can arise initially, S. Chasto is more rare as an outcome acute chronic S. accompanies such diseases as pseudorheumatism (see), system lupus erythematosus (see), system scleroderma (see), Shegren's syndrome (see. Shegrena syndrome ), etc. At education concrements (see) in channels of a sialaden chronic calculous S. develops (see. Sialolithiasis ). Distinguish three forms chronic S.: parenchymatous, intersticial and a chronic sialodochitis (see. Parotitis ). The main morfol. changes in iron at chronic S. are expressed in limfogistiotsitarny infiltration of its stroma. The connecting fabric expanding in a stroma replaces a parenchyma, sometimes squeezing output channels of gland that brings to to a sialoschesis (see); at a sialodochitis channels of gland are unevenly expanded, periduktalny infiltration and a sclerosis is noted.
Chronic S. first can proceed without increase in gland, eventually the sizes of gland increase, she becomes hilly, sometimes reminds a tumor. Morbidity in most cases is absent. At hron. a sialodochitis in the period of an aggravation the symptom of a retention of saliva (salivary colic), spontaneous allocation from the mouth of an output channel of the condensed, muciform, saltish secret is noted.
At chronic S. the same complications can be observed, as at acute, but is much more rare. At a long current of S. can arise xerostomia (see).
For the purpose of chronic S.'s diagnosis apply a number of special methods of a research: X-ray analysis (see), a sialometriya (see. Salivation ), scanning, a sialografiya, a radiosialografiya (see. Sialografiya, radio isotope ), a termoviziografiya (see. Termografiya ), ultrasonic investigation (see. Ultrasonic diagnosis ).
Chronic S.'s treatment can be conservative and operational, it will be out taking into account associated diseases. At conservative treatment use the drugs stimulating function of a sialaden, improving the exchange processes possessing antiinflammatory action: Galantaminum in the form of subcutaneous injections or an electrophoresis, pyrogenal intramusculary, Dimexidum in the form of applications on area of gland, nucleinate of sodium inside, etc. Novocainic blockade in the field of gland gives positive effect. Removal of a sialaden at chronic S. is shown in case of inefficiency of conservative treatment. At calculous S. delete a stone, in case of purulent fusion of fabric of gland in the period of an aggravation of inflammatory process open its capsule, in the presence of a stone in channels of submaxillary gland delete it.
At chronic S. recovery occurs seldom, patients need constant dispensary observation and treatment. At hron. calculous S. after removal of a stone the forecast favorable.
Measures of prevention at chronic S. shall be directed to the prevention of an aggravation patol. process and increase in nonspecific resistance of an organism.
Bibliography: Klementov A. V. Diseases of sialadens, L., 1975, bibliogr.; The guide to surgical stomatology, under the editorship of A. I. Evdokimov, page 226, M., 1972; Sazama L. Diseases of sialadens, the lane from Czeches., Prague, 1971, bibliogr.; Solntsev A. M. and Kolesov V. S. Surgery of sialadens, Kiev, 1979, bibliogr.; Schulz H. G. Das Rontgenbild der Kopfspeicheldriisen, Lpz., 1969.
I. F. Romacheva.