SIALOLITHIASIS

From Big Medical Encyclopedia

SIALOLITHIASIS (sialolithiasis; Greek sialon saliva + lithos stone; synonym sialolithic disease) — the chronic inflammation of a sialaden proceeding with formation of concrements (salivary stones) in its channels. Most often is surprised submaxillary gland (see), parotid is more rare, it is very rare — hypoglossal (see. Parotid gland , Hypoglossal gland ), formation of salivary stones in small is described sialadens (see).

According to various researchers, S. makes apprx. 50% of all diseases of sialadens. Most often S. meets aged from 20 up to 45 years, at children the disease is observed seldom, men get sick more often than women.

An etiology

the Reasons of formation of salivary stones are found not quite out. There is an opinion that in S.'s emergence disturbance is of great importance mineral metabolism (see), hl. obr. calcium, hypovitaminosis And, etc. Such reasons as narrowing of a channel of gland, existence in a channel or iron of a foreign body, play a supporting role, with them all cases of formation of concrements in sialadens cannot be explained.

Salivary stones are formed both in extra ferruterous, and in an intra-ferruterous part of the output canal, there is one stone more often, but also several stones can be formed. Very seldom stones are observed in both pair glands, at the same time submaxillary and parotid glands are surprised even less often. The weight (weight) of a salivary stone can fluctuate from shares of gram to several tens grams. The stone can be oblong, rounded or irregular shape; in the center it is often found by foreign bodys.

Generally inorganic salts are a part of salivary stones: calcium phosphate, calcium carbonate, find also traces of potassium, sodium, magnesium, iron, etc.

Pathological anatomy

At S. in a stroma of gland the phenomena hron are observed. inflammations. Atrophic changes of a parenchyma are followed by growth of the connecting fabric surrounding segments of gland and its channels. Quite often there is a considerable expansion of a gleam of channels. In cases of an aggravation of process the hyperemia and hypostasis of fabrics of gland accrue, in a stroma of gland and in gleams of output channels accumulations of leukocytes appear.

A clinical picture

Depending on expressiveness of inflammatory process allocate three forms of a current of S.: without wedge, manifestations of an inflammation in iron, an aggravation hron. inflammations in iron and hron. current of an inflammation. An early symptom of S. is salivary colic — pain and swelling of a sialaden during food (see. Sialoschesis ).

At an aggravation hron. inflammations in iron note the symptoms characteristic of acute sialadenitis (see). Aggravation hron. The page often leads to abscessing in the field of an arrangement of a stone, at spontaneous opening of abscess or at an operative measure the stone can be allocated together with pus. At hron. the course of inflammatory process of iron gradually, for a row of years, it is condensed, remaining at the same time mobile and painless. From a channel of gland the viscous secret with impurity of flakes of slime, sometimes pus is allocated. Hron. the course of inflammatory process is more often observed at localization of a stone in an intra ferruterous part of the output canal. The page at a long current leads to decrease and the termination of function of gland.

Diagnosis

the Survey roentgenogram of area of the right parotid gland at a sialolithiasis (a front direct projection): salivary the stone in an output channel is specified by an arrow.

Crucial importance in detection of a stone and establishment of its localization is played by a X-ray analysis (fig).

Sialografiya (see) gives the chance to reveal not X-ray contrast-nye concrements and to define extent of change in iron that is important for the solution of a question of operational treatment.

Treatment

At any localization of a salivary stone should aim to be removed it from a channel or from gland. At localization of a stone in submaxillary gland when it is impossible to remove a stone, delete gland (see. Submaxillary gland ). Antiinflammatory therapy is at the same time shown.

During the abscessing in the field of an arrangement of a salivary stone acute management is required. The section is done over the center of fluctuation taking into account anatomic features of area. During the opening of abscess it is necessary to create conditions for rejection of a stone (to widely part edges of a wound, to inspect an abscess cavity a looped spoon).

Forecast at S. favorable. After removal of a salivary stone its repeated education is observed seldom.

See also Concrements .


Bibliography: Klementov A. V. Sialolithic disease, L., 1960; it, Diseases of sialadens, L., 1975; With and-z and m and L. Diseases of sialadens, the lane from Czeches., Prague, 1971; Solntsev A. M. and Kolesov V. S. Surgery of sialadens, Kiev, 1979; Schulz H. Art. of Das Rontgenbild der Kopfspeicheldrusen, Lpz., 1969.


I. F. Romacheva.

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