From Big Medical Encyclopedia

SIALOSYRINXES — the narrow pathological courses connecting channels of big sialadens to the surface of face skin or an oral cavity. Villages of the village can be formed as a result of wound sialadens (see) and their channels, as outcome hron. inflammatory processes in sialadens — sialadenitis (see), sialolithiasis (see) — or it is purulent - necrotic processes in the fabrics surrounding sialadens and also as a complication at operative measures in the field of sialadens. Most often S. of page meet. parotid gland (see), more rare submaxillary gland (see).

Distinguish S. the village of the main output canals and intra ferruterous channels, and also intra oral and extraoral (outside) fistulas. Villages of the village can be full when all of sects rt glands is allocated through fistula, and incomplete when the secret is allocated both from fistula, and from the mouth of an output channel.

In the presence of outside S. of the page representing the pinhole in the field of a hem on face skin which remained after an injury or opening of abscess patients the constant salivation on face skin amplifying at meal disturbs. In the presence of full fistula the amount of the emitted liquid happens quite considerable. At the same time from the mouth of this output channel in an oral cavity saliva is not emitted, and the peripheral department of a channel is obliterated. Intra oral fistulas, most often channel of submaxillary gland (podnizhneche-lyustny channel, T.), as a rule, patients are not disturbed and demand treatment only at a recurrence of inflammatory process and existence salivary kakhmnya.

Diagnosis put on the basis of the anamnesis, complaints of the patient and a wedge, manifestations. Apply such methods of a research to specification of topografoanatomichesky features of damage of a sialaden as sialografiya (see) and fistulografiya (see), With the diagnostic purpose enter colorant (water solution of methylene blue) into the fistular course or the mouth of an output channel of a sialaden. The village of the village of the retromandibular area needs to be differentiated with branchyogenic side fistulas of a neck (see. Branchyogenic cyst ).

Treatment can be conservative or operational. Conservative methods of treatment are directed to oppression of function of a sialaden and are recommended, especially a roentgenotherapy, at impossibility of operational treatment or removal of a sialaden.

Operational treatment of S. of page is directed to elimination of the fistular course and recovery of outflow of saliva through the main output channel. At incomplete outside S. the village of the parotid canal and intra ferruterous channels of a parotid gland most often make the operations offered by K. P. Sapozhkov and A. A. Limberg. Sapozhkov's method is that S.'s mouth of page together with a hem is excised the bordering cuts, then as much as possible allocate the fistular course (it is desirable to gland or its output channel) and take in it a purse-string seam. The skin wound is sewn up layer-by-layer. At operation on Limberg's method the skin wound is closed by means of counter triangular skin rags that covers the taken-in fistular course more reliably.

the Diagrammatic representation of the main stages of plastics of a parotid channel by G. A. Vasilyev's method: and — a section of skin of a cheek (the line of a section is shown at the upper left), the central section of the parotid canal from-preparovan (it is specified by an arrow); — the yazykoobrazny rag from a mucous membrane of a cheek is created; in ~ a podshivaniye of the yazykoobrazny rag which is carried out through thickness of a cheek by the end of a parotid channel; — the wound of a mucous membrane of a cheek is taken in by noose sutures, the arrow specified the mouth of the created output channel of a parotid gland.

For elimination of full outside fistulas of a parotid channel perform more difficult reconstructive operations. At a sufficient dlineostavshegosya of a parotid channel the mouth of fistula is allocated with the bordering cuts on skin of a cheek and through tissues of a cheek carry out a parotid channel to an oral cavity, hemming it to edges of a dissect mucous membrane. At impossibility of carrying out this operation of the most radical and the plastics of a peripheral part of the canal by the method offered by G. A. Vasilyev is reliable. The bordering section excise S.'s mouth of page on skin of a cheek, otpreparovyvat a parotid channel taking into account topography of branches of a facial nerve (fig., a). Further according to a first line of a masseter on a mucous membrane of a cheek find a yazykoobrazny rag with the basis turned kpered (fig., b). Then the free edge of a rag is carried out through dissect tissues of a cheek and hem it to regions of the central section of earlier allocated parotid canal (fig., c). Thus create a channel of a parotid gland with the mouth at the basis of a rag of tissues of a mucous membrane of a cheek (fig., d).

In the postoperative period appoint a sparing diet (liquid and free of food of acids), atropine or tincture of a belladonna (belladonna).

Forecast favorable.

Bibliography: Vasilyev G. A. Plastic recovery of a stenonov of a channel, Stomatology, No. 3, page 39, 1953; 3 and at with and e in V. I., etc. Surgical stomatology, M., 1981; The Guide to surgical stomatology, under the editorship of A. I. Evdokimov, M., 1972.

V. M. Bezrukov.