Chronic sialadenitis

Systemic lesions: Sjögren's and Mikulicz's syndromes

Although these pathologies have different etiologies, both lead to pronounced changes in the salivary glands.

Sjögren's syndrome manifests with agonizing dry mouth — patients are forced to constantly moisten their mouth with water. This condition rapidly triggers mucosal dysbiosis and rapid caries progression. A sialogram reveals the contrast medium extending beyond the ducts and numerous small- and medium-sized spherical cavities. Treatment is managed jointly by a rheumatologist and a dentist:

• Baseline therapy: prolonged administration of low-dose prednisolone and cytostatics.
• Local treatment: oral sanitation, covering teeth with gold crowns.
• Replacement therapy: artificial saliva and moisturizing gels.

Mikulicz's syndrome is more common in women. The exact cause is unknown, but a connection with viral infections and systemic blood disorders (lymphocytic leukemia) is suspected. Unlike Sjögren's syndrome, secretory function is preserved in Mikulicz's disease, and dry mouth is absent. There is a slow, painless, and symmetrical enlargement of all major salivary and lacrimal glands. Diagnosis is based on biopsy: a pronounced lymphoid infiltrate is detected, which compresses the ducts (visible on the sialogram as narrowing), but does not destroy the basement membranes or replace the acinar tissue. Treatment is symptomatic (radiotherapy, procaine blockades, galantamine). The prognosis is unfavorable due to frequent relapses and association with blood disorders.

Acute viral sialadenitis

This group includes mumps (epidemic parotitis) and acute influenzal sialadenitis.

1. Mumps (epidemic parotitis). An acute infectious disease caused by a filterable virus. It primarily affects the parotid glands, most commonly in children. It is transmitted via airborne droplets and contact-household routes. The incubation period lasts 2–3 weeks. In severe forms, against the background of purulent parotitis, nervous system involvement, pancreatitis, and orchitis are possible. Treatment includes isolation (for 9 days), a sialagogic diet, compresses, and physical therapy. The prognosis is favorable, and lifelong immunity develops.
2. Acute influenzal sialadenitis. Develops during an influenza epidemic (the causative agent is the influenza virus). It affects the interstitial tissue of the parotid glands. A characteristic pathognomonic symptom is pain upon opening the mouth and turning the head. The process develops rapidly, and abscess formation with acinar tissue necrosis is possible. The dense inflammatory infiltrate can persist for up to six months. Chronic progression is not typical, but scar deformity of the ducts may occur upon purulent melting.

Acute lymphogenic parotitis

The disease occurs mainly in adults after a recent acute respiratory infection (ARI) or odontogenic infections. There are 6 to 13 lymph nodes located within the thickness of the parotid gland, into which the glandular tissue may extend.

Two forms are distinguished:

• Hertzenberg's false parotitis: inflammation is strictly limited to the intraglandular lymph node.
• True lymphogenic parotitis: the process extends beyond the node into the gland parenchyma.

Clinically manifested by painful induration (often anterior to the tragus of the ear), which slowly enlarges. Salivation decreases, but the general condition is rarely affected. Sialography reveals no pathologies.

Principles of treatment for acute sialadenitis

Therapy depends on the stage and form of inflammation:

• Serous stage: stimulation of salivation (1% pilocarpine solution 8 drops 3 times a day), administration of antibiotics into the gland, compresses with 30% Dimexide solution, and physical therapy (UHF, fluctuotherapy).
• Progression of inflammation: external procaine blockades with antibiotics and systemic antibacterial therapy are used.
• Specific forms: interferon is used topically (irrigations) for viral parotitis.
• Gangrenous and severe forms: require emergency surgical intervention — opening of the salivary gland capsule (e.g., via the H.P. Kovtunovich approach) and intravenous administration of Contrykal solution in an inpatient setting.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Pathomorphological differences of infiltrates in Sjögren's and Mikulicz's syndromes.
• Complications of severe epidemic parotitis: orchitis, pancreatitis, and CNS involvement.
• Methodology and interpretation of sialography: how to differentiate duct narrowing from contrast extravasation.
• Technique for performing the surgical incision according to H.P. Kovtunovich in gangrenous sialadenitis.

Other topics in the section "Chapter 10. Diseases and injuries of the salivary glands (V.V. Afanasiev)"

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