Acute sialadenitis

Investigation methods and malformations

For morphological evaluation of pathologies, cytological examination (Azure II-eosin staining) is used. The punctate of healthy glands reveals cubic and cylindrical epithelial cells, as well as connective tissue elements. Biopsy of minor glands is especially important when systemic connective tissue diseases are suspected, where the severity of lymphoid infiltration serves as the main diagnostic criterion.

Developmental anomalies include:

• Aplasia — most often partial. Complete aplasia results in early xerostomia, which destroys all teeth. Patients require total prosthetics and artificial saliva.
• Dystopia (heterotopia) — atypical location of glandular lobules. They can be found in the neck, root of the tongue, jaw, or even the brain. The danger of dystopia lies in the risk of fistula formation, tumors, or the development of lymphogenic parotitis (if the tissue has penetrated lymph nodes).
• Duct anomalies — most commonly ectasia (dilation) of the parotid or submandibular ducts, as well as diverticula (blind pouches). Multiple diverticula indicate a chronic process (parotitis or sialodochitis).

Sialadenosis: reactive-dystrophic lesions

Sialadenosis (sialosis, interstitial sialadenitis) is a secondary dystrophic disease. It develops as a reaction to systemic disruptions: diabetes mellitus, endocrine disorders, gastrointestinal and blood diseases.

The pathogenesis is based on neurohumoral destruction leading to parenchymal dystrophy and stromal sclerosis. Interesting fact: in diabetes, the duct epithelium begins to produce large amounts of an insulin-like substance.

Clinically, sialadenosis manifests as painless enlargement of the major (most often parotid) salivary glands, resembling a benign tumor without signs of inflammation. On palpation, the gland has a doughy consistency, the oral mucosa is pink, but the salivary secretion rate is reduced due to high viscosity. Sialography shows narrowing of small ducts due to the proliferation of interstitial tissue. Treatment should target the underlying cause (primary disease), improve microcirculatory flow, and stimulate glandular function.

Systemic diseases: Gougerot-Sjögren syndrome

Salivary gland involvement can be part of complex systemic dystrophic syndromes (Mikulicz, Heerfordt, Küttner, Sjögren). In Küttner's tumor (syndrome), for example, the submandibular glands enlarge.

Gougerot-Sjögren syndrome affects predominantly women during menopause (20-50+ years). The classical triad includes:

1. Dry mouth (xerostomia).
2. Dry eyes (xerophthalmia / dry keratoconjunctivitis).
3. Autoimmune or rheumatoid pathology (SLE, scleroderma, polyarthritis).

Morphologically, the gland parenchyma is destroyed and replaced by a lymphoplasmacytic infiltrate, which in severe cases can lead to malignant lymphoma. The connective tissue undergoes fibrinoid changes. At the initial stage, dry mouth occurs periodically (under stress), and pinprick cavities are visible on sialography. In late stages, xerostomia becomes constant, and angular cheilitis and multiple cervical caries develop.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Classification of sialadenosis by etiological factor (endocrine, neurogenic, allergic).
• Features of the sialographic picture in various duct pathologies.
• Morphological changes in the stroma during autoimmune lesions.
• Differential diagnosis of early and late stages of Sjögren's syndrome.

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

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