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Calculous Sialadenitis: Clinic, Diagnostics, Medical Treatment

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Calculous Sialadenitis: Clinic, Diagnostics, Medical Treatment MINISTRY OF HEALTH OF UKRAINE Ukrainian medical stomatological academy “Approved” On the meeting chair Of Propaedeutics Surgical Stomatology The Head of the Department prof. Novikov V.M. ___________ “ ____ ” _____________ 20 ____ GUIDELINES Individual work of students During preparation for Practical classes Educational discipline Surgical stomatology Module № 2 Inflammatory diseases in maxillofacial region. Nonodontogenous inflammatory diseases in Content module № 4 maxillofacial region Calculous sialadenitis: clinic, diagnostics, medical treatment. Fistuls of salivary glands, mechanism of their formation. Examination methods, diagnostics, methods of surgical medical treatment (C.P.Sapozhcov, A.N.Limbexg, G.A.Vasilev and Theme lesson in.). Contribution of chairs of surgical stomatology Ukrainian medicine stomatology academy to working out of questions of an etiology, a pathogenesis and treatment of diseases of salivary glands. Course 3 Faculty Stomatological Poltava 2018 1. Actuality of the topic: On statistical given to N.D. Lesovoj (1979) sialolithiasis compounds 40-61,1 % among all diseases of sialadens. Sialolithiasis - polyetiological disease of sialadens, therefore is a lot of questions of an etiology, a pathogeny, clinic and treatments of this pathology remain thoroughly not investigated to this time (to I.F. Romacheva and joint authors, 1987). 2. The objectives of the studies: To learn students to diagnose and define medical tactics at manifestations a calculus sialadenitis (sialolithiasis). To be able: To make a diagnosis of a calculus sialadenitis (sialolithiasis; To draw up a plan of examination of the patient with a calculus sialadenitis (sialolithiasis); To prescribe proper treatment of a calculus sialadenitis (sialolithiasis). 3. Basic knowledge, skills, skills necessary for study topics (interdisciplinary integration). Name of previous These skills courses Physiopathology Inflammatory processes Anatomical pathology Inflammatory processes Microbiology The infestant, microbic flora of an oral cavity and a secret of sialadens. Operative surgery and Features of an anatomical structure of sialadens. topographical anatomy. Histology Features of a constitution of sialadens. Propedeutics of a surgical Methods of examine of the stomatologic patient. stomatology. Intrasubject integration. Clinic of a calculous sialadenitis (sialolithiasis), acute and chronic inflammatory diseases of sialadens. 4. Tasks for independent work in preparation for the classes. 4.1. A list of key terms, parameters, characteristics that must learn the student in preparation for the lesson: Term Definition Sialolithiasis refers to the formation of stones in the salivary glands Salivary colic periodic attacks of pain in the region of a salivary duct or gland, accompanied by an acute swelling of the gland, occurring in cases of salivary calculus. Salivary stones crystallized minerals in the ducts or in the body that drain the salivary glands 2 4.2. Theoretical questions to lesson: 1. To give concept - a calculous sialadenitis with localization of a salivary stone in a duct of Ferri lactas. 2. To give concept - a calculous sialadenitis with localization of a salivary stone in a sialaden. 3. To give concept - a chronic inflammation of a sialaden owing to sialolithiasis (and - after a spontaneous casting-off of a stone, - after operative treatment of a stone from a duct). 4.3. Practical works (tasks) are performed in class: - examination of thematic patients; - to fill in case history; - to define of clinical diagnosis; - to perform diagnostic and surgical procedures; - to acquire practical skills, to carry out curate the patient with a calculus sialadenitis at localization of a salivary stone in the main excretory duct of a sialaden and in the sialaden; 5. Theme contents Salivary duct lithiasis is a condition characterized by the obstruction of a salivary gland or its excretory duct due to the formation of calcareous concretions or sialoliths, resulting in salivary ectasia and even provoking the subsequent dilation of the salivary gland. A further effect may be the infection of the salivary gland which may result in chronic sialadenitis (1). The clinical symptoms are clear and allow for an easy diagnosis, whenever we take into account that pain is only one of the symptoms and that it does not occur in 17% of the cases (2). Sialolithiasis accounts for 30% of salivary diseases and it most commonly involves the submaxillary glands (83 to 94%) and less frequently the parotid (4 to 10%) and sublingual glands (1 to 7%). Sialolithiasis usually appears around the age of 40, though it can also have an early onset in teenagers and it can also affect old patients. It has a predilection for male patients, particularly in the case of parotid gland lithiasis (1). Several hypotheses have been put forward to explain the etiology of these calculi: mechanical, inflammatory, chemical, neurogenic, infectious, strange bodies, etc. Anyhow, it seems that the combination of a variety of these factors usually provokes the precipitation of the amorphous tricalcic phosphate, which, once crystallized and transformed into hydroxyapatite becomes the initial focus. From this moment on, it acts as a catalyst that attracts and supports the proliferation of new deposits of different substances (2) 3 Salivary calculi affecting the parotid gland are usually unilateral and are located in the duct. Their size is smaller than submaxillary sialoliths, most of them < 1 cm. (3, 4). Different conditions should be considered when carrying out the differential diagnosis of salivary duct lithiasis. The unilateral enlargement of the parotid region is characterized by the presence of a discreet, palpable mass or either a diffuse swelling. Sialodenitis may be considered in the absence of this mass. A superficial mass in the salivary gland may suggest either a case of lymphadenitis, preauricular cyst, sebaceous cyst, benign lymphoid hyperplasia or extraparotid tumor. A mass inside the salivary gland may suggest either a neoplasia (benign or malignant), an intraparotid adenopathy or a hamartoma (5). The clinical symptoms of malignant tumors include rapid growth, facial nerve palsy, petrous texture, pain and a higher incidence rate among elderly patients. The differential diagnosis of the asymptomatic bilateral enlargement of the parotid region includes benign lymphoepithelial lesions (Mikulicz syndrome), Sjogrenis syndrome and sialadenitis secondary to alcoholism, long-term treatment with different drugs (iodine and heavy metals) and Whartin´s tumor. Painful bilateral enlargements may result from radiotherapy or may be secondary to viral sialadenitis (including mumps) whenever they co-occur with other systemic symptoms. Among the conditions presenting with diffuse facial swelling of the parotid region, but unrelated to the glands, we must mention masseter muscle hypertrophy, lesions in the temporomandibular articulation and osteomyelitis affecting the ascending maxillary branch. It is also important to differentiate sialoliths from other soft tissue calcifications. Whereas the former are characterized by pain and swelling of the salivary gland, other calcifications such as those of the lymphatic ganglia are symptom free. In the case of small calculi it is advisable to try a non-surgical treatment (spasmolitics, diet, antibiotics, etc) (6). Odontologists and stomatologists are in charge, together with other sanitary professionals, of the diagnosis of salivary glands diseases. They must be aware of them and must be able to apply modern imaging techniques for their diagnosis and, if necessary, manage and treat these diseases. Salivary fistula. Distinguish an external fistula of a sialaden at which the saliva follows through an aperture located in the region of integuments, and internal when its mouth opens on a surface of a mucosa of mouth. Internal, opening in a mouth salivary the fistula does not cause any disorders and does not demand treatment. External salivary the fistula represents burdensome suffering owing to constant wetting by saliva of integuments of lateral departments of the face following from it and neck, a maceration of skin, dermatitis occurrence. At an occlusion of a fistulous course probably painful augmentation of sialaden. Fistulas submandibularis sialaden, as a rule, settle down on a course of its duct in an oral cavity. Dermal fistulas of this gland and its duct are localised in submandibularis region and represent an appreciable 4 rarity. Dermal fistulas of a sublingual sialaden to us to observe on it were necessary, though in the literature there are such reports. Usually on a skin parotid gland fistulas (its parenchyma) and its duct open. Under duct fistulas understand fistulas outside glandular parts parotid duct, and as parenchyma fistulas - fistulas of ducts of separate lobes of a gland. Fistulas part on full and incomplete. Full fistulas are formed as a result of duct rupture; thus all saliva is allocated through a fistula. Communication of a gland with peripheric department of a lead-out duct is absent. Incomplete fistulas arise at wound of a wall of a duct. Constant partial outflow of a saliva natural by (through a duct mouth) in this case remains. Some authors consider, that and incomplete fistulas parotid a duct can be full only. However both kinds of fistulas as well peripheric (intraglandular) ducts parotid sialaden were observed also. Usually at parenchyma fistulas parotid sialaden on skin to front from an auricle, sometimes below an ear lobule of an ear or
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