INFLAMMATORY PATHOLOGY OF THE SALIVARY GLANDS
Plan
1. Introduction
2. Etiopathogenesis
3. Clinical study
3.1-Sialadenitis
3.1. 1- Viral sialadenitis
3.1.2. Bacterial sialadenitis
3.1.2.1. Acute parotitis due to common pyogenic bacteria
3.1.2.3. Acute submaxillitis of the newborn.
3.1.2.4. Chronic bacterial parotitis in children
3.1.2.5. Chronic or recurrent bacterial parotitis in adults:
3.1.3. Germ-specific sialadenitis
3.1.4. Allergic and toxic parotitis
3.1..5 Sublingualitis
3.2. sialodochites proper
I Introduction
Inflammatory diseases of the salivary glands (sialitis) are very varied and of various etiologies. They can be acute or chronic.
Inflammation of the salivary gland involves the parenchyma, the ductal system, most often both compartments (the parenchyma and the excretory ducts).
The term sialitis covers all inflammatory pathologies of the salivary glands.
- Sialadenitis is damage to the parenchyma (acino-canalicular).
- Sialadochitis is ductal inflammation.
- Sialosis: chronic salivary diseases
2. Etiopathogenesis
Normally saliva is sterile in the acini and infection can be:
*Ascending of buccal origin
*Hematogenous or septicemic
*Invasion of a nearby infection into the gland,
This is all supported by:
– salivary stasis,
-immunodeficiency,
– a dysfunction of salivary enzymes.
3. Clinical study
3.1-Sialadenitis
3.1. 1- Viral sialadenitis : mumps (mumps parotitis)
– the most common viral infection of the salivary glands. It is caused by an RNA paramyxovirus. It is transmitted by direct contact or saliva droplets
-it causes small epidemics in winter/spring
-it affects children and young adults++
-affects both sexes but complications are more serious in boys (orchitis = risk of sterility).
Clinic:
• Typical shape
After an incubation phase of 18 to 21 days, the short invasion phase (24 to 36 hours) appears and corresponds to the phase of maximum contagiousness.
ISOLATION OF THE PATIENT
During the invasion period, parotitis sets in with:
- Pain on palpation of Rillet’s points (TMJ, Mastoid, Mandibular angle).
- Unilateral swelling, filling the retromandibular groove, tender to palpation
- This swelling becomes bilateral in 2 to 3 days.
- Appearance of parotid or submaxillary adenopathy.
- Oropharyngeal erythematopultaceous enanthema associated with inconstant pharyngitis.
- Dry mouth, rare saliva but never purulent + redness around the ostium of the Steno canal
Inconsistent general signs: – fever – bradycardia – meningeal signs (headaches, stiffness) – moderate leukemia.
CLINICAL HEALING IN 10 DAYS
• Misleading forms :
Unilateral or submandibular frustes, Associated salivary and lacrimal forms.
INFLAMMATORY PATHOLOGY OF THE SALIVARY GLANDS
Differential diagnosis:
• 1st episode of chronic bacterial parotitis in the child.
• 1st infectious episode of lithiasis
• Allergic or toxic parotitis
• nutritional sialomegaly.
Positive diagnosis:
Clinical diagnosis can be confirmed by culture of the virus from saliva
Treatment:
Avoidance, rest, ATG, NSAIDs.
Vaccine prophylaxis (MMR)
Prognosis: good
3.1.2. Bacterial sialadenitis
3.1.2.1. Acute parotitis due to common pyogenic bacteria
aclinic
- The onset is sudden or gradual,
- The unilaterality of the signs helps guide the diagnosis.
- significant local and general inflammatory signs (swelling-otalgia-trismus fever-possible facial paralysis)
- Red and turgid ostium with the presence of pus or purulent saliva.
- Risk of fistulization in the absence of treatment or canal drainage
Only ultrasound can confirm the diagnosis.
(clear increase in the thickness of the affected gland with a heteroechoic appearance of the parenchyma). The intraglandular ducts and the Stenon duct are dilated (diameter of more than 2 mm of the Stenon).
b) Processing
• Preventive treatment:
Fight against salivary stasis
• Curative treatment:
- antibiotic therapy depending on the germs involved
- incision and drainage in case of suppuration
- washing of the gland through the duct .
3.1.2.2. acute suppurative non-lithiatic maxillitis in adults:
- Exceptional
• simulates a floor phlegmon
The submaxillary gland suddenly increases in volume, causing unbearable pain. Sometimes pus can be seen at the ostium of Wharton’s duct.
• ultrasound confirms the diagnosis and allows us to distinguish between what is glandular and what is extraglandular.
- Ultrasound: shows multiple hypoechoic images in a non-homogeneous parenchyma
- sialography: small round cavitary images +/- appended to dilated canals, pathognomonic appearance of a “flowering tree” or “shotgun pellet” image.
- Echodopplers show significant hypervascularization, indicating the highly inflammatory nature of the lesions.
3.1.2.3. Acute submaxillitis of the newborn.
It is caused by an infection by staphylococcus or streptococcus and results in an increase in the volume of the submandibular gland.
Ultrasound can confirm the diagnosis by highlighting the presence of a large heteroechoic submandibular gland.
3.1.2.4. Chronic bacterial parotitis in children
Not an exceptional condition, first episode around 5 years old often confused with mumps, it is recurrent and occurs in painful crises with an increase in the volume of the parotid gland. It can be bilateral. Examination of the ostium shows mucoid saliva or
Purulent all occurs in a context of moderate alteration of the general condition, dominated
by asthenia which can precede the disorders by a few dozen hours. An ultrasound gives pathognomonic images of the disease; parenchyma is punctuated by numerous small hypoechoic round formations giving a somewhat miliary appearance.
Ultrasound can be used to monitor the progress of the disease, which may regress at puberty.
INFLAMMATORY PATHOLOGY OF THE SALIVARY GLANDS
3.1.2.5. Chronic or recurrent bacterial parotitis in adults:
Acute episodes (swelling + parotid pain) generally progressing spontaneously towards healing in 3 to 10 days
• rare fistulization
• Rocking seat but may remain unilateral, bilateral location argues for general cause
• Sialography: large drops of lipiodol with regular ductal dilations
Treatment
• ATB continued even after clinical recovery
• washing with lipiodol or antibiotics (penicillin).
3.1.3. Sialadenitis due to specific germs :
syphilitic sialitis has practically disappeared while tuberculous sialitis is still current
a/ tuberculous sialadenitis :
- affects the parotid gland twice as much as the submaxilla.
- affects adolescents and middle age; often unilateral, secondary TBC.
- pre-tragic or s/max cold nodule. In the absence of treatment, other nodules may appear and end up softening with fistulization in the skin
- Thermal curve + telethorax + IDR + culture allow diagnosis.
- Additional examinations
- Ultrasound: several nodules with a +/- anechoic center (caseation)
- Sialography: imprint image on inflammatory parenchyma
- Echodopplers: allow visualization of hypervascularization of the lacuna.
- Differential diagnosis: with adenitis
- Treatment Uses anti-tuberculosis drugs for 6 to 12 months followed or not by surgical treatment (parotidectomy, submaxillectomy).
b/ paratuberculous sialadenitis:
• Atypical mycobacterial adenitis is described in very young children
• the clinical picture is very close to a parotid or s/max TBC
• only culture allows us to distinguish them
• favorable prognosis: complete recovery in a few weeks
3.1.4. Allergic and toxic parotitis:
a) semiology: bilateral or multiglandular parotid swelling, subacute in appearance, without suppuration, persistent or recurring.
b) Sialography: Dense and not very homogeneous parenchymal opacification (subacute inflammation type) and canalicular (multiple dilated canaliculi)
c) Etiology:
Anti-inflammatory drugs: Phenyl butazone.
3.1..5 Sublingualitis:
• Their etiology is still poorly defined
• two semiological aspects can be observed,
– one properly sublingual and it is a unilateral lifting of the crest +/- nodular not exceeding the Warthon canal in front with clear saliva
– The other aspect shares the same semiology with s/maxillitis.
• Sialography:
the normal appearance of the submaxilla constitutes a diagnostic argument for the
sublingualitis.
Differential diagnosis:
*cylindrome
*infected mucocele
*lipoma
*chronic cellulite.
Treatment :
Almost always surgical
3.2..sialodochitis proper
Chronic ductal infection is mainly due to megaducts or stones. Acute ductal infection only exists as an initial stage of parotitis or ascending bacterial maxillitis.
END
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