Granulomatous sialadenitis
This is a group of rare conditions that affect the salivary
glands producing a variety of signs and symptoms,
particularly painless swellings
of the parotid
and/or
submandibular glands.
Sialadenosis
Sialadenosis
(sialosis)
is
used
to
describe
non-
inflammatory swelling particularly affecting the parotid
gland. It is usually occurs in association with a variety of
conditions including diabetes mellitus, alcoholism, other
endocrine diseases, pregnancy, drugs, bulimia and other
eating disorders, and idiopathic diseases.
Most patients present between 40 and 70 years of age, and
the salivary swellings are soft and often symmetrical.
When the parotid glands are affected, patients may
complain of hamster-like appearance.
Drug-induced
sialosis
is
particularly
common
with
sympathomimetic drugs. In many patients, no underlying
disorder
can
be
identified.
Severe
and
prolonged
malnutrition,
as
seen
in
eating
disorders,
produces
sialadenosis by a process of glandular atrophy and fatty
replacement.
The
pathological
mechanism
of
sialadenosis
can
be
associated with a process of neuropathy, which interferes
with salivary gland function and subsequent acinar cell
atrophy. This may be the case in diabetes mellitus, where
autonomic neuropathy is a recognised complication as
well as drug-induced sialosis.
The treatment of sialosis is unsatisfactory, but treatment is
aimed at the correction of the underlying disorder.
Drug associated sialadenosis may regress when the drug
responsible is withdrawn.
. Degenerative conditions
Sjögren’s syndrome
Sjögren’s syndrome is an autoimmune condition causing
progressive destruction of salivary and lacrimal glands.
Its 2 types primary and secondary;
Primary
Sjögren’s syndrome differs from secondary
Sjögren’s syndrome in that
1-
xerostomia and keratoconjunctivitis sicca occur
without the associated connective tissue disorder.
2-
the symptoms are often more severe,
3-
the incidence of lymphomatous transformation in
the primary group is higher than that in the
secondary group.
Females are affected more than males in the ratio 10:1.
Occasionally, there is enlargement of the salivary glands,
more commonly the parotid rather than the submandibular
glands. The glands are occasionally painful, and the
patient sometimes develops a bacterial sialadenitis due to
ascending infection from the associated xerostomia.
Management
Management
of
Sjögren’s
syndrome
remains
symptomatic. No known treatment modifies or improves
the
xerostomia
or
keratoconjunctivitis
sicca.
An
ophthalmological assessment is important, and artificial
tears are essential to preserve corneal.
The characteristic pathological feature of Sjögren’s
syndrome
is
the
progressive
lymphocytic
infiltration,
acinar cell destruction and proliferation of duct epithelium
in all salivary and lacrimal gland tissue. The diagnosis is
based on the history as no single laboratory investigation
is
pathognomonic
of
either
primary
or
secondary
Sjögren’s syndrome function. For dry mouth, various
artificial salivary substitutes are available, but patients
often consume large volumes of water, carrying a bottle
of water with them at all times. In the dentate patient, the
use of salivary substitutes with fluoride is important to
counter the risk of accelerating dental caries. Other oral
complications include oral candidosis and accelerated
periodontal disease.
Complications of Sjögren’s syndrome
There is an increased incidence of developing lymphoma
(most
commonly
monocytoid
B-cell
lymphoma)
in
patients with Sjögren’s syndrome. The risk is highest
within the primary group, and the onset of lymphoma is
heralded by immunological change within the blood
Xerostomia
Xerostomia is a common symptom in many aspects of
medical practice. Normal salivary flows decrease with
age in both men and women, although many patients with
xerostomia
are
postmenopausal
women
who
also
complain of a burning tongue or mouth.
Common causes of xerostomia are:
• chronic anxiety states and depression;
• dehydration;
• anticholinergic drugs, especially antidepressants;
• salivary gland disorders – Sjögren’s syndrome.
Ascending
parotitis is an occasional complication of xerostomia and
is managed with antibiotics and increased fluid intake;
• radiotherapy to the head and neck.
Sialorrhoea
Certain drugs and oral infection produce a transient
increase in salivary flow rates. In healthy individuals,
excess salivation is rarely a symptom as excess saliva is
swallowed
spontaneously.
Uncontrolled
drooling
is
usually
seen
in
the
presence
of
normal
salivary
production. It is seen in children with mental and physical
handicap,as cerebral palsy.
Management
Uncontrollable drooling is managed surgically, and many
operations are available.
Surgical options include:
•
bilateral
submandibular
duct
repositioning
and
simultaneous sublingual gland excision;
• bilateral submandibular gland excision;
• transposition of the parotid ducts and simultaneous
submandibular gland excision.
Most
resting
salivary
gland
flow
arises
from
the
submandibular glands, and surgery should be focused on
this gland to control uncontrolled sialorrhoea
Cervical lymph nodes
The common cause of lymph cervical lymph adenopathy are;
1- reactive lymph adenopathy due to infection
2- t.b lymph adenopathy
3- secondary malignant deposit
4- primary malignancy as lymphoma
5- sarcoidosis
Principal managements;
Full history , examination and investigations
If primary found enbloc or other appropriate treatments
If infection treated according to the cause