Diseases of the salivary glands
In the area of the salivary glands a variety of diseases can occur.
- Tumors: Tumors of the salivary glands are divided into benign (adenomas) and malignant (adenocarcinomas) neoplasms. About 80% of these changes affect the parotid gland.
The most common tumor of the salivary glands is the so-called pleomorphic adenoma, which is a mixed tumor that occurs primarily in women. Although it is primarily benign, it is usually removed early to prevent degeneration. After the operation, however, relapses occur in about 10% of patients.
Malignant tumors often develop under the influence of radiation and usually require a generous removal of glandular tissue, which is usually not without danger, since the important facial nerve, for example, passes through the parotid gland, which runs a fairly high risk of being injured during surgery.
- Salivary stones: The formation of salivary stones (sialolithiasis) can occur in the excretory ducts of the salivary gland. The most frequently affected gland is the mandibular salivary gland, which accounts for about 80% of the stones. Stones are usually caused by an incorrect composition of the saliva (dyschyria), their main component is usually calcium phosphate and they are not uncommon.
In most cases, salivary stones can be removed relatively easily or, more recently, they can be crushed with the help of ultrasound shock waves, whereupon the body can remove the small fragments itself. A long persistence of salivary stones promotes the occurrence of salivary gland inflammation (sialadenitis) through secondary colonization with germs.
- Inflammation of the salivary glands: By far the most relevant to everyday medical life (though fortunately not too often nowadays due to the introduced vaccination) is parotid gland inflammation, which is caused by the mumps virus. In this disease, the affected salivary gland swells up considerably and hurts.
A dreaded complication is the tearing of the excretory duct, which leads to saliva leaking into the adjacent tissue and can cause the formation of a salivary cyst. In most cases, however, the parotid gland heals on its own without permanent damage. More dangerous in the context of mumps are the complications that can take place outside the parotid gland, namely the encroachment on the testicles, which causes a very painful inflammation (orchitis) or even a involvement of the brain, which leads to encephalitis.
- Autoimmune diseases: In the autoimmunological disease S jögren’s syndrome, various glands of the face are restricted in their secretion production, resulting in dry mouth, dry eyes (possibly with conjunctivitis) and inflammation of the lacrimal glands.
Classically, the parotid gland swells first in affected persons before it finally decreases significantly in size (atrophy). It is assumed that this syndrome is caused by the presence of autoantibodies directed against the gangetic epithelium of the glands. In addition to the above-mentioned complaints, patients often suffer from joint inflammation (polyarthritis) and pain.
This disease is usually diagnosed by taking tissue samples (biopsy) from the oral cavity.
- Swellings: Swelling of the salivary glands can also have non-inflammatory causes. These include the side effects of some medications (e.g. beta blockers), metabolic disorders such as hyperthyroidism or diabetes mellitus or alcohol abuse.
Inflammation of the salivary gland is one of the most common diseases that occur in the enriched salivary glands. In general, especially elderly and/or immunocompromised persons are affected by inflammatory processes in the area of the salivary glands.
The causes that lead to the development of an inflammation of the salivary glands can be different. In most cases, this disease is caused by bacterial or viral pathogens that ascend through the oral cavity into the salivary glands. In case of bacterial genesis, staphylococci and streptococci play a decisive role.
Coxsacki and mumps viruses are among the most common viral pathogens of salivary gland inflammation. In addition, the smallest stones that accumulate in the excretory ducts of the salivary glands are among the most common causes of salivary gland inflammation. In the course of this relocation, the secretary of the salivary glands becomes backed up and large quantities of this secretary accumulate within the glands.The secretion ultimately forms the ideal breeding ground within the salivary glands for bacterial pathogens that cause salivary gland inflammation.
Furthermore, swelling and tumors can limit the regular outflow of the secretion and lead to salivary gland inflammation via the same mechanism. In addition to these causes of inflammatory processes within the salivary glands, various autoimmune diseases can also cause problems. A classic example of such an autoimmune disease is cystic fibrosis (mucoviscidosis).
In the course of this disease, special chloride channels lose their function and the salivary fluid thickens. In addition, various underlying diseases and behaviours can increase the risk of developing inflammatory processes within the salivary glands. The relevant underlying diseases and behaviors in this context include Salivary gland inflammation usually occurs on one side of one of the two large salivary glands.
Patients affected suddenly develop symptoms with severe swelling and pain. Typically, most affected patients observe the onset of the symptoms during or immediately after eating. Furthermore, the inflammatory processes within one of the salivary glands lead to a restriction of the opening of the mouth.
If the salivary gland inflammation is very pronounced, general symptoms such as fever, chills and headaches may also occur. The treatment of salivary gland inflammation depends on the causative disease. Small salivary stones can often be removed by stimulating saliva production and performing juicy massages.
Bacterial infections usually require antibiotic treatment. In the case of a vital-induced salivary gland inflammation, only a symptomatic therapy can be performed.
- Diabetes mellitus
- Gout
- Excess of calcium ions
- Tobacco consumption
- Alcohol consumption
The formation of a stone of the salivary glands can have serious consequences.
For example, a small stone can be flushed from the salivary gland and get stuck in its excretory ducts. As a result, the normal passage of secretions is blocked. The secreted saliva accumulates and begins to cover the gland.
This provides an ideal breeding ground for bacterial pathogens that can settle in the salivary glands, multiply and cause inflammatory processes. The formation of a stone in the salivary glands can have various causes. Above all, a restriction of saliva production as a result of a pronounced fluid deficiency plays a decisive role in this context.
A stone that is firmly lodged in the excretory duct of the salivary glands does not always cause discomfort. Especially in the case of a very small stone, the glandular secretion can often flow past the stone. Usually, however, the constant passage of saliva leads to an enormous increase in the size of the salivary stone within a certain period of time.
In the course of time, the stone, which is getting bigger and bigger, begins to completely block the excretory duct and to provoke an inflammation of the salivary glands. Patients suffering from an inflammation of the salivary glands caused by a stone usually develop sudden pain. In addition, there is visible swelling in the area of the affected salivary glands.
Treatment of the salivary gland inflammation can only be successful if the causal stone is removed from the excretory duct of the salivary glands. In many of the affected patients, this is possible by stimulating the production of saliva. Affected patients are encouraged to consume sufficient amounts of fluid.
The increasing rate of saliva secretion can, under certain circumstances, lead to the stone being flushed out of the excretory duct of the salivary glands. In addition, careful massage of the salivary glands can help to flush a stone out. If these measures do not lead to the desired result, another treatment method must be initiated promptly.
Even a stone that is not palpable from the outside can often not be treated by increasing the salivary secretion rate and requires the initiation of other treatment methods. One of the most important measures in the therapy of stones in salivary glands is the so-called “extracorporeal shock wave lithotripsy”.In this treatment method, sound waves are directed at the stone from the outside and attempt to split it into smaller fragments. Subsequently, the fragments of the stone (concrements) can be flushed out via the regular salivary flow.
Patients who suffer from many and/or frequently recurring stones in the salivary gland, surgical removal of the affected salivary glands may be useful. A blockage of the salivary glands can occur for various reasons. The main cause of a blockage of the salivary glands is the formation of salivary stones.
In addition, severe swelling within the salivary glands and/or surrounding tissue can lead to a blockage of the salivary glands. Some patients develop a blockage of the salivary glands caused by the development of an ulcer. These ulcers can be either benign or malignant (tumors).
Ultimately, regardless of the causative disease, the backlog of secretion released causes the actual blockage. For this reason, the typical symptoms of constipation of the salivary glands usually occur during or shortly after eating. Among the classic symptoms indicating a blockage of the salivary glands are local swelling and pain.
In addition, depending on which of the salivary glands is clogged, the opening of the mouth may be impaired. Patients who suffer from the classic symptoms should consult a specialist as soon as possible and have the underlying problem clarified. In this way, complications and/or consequential damage can be prevented in most cases. In the end, the treatment always depends on the underlying disease.
