Medicine

Candidate of Medical Science H. H. Boyko, A. I. Sereda

State Institution “Dnipropetrovsk Medical Academy of Health Ministry of Ukraine”. Department of Dentistry. Faculty of Postgraduate Education. Ukraine.

Experience of Examination and Treatment of Patients with Chronic Sialoadenitis

Summary

The performed analysis of records of patients having salivary gland diseases showed that in the observed industrial region of Kryvyi Rih this pathology was suffered mostly by older persons and persons of a senile age, mainly women.

Salivary gland diseases had mostly inflammatory, and inflammatory and dystrophic character with concretion both in gland ducts and depth.

Retrospective and statistical analysis has been done on the basis of archive materials taken from the records of patients who underwent treatment in the dental surgery department of Kryvyi Rih Municipal Hospital No. 2. The analysis results showed that the frequency of salivary gland diseases among other dental illnesses made 164 patients (6.33 %) of all patients who underwent treatment in the hospital (3066 patients).

к. мед. н. Бойко Г. Г., Середа А. І .

ДЗ «Дніпропетровська медична академія Міністерства охорони здоров'я України», кафедра стоматології ФПО. Україна.

Досвід обстеження та лікування хворих з хронічними сиалоаденітами.

Резюме.

Проведений аналіз історій хвороби хворих з захворюваннями слинних залоз, показав, що в промисловому регіоні Кривбасу на дану патологію страждали, в основному, люди похилого та старчого віку, переважно жіночої статі. Захворювання слинних залоз носили переважно запальний і запально - дистрофічний характер, з утворенням конкрементів як в протоках, так і в товщі залози. Нами був проведений ретроспективний і статистичний аналіз архівного матеріалу історій хвороби хворих, що лікувалися в хірургічному стоматологічному відділенні 2 міської лікарні м. Кривого Рогу. Результати аналізу показали, що частота захворювань слинних залоз серед інших стоматологічних захворювань склала 194 хворих з серед усіх які лікувалися у клініці - 3066 хворих (6,33 %).

It should be noted that the obtained results to some extent depict an epidemical situation.

According to the diagnoses written in the records of patients, 83 patients of the total amount (42.7%) were treated for acute and chronic inflammatory salivary gland diseases, provided that only cases of sialolithiasis made 31.9% – 62 patients.

Neoplasms of salivary glands were found in 44 patients (22.9%); cysts separately made 2.5% – 5 cases.

The performed analysis of records of patients having salivary gland diseases showed that in the observed industrial region of Kryvyi Rih this pathology was suffered mostly by older persons and persons of a senile age, mainly women.

Salivary gland diseases had mostly inflammatory, and inflammatory and dystrophic character with concretion both in gland ducts and depth.

Taking into account the data taken from records of patients we set ourselves the task of defining not only functional but also morphological changes of gland tissues. We have examined 50 patients with chronic salivary gland diseases.

During clinical examination and palpation of salivary glands the following was found: salivary glands were enlarged, palpation was painless, mouth was dry, tongue was dry and furred, mucous tunic of mouth was hyperemic and swollen in 12 patients; the other above mentioned symptoms appeared separately. All patients had passed the following examinations: clinical blood analysis, quantity and viscosity of the saliva, saliva pH, cytological examination, and ultrasonography.

The role of morphological methods of study in the diagnostics of salivary glands diseases should not be underestimated. The cytological examination of saliva smear was used as a minimal invasive and informative method to determine the depth of destructive changes in gland tissues as well as to find the possibilities to diagnose sialadenonci.

The cytological examination of saliva was carried out after predrying of preparations and staining them according to Pappenheim's method.

Microscopy was carried out under the immersion system of the microscope. Stratified squamous epithelium cells were found almost in each preparation taken from patients with salivary glands pathology. In 36 of the 50 preparations a considerable amount of stratified squamous epithelium cells were dilapidated and destroyed having no clear contours; cells of the transition type covering the entire field of vision and “naked” nuclei were also found, thus we may speak about a cytolysis.

In 26 specimens a significant number of leucocytes was revealed: up to 100 leucocytes and covering the entire field of vision, including dilapidated ones; also there was a large number of neutrophils, isolated lymphocytes, monocytes, desquamated epithelium cells, which is characteristic for a chronic inflammation. Red blood cells were found in several preparations (1-3 in the field of vision).

In the remaining 24 preparations a moderate number of leucocytes was found (5-6 in the field of vision of the usual form); neutrophils, histiocytes, and lymphocytes were found in small amounts – isolated in the field of vision. The excessive bacterial flora was observed in all the preparations, notably that it was more significant in the elderly people’s preparations.

All patients with salivary glands diseases also passed ultrasound diagnostics. Echo-sialography makes it possible to obtain a layer-by-layer image of a salivary gland and thus it helps to evaluate its microstructure. Depending on the density, the analyzed tissues differently reflect the ultrasonic vibrations, so by the nature of echogram changes one may identify the areas where glandular tissue is substituted with an acoustically denser one (by a scar or a tumor tissue), and may specify the size and localization of the nidus.

The ultrasound machine НДI 50000 was used to perform the expert level of the ultrasonography of focal lesions of the thyroid gland and salivary glands; it allowed to receive images of salivary glands in three dimensions.

Examinations have shown that there was a hypoechogenity in 8 cases; inhomogeneous structure due to hypoechoic inclusions was revealed in 12 cases; hypoechogenity, salivary ducts dilatation, enlarged regional lymph nodes, parotid salivary glands enlarged to different extent in 14 cases. The echographic picture of the remaining patients was not changed. Thus, the echographic picture of salivary glands confirmed the decrease in the functional activity of salivary glands. Complaints about dry mouth, occasional or persistent enlargement of glands, reduction in saliva, secretion viscosity growth, changes in cytological composition of saliva, and the echographic picture characterized the severity of chronic inflammatory and dystrophic processes in glands tissues.

In the result of the comprehensive examination of salivary glands state in patients living in environmentally unfriendly region we found a true decrease in the functional activity of salivary glands (complaints about dry mouth, occasional or persistent enlargement of glands, reduction in saliva, secretion viscosity growth), changes in cytological composition of saliva, and the echographic picture characterize the severity of chronic inflammatory and dystrophic processes in glands tissues.

Such changes indicate that this category of patients should be referred to a high risk group, and taking into account the data of the performed hygienic index it is observed that these patients at the same time suffer from oral mucosal diseases and dental illnesses.

Patients with chronic diseases of salivary glands should be registered in a dental dispensary in a dental clinic; they should also periodically undergo examination at a dental surgeon. In such a case a dentist should pay a special attention to patients' complaints, perform an objective examination of glands, reveal the abnormality of the amount of saliva coming from ducts, define the quality of the saliva, and inspect the state of regional lymph nodes and the state of the oral mucosa.

Treatment of patients with chronic sialoadenitis, regardless of its form, during the exacerbation of the process does not pose much difficulty. Application of comprehensive treatment used in the treatment of patients with acute sialoadenitis leads to cupping of the process.

Treatment of patients with chronic sialoadenitis during the process of remission, regardless of its form, should be comprehensive. It is appropriate to commence the treatment with the sanitation of all chronic lesions in the mouth cavity and nasopharynx. It is necessary to recommend to patients to adhere to a rational mode of the day, to mix work and rest, to do therapeutic exercises, and to give up harmful habits (drugs, smoking, and alcohol abuse).

Chronic sialoadenitis was treated according to the following scheme:

1.

Correction of the impaired immunity (increase of a non-specific resistance of the body), especially in spring and autumn.

2.

Reduction of toxic effects of systemic diseases specific to each form of chronic sialoadenitis to the body. For this purpose, patients suffering from sialoadenitis were sent to subject matter specialists to treat concomitant diseases. The particular attention should be paid to gastrointestinal diseases and endocrine organs diseases.

3.

The pathological process in the salivary gland was affected: the trophism of its tissues was improved, glands function was increased.

4. The treatment was also aimed at removing hyposalivation, strengthening the walls of salivary glands ducts, improving the regeneration of the oral mucosa epithelium, suppressing secondary infections, improving the trophism of gland tissues, correcting factors of nonspecific reactivity of the body, and preventing exacerbations.

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