Inflammation of the salivary gland

introduction

Both bacteria and viruses play a major role in salivary gland inflammation, along with dry mouth and autoimmune diseases.

The paired salivary glands, especially the three large on both sides of the ears, under the tongue and on the lower jaw, fulfill numerous tasks in our everyday life. They moisturize the oral cavity and thus play a major role in, among other things, food intake, speech and cleaning, as well as the protection of the oral mucosa from bacteria and viruses.

Like any other organ, the salivary glands can also become inflamed. In technical terms, this disease is called sialadenitis . " Sial " here is the Greek translation for saliva, " Aden " for gland and the ending - itis refers to the inflammation.

The most common are the large salivary glands, and most of them the parotid glands ( Glandula parotis ) are affected by inflammation. An inflammation especially of the parotid gland is called, based on their technical name, as parotitis . As a rule, only one of the paired salivary glands becomes inflamed. In about 20% of those affected a bilateral gland inflammation can be observed.

Epidemiology

Most commonly, people between 20 and 50 years of age from a salivary gland inflammation.

There are, however, two exceptions that stand out from the age spectrum. This is on the one hand mumps, colloquially also referred to as Ziegenpeter, probably the most famous virally induced salivary gland inflammation, which occurs mainly in childhood, and on the other a purulent, bacterial inflammation of the parotid glands, which usually fall ill people over the age of 50 years.

Causes and risk factors

As a trigger of salivary inflammatory infectious and non-infectious causes are distinguished.

The infectious inflammations are caused by bacteria or viruses, with bacterial infections caused by staphylococci or streptococci, which can also occur in healthy people in the mouth and throat, are more common.

The non-infectious causes of salivary gland inflammation include autoimmune diseases such as Sjögren's syndrome, inflammation due to head and neck radiation ( radiation adenitis ), or radioiodine therapy in thyroid adenomas. Radiation or radioiodine therapy damages the mucous membrane, resulting in dry mouth with already described consequences.

Furthermore, acute diseases are still distinguished from chronic forms.
The acute forms occur within days or even suddenly and heal relatively quickly, especially under treatment. It is mainly caused by bacteria and viruses. Thus, mumps, which is triggered by the mumps virus and usually affects both parotid glands is calculated to. Mumps is the most common viral salivary gland inflammation and occurs especially in childhood. Other viruses as causes are possible, but very rare.
One speaks of a chronic form when recurrent, often in spurts, comes to salivary inflammations. This is usually observed in immunocompromised individuals or in those who suffer from an autoimmune disease such as the aforementioned Sjögren syndrome. In Sjögren syndrome, which primarily affects women over the age of 40, the body falsely produces antibodies that attack the salivary and lacrimal glands. Consequently, those affected suffer from eye and mouth dryness, pain and salivary inflammation. Of the latter, especially the parotid glands are affected in this case. This disease usually occurs in combination with other rheumatic complaints.

One of the most important risk factors for the development of salivary gland inflammation is the decrease in oral moisture due to decreased saliva production. As already mentioned, the saliva cleanses the oral mucosa and protects it from germ colonization. If dry mouth is present for a long time, bacteria and viruses can multiply and the salivary gland tissue can be infected via the glandular ducts that terminate in the oral cavity. Consequently, salivary gland inflammation occurs.

Older people, in particular, suffer from xerostomia (dry mouth), which is termed as specialized in terms of language, as the hunger and thirstiness decreases with age. Less fluid is consumed and subsequently less saliva is produced. In addition, there are numerous medications, such as water tablets (diuretics), those for heart problems (beta blockers, calcium antagonists) and antidepressants, which are mainly prescribed to the elderly and promote a dry mouth by inhibiting saliva production. Also, stimulants, especially the excessive consumption of alcoholic beverages leads in the course of the decrease in saliva production.

Another important risk factor for the development of salivary gland inflammation is salivary stones. They arise mainly in the gland ducts of the salivary glands in the lower jaw ( glandula submandibularis, glandula = gland). The salivary stones are able to constrict or even clog the duct that allows saliva to enter the oral cavity from the glandular tissue. On the one hand, the resulting dry mouth favors the germination of the oral cavity, on the other hand, the saliva accumulated behind the salivary stone forms an ideal breeding ground for the multiplication of these germs, which can subsequently end in a salivary gland inflammation. The main components of salivary stones, referred to in technical terms as sialolites, are calcium phosphate and calcium carbonate. Both are found again in teeth and bones. The emergence of the sialolites is favored by an altered salivary composition in the context of metabolic diseases or after already undergone inflammation and / or an already narrowed gland duct, among others, after undergoing mumps disease in childhood or cystic fibrosis.

However, it is important to know that not every salivary directly results in salivary gland inflammation. As already mentioned, almost all stones are created in the area of ​​the lower jaw salivary glands. However, this is hardly affected by inflammation, in contrast to the parotid glands, in whose gland ducts arise only about 2 of 10 stones. Nonetheless, a well-known stone should be observed to avoid or mitigate worse consequences. Poor oral hygiene accelerates the inflammatory process in each case, since the bacteria and / or viruses do not first have to colonize the oral cavity.

When Heerfordt syndrome, which is mainly observed in young women and how the Sjögren syndrome is counted among the autoimmune diseases, there is also an antibody-related destruction of glandular tissue of the tear and parotid gland. The symptoms are similar to those of Sjögren's syndrome. Women with Heerfordt syndrome often also suffer from sarcoidosis.

Also in the context of tumors in the area of ​​the salivary glands and gland ducts, which narrow the excretory ducts or completely occlude, recurrent salivary inflammations may occur.

Mumps (Parotitis epidemica)

Especially in childhood and adolescence occurs mumps, so an inflammation of the parotid gland. It should be noted that children are contagious even before the onset of symptoms. In addition to the swelling, fever and pain occur.

Mumps is the most common viral salivary gland inflammation, more specifically, the parotid gland in childhood and adolescence, and is caused by the so-called paramyxo virus . Colloquially, the disease is also referred to as a goat's peter, because the swelling of the inflamed parotid gland causes the ears to protrude forward during the illness. The infection takes place via germ-settled air. For example, a sufferer excretes tiny droplets called aerosols when they speak, sneeze and cough. These aerosols contain the virus, which can eventually infect other children by inhalation. For this reason, sick children should stay at home; on the one hand to spare oneself, on the other hand, in order not to infect other children with mumps.

The dangerous thing about the mumps virus, however, is that not only infectious children are already having symptoms, because even about a week before symptoms occur and one week after they have subsided, the affected child excretes the virus. The virus usually infects and infects both parotid glands. Once the virus has invaded a previously healthy body, it takes some time to replicate and settle. This time is called the incubation period. It is two to four weeks for the mumps virus.

At the beginning, as with other viral infections, the children are tired and weak. You also have no appetite. In the course of the salivary glands in most of the children swell and are enlarged and painful palpable. In the course of it can come with the sick child to a slight increase in temperature. However, there are also fewer children who have also become infected with mumps and have no symptoms or malaise.

Since mumps are triggered by a virus, only a therapy is useful, which relieve the symptoms of the child and the symptoms of the disease. Unfortunately, a therapy that specifically attacks and destroys the virus does not exist. The symptomatic therapy includes cold compresses that are wrapped around the head along the inflamed parotid glands. Fever and pain can be contained by medication. However, it is still advisable to see a doctor to clarify the exact further therapy. The disease heals without consequences within seven to fourteen days. After a persistent infection, there is a lifelong immunity, which also explains that the age of onset of the disease is in children and adolescents.

symptoms

Children are affected by a mumps virus, this manifests at the beginning in fatigue and laxity, later by swollen and tender pancreas.

Also in some symptoms differ acute and chronic forms of salivary gland inflammation. Those affected by acute sialadenitis frequently complain of sudden onset, one-sided swollen, and often painful salivary glands. The infected gland feels rough to the touch when pressed. The overlying skin may be overheated due to the inflammation and appear red. It often comes to a significant swelling of the face. If the acute salivary gland inflammation is due to bacterial conditions, an emptying of pus into the oral cavity is possible. In viral salivary inflammation both sides are often affected, in bacterial usually one side. In contrast to the bacterial inflammation, there is no purulent, but an aqueous secretion.

When eating and chewing, the pain can increase, as the salivary glands work more during food intake and produce more saliva and transport it into the oral cavity to moisten and utilize the food. As the inflamed tissue swells and obstructs the drainage of saliva, this additional pressure exerts on the already sensitive salivary gland, which subsequently causes it to swell even more and more hurts. Some sufferers suffer from such severe pain that it is difficult for them to open their mouths or swallow. The corresponding muscles are located in the immediate vicinity of the glands and irritate the inflamed salivary gland tissue during movement.

The body reacts with fever to the inflammation. Even surrounding lymph nodes can swell as a result of salivary gland inflammation and be mistaken during scanning with this. By creating a blood count and assessing inflammatory parameters, such as the number of white blood cells, the treating physician may find evidence of inflammation.

Chronic salivary gland inflammation can progress over several weeks. In contrast to the acute form, the onset is not sudden, but is characterized by a gradual worsening of the symptoms for weeks. In addition, a relapsing appearance of salivary gland inflammation is typical of a chronic manifestation. Once the chronic inflammation has reached its peak, the affected salivary gland is also painful and hard to palpate. It occasionally secretes milky-grainy secretions, which may also contain pus admixtures.

Chronic salivary gland inflammation usually occurs on one side, but can change sides from one thrust to the next. If a salivary stone triggers the evil, it can occasionally be palpated in the gland duct as hardening, depending on its size. If one palpates a pressure-sensitive and swollen enlarged salivary gland, it is important to visit a doctor and discuss the further procedure with him. If one waits too long and the cause responsible for the salivary gland inflammation is not properly counteracted, a serious complication can be an abscess, that is, a purulent accumulation triggered by the colonized bacteria. The danger of the abscess is that it can break into blood vessels and the bacteria can subsequently trigger life-threatening blood poisoning in the worst case.

diagnosis

When it is determined which pathogen is present, the appropriate antibiotic can be selected for targeted therapy.

The doctor can usually make the diagnosis already on the basis of the clinical symptoms and in conversation with the person concerned or at least a suspicion. The presence of inflammation of the glandular tissue of the salivary glands is characterized by swelling and tenderness in this area and an increase in the symptoms of food ingestion. Earlier head and neck radiation and the use of certain medications, combined with the corresponding symptoms, may be indicative of the presence of salivary gland inflammation.

If the inflammations occur again and again and the person suffering additionally from rheumatic disorders, this indicates to the doctor a chronic form of inflammation. When inspecting the oral cavity, inflammatory lesions may be seen in some patients, especially those with bacterial and viral salivary gland inflammation. The doctor will try in case of suspected bacterial inflammation to massage the pus out of glandular tissue and duct system to ensure his guess. A swab may be useful in bacterial salivary gland inflammation to find out which antibiotic responds to the triggering pathogen, to subsequently start a targeted therapy can.

If salivary stones are involved as a trigger, they can be gently detected during an ultrasound examination. Also tumors or possible abscesses can be seen with the help of this diagnostics. Rarely imaging by MRI, CT or endoscopic examination of the salivary gland ducts using a small camera as a diagnostic tool is considered. Indications for an endoscopic examination are the suspicion of an autoimmune disease as the triggering cause, because during the procedure sample material can be obtained and examined. Furthermore, during the examination, the gland duct can be rinsed and freed from stuck stones. The disadvantage of the study is that it must be done under local anesthesia.

therapy

With the exception of viral salivary gland inflammation, it is important to detect and treat the cause of it, so that glandular tissue can subsequently recover and heal. If possible, stones should be removed from the gland duct in order to avoid inflammation recurrence. If diseases of the rheumatic type, such as Sjögren's syndrome, are the cause of recurrent inflammation, this should be treated as far as possible with medication.

As already mentioned, a dry mouth forms the basis for the colonization with pathogens. This colonization can be counteracted with sufficient fluid intake and oral hygiene. During the illness it is advisable to use soft food, so that the chewing and swallowing does not hurt too much. The saliva production can also be stimulated by picking up acidic foods such as sugar-free, sour candies or with the help of acidic juices or water mixed with lemon juice and in this way the gland ducts and tissue are rinsed and cleaned. In many cases, even smaller salivary stones can be transported in this way from the gland duct into the oral cavity, which saves the person endoscopic removal under short-term anesthesia. Even massages in the area where the salivary stone is stuck in the gland duct can help to loosen it and thus facilitate the removal.

If bacteria trigger the inflammation, antibiotics are used for treatment. Viral gland inflammation focuses on symptomatic therapy. It includes, among other things, drug treatment of pain and fever. Suitable medications include ibuprofen and paracetamol. However, the symptomatic therapy is also a treatment component in other, above triggers. If a purulent abscess has formed as a complication, it must be opened in order to allow the pus to drain and to prevent a breakthrough into the blood vessels and possible blood poisoning. Existing bottlenecks in the gland ducts should be corrected, as these can also be the cause of recurrent inflammation.

Repeated attacks of salivary gland, which heal little or only after a long period of time, should be considered for removal of the affected gland.

forecast

The prognosis of an acute, once occurred salivary gland inflammation is usually very good. If the trigger is found in time and a targeted, symptom-oriented therapy is started, it heals without problems and without consequences within a few days.

When removing the salivary glands, especially those of the parotid gland, there is a risk that the embedded facial nerves are damaged, resulting in facial paralysis of the affected half of the face. However, the nerves are repeatedly checked for their function during the operation and spared by a special surgical tool as well as possible to maintain their function.

prophylaxis

There is a combined vaccine against measles, mumps and rubella, which protects the child against infection.

Prophylactic care should be taken to ensure adequate fluid intake to prevent dryness of the mouth. Oral hygiene, especially after ingestion, prevents excessive colonization with harmful germs. Bubble gums and sour, sugar-free candies also stimulate the salivation and thereby clean salivary glands and ducts. Chewing gums also contribute to oral hygiene.

It is possible to vaccinate children in combination with rubella and measles against the mumps virus. As a result of the vaccine, the body produces antibodies which, like after a sustained mumps infection, confer protection and immunity against re-infection to the vaccinated child.


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