Salivary gland disorders

Salivary gland disorders can be cancerous or non-cancerous in nature, and these are diseases related to or affecting the salivary glands, which are paired organs and are present on both the right and left side of the face in every person. Some diseases are uncomfortable and painful, or may manifest themselves in the oral cavity and not only externally, but others are severe and develop undetected for a long time in asymptotic stages, which is particularly typical of tumours and cysts.

The salivary glands are exocrine glands of the oral cavity whose main function is the secretion of secretion, or saliva. These moisten the oral cavity, facilitate swallowing, coat food and also contain enzymes that help digest food. Every person has both large and small salivary glands, some of which are serous, these produce a watery secretion, others are mucinous, which produce a mucus-like secretion, and there is a third type of glands which are mixed and produce a secretion of a combined consistency.

The major salivary glands are located under the mucous membranes and skin and a person has three paired major salivary glands, namely parotid, submandibular and submandibular. There are also a number of small salivary glands located in the submucosal ligament of the oral cavity, namely Ebner's glands, lingual glands, palatine glands, buccal glands, facial glands and molar glands. All glands produce a secretion based on nerve stimulation and are usually affected by inflammatory, tumour or functional diseases and disorders.

Disorders of secretion

The most common disorders and pathologies include problems with secretion from the salivary glands. These disorders include hypoptyalism, ptyalism, xerostomia and sialosis. These are disorders where there is either reduced or, conversely, extremely increased salivation, and this may be due to various pathological causes, either directly in the salivary glands or related to other types of disease outside the salivary glands and outside the oral cavity.

In ptyalism, there is increased salivary secretion, and this condition can have several different causes, such as neurological causes, field conditions, intoxication with heavy metals or central nervous system disorders, where the transmission of nerve signals fails for various reasons. Diagnosis of the disease consists both in measuring the level of increased salivation and also in finding out the causes. Treatment is then causal, so that it is not the symptom that is addressed, but the cause of salivation.

Hypoptyalism is the opposite condition and in it there is insufficient saliva production. Such decreased secretion may be due to decreased function of the digestive system, but it is also related to inflammation in the oral cavity or occurs in febrile illnesses. Dry mouth and therefore inadequate saliva production also occurs in xerostomia, which can either be a separate functional disease, for example in upper gastrointestinal tract problems, or a symptom for other diseases.

In contrast, sialosis is directly related to the salivary glands and involves changes in these glands that are of a non-inflammatory type, but are accompanied by disturbances in secretion and also other changes. Sometimes the disease is related to general changes in the body due to other diseases, such as diabetes, but it can also be a condition caused by external factors, for example, when taking medication or on an allergic basis. There are several types of sialosis and it usually manifests itself by swollen glands.

Tumour diseases

In addition to problems with secretion, the salivary glands can also be troubled by various tumours. Benign, or non-cancerous, tumours are usually not so serious, but on the other hand, they usually grow slowly and painlessly and affect both sexes equally. Benign tumours include pleomorphic adenoma, papillary cystadenolymphoma, also called Warthin's tumour, basal cell adenoma, myoepithelioma, oncocytoma, tubular adenoma, sebaceous adenoma and ductal papilloma.

The most common benign tumour is the pleomorphic adenoma, which is sometimes also called myxochondroepithelioma. This tumour occurs in the elderly or middle-aged, is very slow-growing and is the epithelial tumour most commonly found on the large salivary glands. It often recurs after surgical removal, and in some cases there is also the possibility of it turning malignant. The tumour is painless and appears as a swelling of the gland.

However, malignant, or cancerous, tumours are a more serious problem, as they often metastasize and spread aggressively. These tumours are divided into epithelial and mesenchymal tumours, depending on where the tumour grows from and what it originates from. Some mesenchymal tumours arise in association with other diseases, such as malignant lymphoma, which can be primary, but also secondary, where it arises in association with Sjogren's syndrome.

Other similar tumours include neurinoma, neurofibroma or haemangioendothelioma. More common, however, are epithelial malignant tumours of the salivary glands, namely acinocellular carcinoma, mucoepidermoid carcinoma, adenoid cystic carcinoma or carcinoma in the pleomorphic adenoma, which arises originally from a benign form of a similar tumour. Tumours affecting the major salivary glands are also more common, most often in the form of acinocellular carcinoma.

Atrophy, hypertrophy and inflammation

The salivary glands are affected by various inflammatory and non-inflammatory diseases. The non-inflammatory ones include atrophy and hypertrophy, where the salivary gland is either enlarged or shrunken either locally or generalized. In atrophy, there is shrinkage and epithelial disruption, which may also be accompanied by functional impairment of the patency of the affected salivary gland; in hypertrophy, on the other hand, there is enlargement and swelling of the gland lining, which is also accompanied by swelling.

Atrophy is a part of various diseases, for example in Sjogren's syndrome, when hypertrophy and exuberance occur first and later atrophy and infiltration of glandular tissue by lymphocytes and plasmocytes. In addition to these non-inflammatory changes, the glands are also affected by various inflammatory processes called sialoadentities. This is a distinct group of salivary gland diseases, and these inflammations can have both an acute and chronic course and may arise from a number of causes.

Acute inflammations are most often caused by viral or bacterial infection, while chronic ones may be caused not only by bacteria, but also by fibroproductive, post-actinic and immune reasons, so called immunosialoadenitis. The most well-known form of viral acute inflammation is mumps, so called mumps mumps. This inflammation affects one of the large salivary glands, the parotid gland, and most commonly affects children. However, similar inflammations can also affect other submandibular glands.

Common chronic inflammations include chronic recurrent parotitis. This is a problem of the outlet of a large salivary gland, which may have various causes, such as congenital, post-infectious or obstructive. The main symptom of this chronic inflammation is a decrease in saliva production. However, many salivary gland problems are also asymptomatic or with only minor pain and so are best detected only at an advanced stage or by a random ENT examination.

Sialolithiasis and mucoceles of the salivary gland

Mucoceles and sialolithiasis are also relatively common salivary gland diseases. Mucoceles are like diseases of a cystic nature, and there are two forms of this group of diseases. The first is the mucocele mucocele, which includes the retention cyst of the salivary gland and the extravasal cyst of the salivary gland. The second form is ranula. In addition, sialolithiasis, which includes a stone of the salivary gland duct or outlet and calculosis of the salivary gland or outlet, also occur in connection with the salivary glands.

The most common type of mucocele is a retention cyst of the minor salivary gland, which arises in the case of obstruction of the duct of the gland, either after inflammation, or in case of some injury or as a result of hyperplasia of the epithelium of the gland. Either serous, or watery salivary, or mucoid, or mucopurulent, secretion accumulates at the same time over the obstruction formed to the outflow and the outlet, and later on there is enlargement of the outlet or gland. This mucocele looks like a small tumour at first sight, but it is only a cyst.

A much rarer form is ranula. In contrast to the retention cyst, not only is there retention of secretion due to a blocked outlet, but also cystic transformation of the glandular epithelium and later the development of a deep ranula. Sometimes this disease is also referred to as a pseudocyst. Painful swelling of the salivary glands is most often associated with sialolithiasis, when the composition of the saliva changes, most often after inflammation or changes in the viscosity of the saliva.

Subsequently, obstruction of the duct forms and stenosis occurs with deposition of inorganic material, most often affecting the submandibular gland and manifested, for example, by a lump under the tongue. Soreness is highest when saliva production is increased, for example by visual or other neurological stimulus, and then the pain may be of a colicky nature. Therapy consists of oral removal of the concrement or via shock waves to crush the stones.

Abscesses, fistulas and other diseases of the salivary glands

The salivary glands can also be affected by some other inflammatory diseases associated with tissue necrosis, for example, various abscesses, various inflammatory fistulas of the salivary gland ducts. Various other pathologies or disorders also arise, such as sialectasia, stenosis, which is a narrowing of the salivary duct, stricture, but also necrotising sialometaplasia, benign lymphoepithelial lesion of the salivary gland or Mikulicz's disease, which is a disease affecting both large and small glands.

In this syndrome there is a slow and painless enlargement of these glands, especially the parotid and minor salivary glands, and the swelling is semi-solid. Sometimes there is also a rather large enlargement of these glands, when the ductal system of the glands changes into a system of irregular cavities and fissures. There is also atrophy of the glandular elements. Sometimes the disease is caused by chronic inflammation or toxic reaction, but in most cases the origin is unknown.

A less common problem is a salivary gland abscess. This is a disease of bacterial origin, where the large parotid gland or the smaller submandibular gland is most often affected, and the bacterial infection most often enters the gland by passage from the surrounding area, for example in periorbital inflammation of dental origin. The swelling of the gland is painful, the surrounding area is swollen and sometimes paralysis of the associated facial nerve occurs. Treatment is antibiotic and drainage of the lesion and lavage of the salivary gland outlet is important.