Classification of inflammation of the salivary glands. Classification of non-neoplastic diseases of the salivary glands Diseases of the salivary glands classification

The salivary glands are organs located in the oral cavity that produce saliva. They are localized on the mucous membrane of the cheeks, lips, palate, under the jaw, near the ears, behind the tongue.

But unfortunately, it often happens that they become inflamed and cause a lot of discomfort. Diseases of the salivary glands are a group of diseases that should not be ignored, because it is with them that the production of saliva and the beginning of the digestion process begin.

Inflammation causes

Diseases of the salivary glands can appear as a result of many reasons. The most common ones are:

• viral or bacterial infection (causative agents of influenza, herpes, HIV, mumps, pneumonia, meningitis and others);
• obstruction of the salivary ducts due to falling into them foreign object or formed stones;
• improper or inadequate oral hygiene. Teeth damaged by caries, gum disease and irregular brushing promote the growth of bacteria and make the glands more vulnerable to foreign agents;
• complications after suffering surgical intervention;
• severe intoxication from heavy metal salts;
• dehydration of the body;
• grueling diets, poor essential vitamins and minerals.

The most common diseases of the salivary glands

The branch of medicine, like dentistry, includes not only the treatment of diseases of the teeth and gums. It involves the treatment of all pathologies that have developed in oral cavity and inflammation of the salivary glands, including. Further, the main diseases of the salivary glands, which dentists have to deal with most often.

Sialolithiasis

Salivary stone disease - chronic illness, characterized by the formation of calculi in the ducts of the salivary glands. Most often, the submandibular gland is affected, less often the parotid, and it is extremely rare to find a defeat of the sublingual gland.

Pathology is widespread among the male population and practically does not occur in children. Improper functioning of the salivary glands leads to stagnation of saliva in the duct. At this point, salts precipitate and stones begin to form.

The calculi consist of phosphate and calcium carbonate, they can contain the content of sodium, iron and magnesium

Stones can grow at a rapid pace, and the size of dense formations sometimes reaches the size of a hen's egg. Symptoms of the pathology are edema and hyperemia of the skin in the affected area, difficulty in chewing, swallowing and speaking, dryness of the oral mucosa, soreness on palpation in the mouth and cheeks, unpleasant taste in the mouth, hyperthermia, deterioration general condition, headache and weakness.

Treatment involves conservative treatment (drugs that enhance the secretion of the salivary glands, relieve swelling and inflammatory process, antipyretic, pain relievers, antibacterial) and surgical treatment.

Sialoadenitis

Acute or chronic inflammatory disease salivary glands, which occurs for various reasons (infectious diseases, trauma, developmental anomalies). The disease most often occurs in children and people over 60 years of age. There are 3 types of sialoadenitis: submandibular, sublingual and parotid.

Besides pain in the ears, throat and nose, the following signs can be attributed: increased body temperature, hyperemia and swelling of the skin in the ear area, an unpleasant taste in the mouth (putrid breath), soreness when pressing on the earlobe, taste disturbance, dryness of the oral mucosa as a result of insufficient saliva secretion.

In case of complications, stenosis of the ducts, salivary fistulas, abscess, phlegmon of the parotid and submandibular zones may appear. Sialoadenitis is treated conservatively with antibiotics, antiviral drugs, physiotherapy procedures. With a frequent recurrent course of the disease, it is recommended complete removal salivary gland.

Salivary cyst

Education, which is formed as a result of a difficult or complete cessation of the outflow of saliva, a violation of the patency of the salivary ducts due to their blockage. The cyst is classified as follows: small gland retention cyst (56%), wound, submandibular cyst, cyst parotid gland.

Most often it forms on the mucous membrane of the cheeks and lips. Most often it is asymptomatic. Measures to combat cystic formation anywhere in the localization does not provide conservative treatment... The best option is to remove the cyst together with the adjacent tissues with self-absorbable sutures.

Sjogren's syndrome

Dry syndrome - autoimmune disease, which affects the glands of external secretion, as a result of which it is possible to observe dryness of the mucous membranes not only of the oral cavity, but also of the nose, eyes, vagina and other organs. Pathology most often occurs among women after 40 years of age, often accompanied by diseases such as scleroderma, lupus, periarteritis.

The first non-specific signs of Sjogren's syndrome are dry mouth and soreness of the eyes, which is cutting and sharp when watching, for example, TV.

When examining the tongue, there is its complete dryness, the inability to swallow saliva, a dry lump in the throat, causing discomfort.

With the development of the disease, photophobia appears, pain in the eyes, blurred vision, dystrophic changes... If you want to "squeeze out" a tear, nothing happens, because there is no tear fluid. Two weeks after the onset of the disease, loosening of the teeth and loss of fillings can be noticed.

Treatment includes taking glucocorticosteroids, immunosuppressive cytostatics, symptomatic therapy.

Tumors

Oncological diseases that rarely affect the salivary glands. Among all cancers, they account for only 0.5–1% of all oncological pathologies. Despite its rarity, cancer of the salivary gland poses a great danger, since the course of the disease is secretive and asymptomatic at the first stage.

Neoplasms are 2 times more common in women after 50 years of age, they tend to malignancy and metastasis. As the tumor grows, swelling may appear in the localization area, a feeling of fullness from the inside. In the later stages, discomfort, soreness, ulceration appear.

Treatment of neoplasms is exclusively surgical, followed by chemotherapy and radiation therapy. Measures aimed at eliminating diseases are coordinated by several doctors: dentist, surgeon, otorhinolaryngologist.

Diagnostics

All patients who have asked for help from a specialist, without fail, for the purpose of diagnosis, are examined, palpated, surveyed, blood and urine tests. Depending on the results obtained, the specialist can refer him to comprehensive examination in a hospital setting.

This most often happens if there is a history of diseases such as diabetes, pathology of the thyroid and gonads, diseases of the digestive tract, liver, kidneys, of cardio-vascular system, nervous and mental disorders other. All of them can cause inflammation of the salivary glands or aggravate the course of the disease.

The probing procedure is carried out carefully, without the use of force, since the duct wall is very thin and does not have a muscle layer, so it can be easily damaged

To more accurately diagnose, doctors prescribe the following procedures:

• Probing the ducts of the salivary glands - carried out with a special salivary probe. With this method, you can determine the direction of the duct, its narrowing, stone in the duct.
• X-ray of salivary ducts (sialography) - a diagnostic method aimed at introducing into the ducts contrast agent and performing radiography. It can be used to determine the expansion or narrowing of the ducts of the salivary glands, the clarity of the contours, the presence of calculi, cysts and tumors, etc. The procedure is carried out using a syringe and can cause discomfort to the patient.
• Sialometry is a method in which the functional ability of small and large salivary glands is determined. The procedure is performed on an empty stomach, you cannot brush your teeth, rinse your mouth, smoke, chew chewing gum... The patient takes orally 8 drops of 1% polycarpine, diluted in half a glass of water. After that, a special cannula is inserted into the gland duct and the secretion of the salivary glands is collected in a test tube for 20 minutes. After a certain time, the amount of saliva produced is estimated;
• Cytological examination of saliva - a method that helps to identify inflammation and tumor diseases of the small and large salivary glands.

Preventive actions

To try to completely protect yourself from damage to the salivary glands, you must follow simple rules: observe the rules of oral hygiene, monitor the condition of the teeth, gums and tonsils. If any viral or bacterial disease the necessary therapeutic measures should be carried out on time.

When the first signs of inflammation of the salivary glands are found, it is necessary to rinse the mouth with a weak solution of citric acid. It promotes abundant production of saliva and frees the ducts from the accumulation of infections or foreign bodies in them.

They are represented by paired parotid, submandibular and sublingual glands, as well as small salivary glands, the number of which can reach 600-1000.

Everything diseases of the salivary glands are subdivided into neoplastic (tumor) and non-tumor. Non-neoplastic diseases are further subdivided into infectious inflammatory, non-infectious inflammatory, and non-inflammatory.

Non-neoplastic diseases of the salivary glands
1. Infectious inflammatory:
Acute bacterial sialadenitis
Acute viral sialadenitis
Granulomatous infections

2. Non-infectious inflammatory:
Sialolithiasis
Beam sialadenitis
Sjogren's syndrome
Sarcoidosis

3. Non-inflammatory:
Sialorrhea (ptyalism)
Xerostomia
Sialosis
Cysts
Mucocele
Trauma

Anatomy of the salivary glands

Plays a critical role in oral hygiene because saliva has antimicrobial properties and serves as a barrier to protect the mucous membrane from irritating substances. Saliva also plays a role in articulation and swallowing by acting as a lubricant.

Thus, damage to the salivary glands can manifest itself in completely different ways, from a minor cosmetic defect to disabling functional disorders. Knowledge of the anatomy of the salivary glands is necessary to understand the diseases of this area. During the examination, it is important to palpate the salivary glands both externally and through the oral cavity.

and) Parotid salivary gland... The parotid salivary gland is the largest salivary gland. It secretes mainly serous secretion, which is secreted through the stenon duct, which opens on the mucous surface of the cheek at the level of the second molar of the upper jaw.

The gland is located lateral chewing muscle and in front of auricle, above it lies the zygomatic arch, and downward from it there is an angle lower jaw... The posterior tail of the gland bends around the sternocleidomastoid muscle. The facial nerve divides the gland into superficial and deep lobes.

Parasympathetic innervation provided by the glossopharyngeal nerve (auricular-temporal nerve extending from the ear ganglion). The sympathetic innervation of all salivary glands is provided by the superior cervical ganglion.

b) Submandibular salivary gland... The submandibular salivary gland is the second largest salivary gland. It produces a serous-mucous secretion and opens to the bottom of the oral cavity through the Wharton's duct. The gland is located on the jaw-hyoid muscle, within the submandibular triangle between the abdomens of the digastric muscle.

Parasympathetic innervation of the submandibular and sublingual is provided by the superior salivary nucleus through the tympanic string (part of the lingual nerve) before it enters the submandibular ganglion.

in) Submandibular salivary gland and small salivary glands... The sublingual and small salivary glands produce a viscous mucinous secretion with a large number of lysosomes and a more pronounced antimicrobial effect.

The sublingual salivary gland is located superficially from the musculohyoid muscle and opens to the floor of the oral cavity through the rivinus duct (sometimes they merge, forming the Bartholin duct, which connects with the excretory duct of the submandibular salivary gland). Small salivary glands are located along the entire surface upper divisions respiratory and digestive tracts, each of the glands has its own excretory duct.

Major salivary glands.
Parotid gland (1) with a small accessory gland (2) and stenonic duct (3).
The submandibular gland (4) with a hooked process (5) and a submandibular (warton) duct (6).
The sublingual gland (7) with the sublingual papilla (8).
A - chewing muscle; B - buccal muscle; B - jaw-hyoid muscle.

1. Salivary glands. Morpho-functional characteristics of the end sections and excretory ducts. Classification of the salivary glands.

The tongue contains a large number of salivary glands. Their end sections lie in layers of loose fibrous connective tissue between muscle fibers and in the submucosa of the lower surface. There are three types of glands: protein, mucous and mixed. They are all simple tubular or alveolar-tubular. At the root of the tongue there are mucous membranes, in the body - proteinaceous, and at the tip - mixed salivary glands.

Large salivary glands

In the oral cavity, along with the mechanical chemical treatment food. The enzymes involved in this processing are found in saliva, which is produced by the salivary glands. In the oral cavity, these glands are located in the cheeks, lips, tongue, palate. In addition, there are three pairs of large salivary glands: the parotid, submandibular, and sublingual. They are located outside the oral cavity, but open into it by excretory ducts.

Functions:

• production of saliva. Saliva contains a mucous substance - the glycoprotein mucin and enzymes that break down almost all food components: amylase, peptidase, lipase, maltase, nuclease. However, the role of these enzymes in the general balance of enzymatic reactions of the gastrointestinal tract is small. The importance of saliva is that it moistens food, making it easier to move. Saliva also contains bactericidal substances, secretory antibodies, lysozyme, etc.
• Endocrine function salivary glands consists in the production of an insulin-like factor (growth factor), a factor that stimulates lymphocytes, a growth factor of nerves and epithelium, kallikrein, which causes dilation of blood vessels, renin, which constricts blood vessels and enhances the secretion of aldosterone by the adrenal cortex, parotin, which reduces calcium in the blood and etc.

Structure

All large salivary glands are organs of the parenchymal lobular type, consist of parenchyma (epithelium of the terminal sections and excretory ducts) and stroma (loose fibrous loose connective tissue with blood vessels and nerves).

Parotid gland. It is a complex alveolar branched gland with purely protein secretion. Like other large salivary glands, it is a lobular organ. Each lobule contains end sections of the same type - proteinaceous, as well as interlobular and striated intralobular ducts. The terminal sections include two types of cells: serous (serocytes) and myoepithelial cells. Myoepithelial cells lie outside of the serocytes. They have a processional shape, myofilaments are well developed in their cytoplasm. By contracting, the processes of these cells compress the end sections and promote secretion. The excretory ducts of the parotid gland are divided into intercalated, striated, interlobular and common excretory duct. The interstitial ducts are the initial section of the duct system. They are lined with low cubic or squamous epithelium, which contains poorly differentiated cells. Outside are myoepithelial cells, and behind them are the basement membrane. The striated excretory ducts are formed by cylindrical epithelial cells, in the basal part of which striation is found, in an electron microscope representing deep invaginations of the cytolemma with a large number mitochondria in between. Due to this, cells are able to actively transport sodium ions, followed by water passively. Outside of the epithelial cells are myoepithelial cells. Function of striated ducts consists in the absorption of water from the saliva and, therefore, in the concentration of saliva. The interlobular excretory ducts are lined at first with a two-row, and then with a stratified epithelium. The common excretory duct is also lined with stratified epithelium

Submandibular salivary glands... Complex alveolar or alveolar-tubular. They produce a mixed protein-mucous secret with a predominance of the protein component. In the lobules of the gland, there are end sections of two types: protein and mixed. The mixed end sections are formed by three types of cells: protein (serocytes), mucous (mucocytes) and myoepithelial cells. Protein cells lie outside of the mucous membranes and form Gianuzzi protein crescents. Outside of them are myoepithelial cells. The inserts are short. The striated excretory ducts are well developed. They have several types of cells: striated, goblet, endocrine, which produce all of the above hormones of the salivary glands

Sublingual glands... Complex alveolar-tubular glands that produce muco-protein secretion with a predominance of the mucous component. They have end sections of three types: protein, mixed and mucous. The mucous end sections are built of two types of cells: mucocytes and myoepithelial cells. For the structure of the other two types of end sections, see above. The intercalated and striated excretory ducts are poorly developed, since their forming cells often begin to secrete mucus, and these excretory ducts in structure become similar to the terminal sections. The capsule in this gland is poorly developed, while the interlobular and intralobular loose fibrous connective tissue, on the contrary, is better than in the parotid and submandibular glands.

Sialadenitis is an inflammatory lesion of large or small salivary glands, leading to disruption of the process of salivation. In dentistry, sialadenitis accounts for 42-54% of all diseases of the salivary glands. The most common cases of sialadenitis are children and patients 50-60 years old. The most frequent form sialadenitis serves parotitisstudied in the framework of infectious diseases and pediatrics. In addition, sialadenitis can accompany the course of systemic diseases (for example, Sjogren's disease), which are considered by rheumatology. Specific inflammatory lesions of the salivary glands in tuberculosis, syphilis are the area of \u200b\u200binterest of the relevant disciplines - phthisiology and venereology.

Causes

Infectious agents in nonspecific sialadenitis can be representatives of the normal microflora of the oral cavity, as well as microorganisms brought in with blood or lymph flow from distant foci. For example, the lymphogenous form is observed against the background of odontogenic diseases (in particular, with periodontitis), boils, conjunctivitis, and ARVI.
Contact sialadenitis is often the result of purulent inflammation of the tissues adjacent to the salivary gland. The defeat of the gland may be associated with surgical interventionsheld on the adjacent tissues. Specific varieties can be caused by pale treponema (against the background of syphilis), Koch's bacillus (mycobacterium - the causative agent of tuberculosis), as well as actinomycetes. In some cases, the cause of the pathology is the blockage of the duct against the background of calculus formation (sialolithiasis) or the ingress of foreign bodies (small solid food particles, toothbrush villi, etc.).
Infectious agents most often enter through the orifice of the duct of the gland. Less commonly, they can penetrate by contact, as well as through the blood and lymphatic vessels. An acute process can sequentially go through several stages:

1. serous inflammation;
2. purulent inflammation;
3. tissue necrosis.

RISK FACTORS FOR THE DEVELOPMENT OF SALIVARY GLAND INFLAMMATION Factors predisposing to the development of sialadenitis include:

• decrease in general and (or) local immunity;
• stagnation of the secretion produced by the gland in its ducts;
• hyposalivation against the background of severe common diseases;
• trauma to the salivary gland;
• xerostomia;
• sinusitis;
• rheumatoid arthritis;
• systemic lupus erythematosus;
• radiotherapy course (for oncological diseases);
• anorexia;
• dehydration (dehydration);
• hypercalcemia (increases the likelihood of stone formation in the ducts).

Classification

Depending on the nature clinical course, the mechanism of infection, the causes of development and the emerging morphological changes in the salivary glands, the following types of sialadenitis are distinguished:

• acute viral - caused by influenza viruses, cytomegalovirus, pathogens of mumps;
• acute bacterial - caused by bacterial pathogenic flora that enters the salivary glands after surgery or infectious diseases, by lymphogenous or contact, with foreign bodies that cause overlap of the salivary gland;
• chronic parenchymal - the inflammatory process affects the parenchyma of the salivary glands;
• chronic interstitial - the inflammatory process affects the connective tissue stroma of the salivary gland;
• chronic sialodochitis - inflammation develops in the duct of the salivary gland.

In acute sialadenitis, the inflammatory process can be:

• serous;
• purulent.

Symptoms

Depending on the form of sialadenitis, they will differ characteristic signs diseases. The acute course is accompanied by symptoms such as:
With a complex course acute form sialadenitis begins to form fistulas, abscesses and stenoses. In cases of detection of stones in the oral cavity, the patient is diagnosed with calculous sialadenitis. It can only be treated with the help of medical intervention. The chronic form is characterized by periods of subsidence and exacerbation of symptoms and has the following symptoms:

• slight swelling in the area of \u200b\u200bthe inflamed salivary gland;
• slight expression of pain, which may worsen slightly with eating or talking;
• decrease in the amount of saliva secreted;
• occurrence unpleasant odor from the oral cavity;
• hearing loss;
• general weakness organism.

Diagnostics

To identify sialadenitis, specialists use diagnostic methods such as:
The final diagnosis can only be made by a doctor during examination. For this, the patient is assigned x-ray examination the affected area in order to exclude or confirm the presence of stones of the salivary gland.

Treatment

Sialadenitis requires the most serious attention to itself, therefore, treatment should only take place under the guidance of a specialist. Self-medication can lead to the transition of the disease into a chronic form with regular seasonal exacerbations. With timely application for medical help therapeutic measures are carried out on an outpatient basis. In difficult cases, the patient may need to be hospitalized.

Conservative therapy

In uncomplicated forms of auricular sialoadenitis, methods of conservative therapy are sufficient, which includes the following: A balanced diet, mainly consisting of finely ground foods, since it is usually difficult for the patient to swallow. The menu includes all kinds of cereals, mashed potatoes, stewed vegetables, soups. Bed rest... Minimizing physical activity in the early stages of the disease with high temperature aims to eliminate possible complications on the cardiovascular system. Drinking plenty of fluids... In addition to water, you can also use various juices (natural and freshly squeezed), fruit drinks, decoctions (wild rose, chamomile), tea, milk. It is better to avoid coffee and carbonated drinks. Local treatment... Warming dry, camphor-alcohol and dimexide (50% solution) compresses, UHF therapy are very effective. Special salivary diet... Since the process of salivation is difficult, patients should hold a lemon slice in their mouths before eating, and include foods such as sauerkraut, cranberries in the diet itself. Medicines... Non-steroidal anti-inflammatory drugs are prescribed to reduce fever and pain syndrome (Ibuprofen, Analgin, Pentalgin, etc.), and to improve the saliva outflow process - 1% pilocarpine hydrochloride solution 7-9 drops 3 times a day. Abstaining from bad habitsespecially smoking... Tobacco smoke negatively affects the work of all organs, even in completely healthy person, and for a patient with sialoadenitis, such an effect can be very serious, because of which the disease can become chronic. In the absence of the effectiveness of the above complex of therapeutic measures, the doctor prescribes antibacterial therapy, which is novocaine blockade (50 ml of 0.5% novocaine solution and 200,000 U of penicillin) and other antibacterial and antiviral agents. High efficacy in the treatment of non-epidemic sialoadenitis is shown by preparations containing immobilized proteolytic enzymes, in particular, imosimase, which does not cause allergic manifestations and retains its activity for a long time. In the chronic form, in addition to antibacterial therapy during an exacerbation, drugs are prescribed to stimulate salivation. Into the ducts, 2 ml of a 15% solution of cstantinol nicotinate are injected. Practice has shown that exposure to X-rays and electric current is also effective in treating mumps, especially if it is a disease associated with salivary stone disease.

According to International classification dental diseases based on ICD-10 (Fig. 21), diseases of the salivary glandsassigned to class 11 (K11): K11.0. Salivary gland atrophy. K11.1. Salivary gland hypertrophy. K11.2. Sialadenitis (excluded: mumps - B26, Heerford uveoparotitis fever - D86.8).

K11.3. Salivary gland abscess.

K11.4. Fistula of the salivary gland (congenital fistula of the salivary gland is excluded - Q38.4).

K11.5. Sialolithiasis (stones of the salivary gland or duct).

K11.6. Mucocele of the salivary gland.

K11.60. Mucous retention cyst.

K11.61. Mucous cyst with exudate.

K11.69. Mucocele of the salivary gland, unspecified. K11.7. Disorders of the secretion of the salivary glands (excluded dry mouth NOS - R68.2).

K11.70. Hyposecretion.

K11.71. Xerostomia.

K11.72. Hypersecretion (ptyalism).

K11.78. Other specified disorders of the secretion of the salivary glands.

K11.79. Unspecified impairment of the secretion of the salivary glands.

K11.8. Other diseases of the salivary glands (excluded dryness syndrome (Sjogren's disease) - M35.0). K11.80. Benign lymphoepithelial lesion of the salivary gland. K11.81. Mikulich's disease.

K11.82. Stenosis (narrowing) salivary duct... K11.83. Sialectasia.

K11.84. Sialosis.

K11.85. Necrotizing sialometaplasia.

K11.88. Other specified diseases of the salivary glands. K11.9. Disease of the salivary gland, unspecified.

Sialadenopathy. Sjogren's disease and sarcoidosis are excluded from the salivary gland diseases section and assigned to other sections.

Diseases of the musculoskeletal system and connective tissue:

M35. Other systemic connective tissue lesions.

M35.0. Dry syndrome (Sjogren). M35.0X. Manifestations in the oral cavity.

Certain disorders involving the immune mechanism:

D86. Sarcoidosis

D86.8. Sarcoidosis of other specified and combined localizations.

Included:uveoparotid fever (Heerfordt's disease).

D86.8X. Manifestations in the oral cavity.

It should be noted that, despite persistent recommendations, the use of this classification in practice in Russian Federation difficult due to a number of disadvantages related to inflammatory and degenerative diseases. In particular, the exclusion of Heerfordt's syndrome and Sjogren's disease from the section of diseases of the salivary glands is unjustified, since, in general, their clinical picture is characterized by damage to the salivary glands and requires the obligatory participation of a dentist in the diagnosis, treatment and dispensary observation of these patients. Sjogren's disease is a disease of the musculoskeletal system and connective tissue, which, by etiology and the presence of autoantibodies in the blood, indisputably classifies it as systemic and autoimmune. Consistency the specified disease is associated with damage not only to all glands of external secretion, but also to muscles, joints, blood vessels, etc. Despite the fact that dentists and ophthalmologists have initiated the study of this disease (due to the early and obligatory

lesions of the lacrimal and salivary glands), today the basic treatment and the main dispensary observation carried out by a rheumatologist. The basis of therapy is made up of small doses of glucocorticoids and cytostatics, against the background of the intake of which there was a reduction in the aggressive lympho-histioplasmacytic infiltrate, an increase in saliva and lacrimation.

The defeat of the salivary glands against the background of sarcoidosis, which refers to granulomatous diseases and often occurs with lesion facial nerve and clinical picture uveitis, little studied. However, thanks to research over the past decade, significant progress has been made in the diagnosis of this disease.

Difficulties are also associated with the diagnosis of chronic forms of sialadenitis. Traditionally, three forms are distinguished (which is convenient for practical use): parenchymal, ductal and interstitial, for them the clinical, sialographic and, to some extent, morphological characteristics are clearly defined. These forms are absent in ICD-10. It is incorrect to isolate an abscess of the salivary gland in the specified classification, because in this case we can talk about acute or exacerbated chronic purulent parotitis, purulent lymphadenitis of deep parotid lymph nodes or exacerbation of salivary stone disease. An abscess is not an independent disease, but a consequence of the named diseases.

Difficulties also arise in understanding the disease, which is designated as sialosis (sialadenosis).

In Russia and the CIS countries, the classification of I.F. Romacheva and V.V. Afanasyeva (1987):

I. Malformations of the salivary glands.

II. Damage to the salivary glands.

III. Reactive dystrophic diseases of the salivary glands (sialadenosis):

Violations of the excretory and secretory function of the salivary glands;

Disturbances in the salivary glands in neuroendocrine diseases;

Disorders in the salivary glands in autoimmune rheumatic diseases.

IV. Inflammation of the salivary glands.

1. Acute sialadenitis:

Acute viral sialadenitis:

Parotitis;

Influenza sialadenitis;

Cytomegalovirus sialadenitis;

Sialadenitis caused by the Coxsackie virus;

Acute bacterial sialadenitis:

Post-infectious and postoperative sialadenitis;

Lymphogenous sialadenitis;

Contact sialadenitis;

Sialadenitis caused by implantation foreign body into the duct of the salivary gland.

2. Chronic sialadenitis:

Interstitial sialadenitis;

Parenchymal sialadenitis;

Sialodochitis.

3. Specific damage to the salivary glands:

Actinomycosis of the salivary glands;

Tuberculosis of the salivary glands;

Syphilis of the salivary glands.

V. Salivary stone disease.

Vi. Cysts of the salivary glands.

Vii. Tumors of the salivary glands.

In connection with the emergence of new data in the above classification, some changes have been made regarding the isolation from the group of sialadenoses - syndromes with damage to the salivary glands (Sjogren's disease and syndrome, Mikulich's disease, Madelung's disease, Küttner's inflammatory tumor, sarcoidosis). With these diseases, changes in the salivary glands in the stage clinical manifestations are pronounced inflammatory, not dystrophic, and are combined with similar changes in other organs. The symptom of prolonged bilateral enlargement of the parotid salivary glands in these diseases makes them similar to true sialadenoses and requires a thorough examination and differential diagnosis.

The modern classification of non-neoplastic diseases of the salivary glands is presented in the table of contents.