Salivary gland infection

2021-02-02 12:00 AM

In patients who have just gone to dental work or patients with a habit of biting the cheeks, inflammation of the parotid gland upstream

Classify

If the tumour is not included, most of the remainder of the salivary gland usually involves acute or chronic infection of the parotid gland, the lower jaw and sometimes the sublingual caused by bacteria, viruses or mycobacteria. Either primary or secondary salivary glands may be affected, but the parotid and hypothalamic glands are most commonly associated with acute bacterial parotitis and acute bacterial parotitis. bacteria (ABSS: acute bacterial submandibular sialolenitis). The causes of inflammation of the salivary glands are quite diverse, such as - decreased saliva flow (due to dehydration, malnutrition, congestion, and medications), - tube injury or duct hole (due to occupation, habits, teeth). or - blockage of saliva circulation (due to duct injury, mucus plug, stones, or vascular disease - colloid formation) .. It is important to emphasize caution to distinguish an inflammatory process from other conditions that also cause swelling of the salivary glands, for example benign or malignant adenomas. Inflammation of the lower jaw gland is usually obstructive, while inflammation of the gland gland is due to non-obstructive reasons. Inflammation of the ductus glandular system can also occur after acute episodes of blockage due to stones. Acute and chronic salivary gland inflammation is affected by many factors such as age, medical history, surgery, immune status, systemic fluid balance, medications and allergies. In addition, there are other causative factors such as: congenital or acquired duct abnormalities, foreign bodies, dental procedures, systemic granulomatosis, HIV infection, facial trauma and status) recently hospitalized. for example benign or malignant adenoma. Inflammation of the lower jaw gland is usually obstructive, while inflammation of the gland gland is due to non-obstructive reasons. Inflammation of the glandular system can also occur after acute episodes of blockage due to stones. Acute and chronic salivary gland inflammation is affected by many factors such as age, medical history, surgery, immune status, systemic fluid balance, medications and allergies. In addition, there are other causative factors such as: congenital or acquired duct abnormalities, foreign bodies, dental procedures, systemic granulomatosis, HIV infection, facial trauma and status) recently hospitalized. for example benign or malignant adenoma. Inflammation of the lower jaw gland is usually obstructive, while inflammation of the gland gland is due to non-obstructive reasons. Inflammation of the glandular system can also occur after acute episodes of blockage due to stones. Acute and chronic salivary gland inflammation is affected by many factors such as age, medical history, surgery, immune status, systemic fluid balance, medications and allergies. In addition, there are other causative factors such as: congenital or acquired duct abnormalities, foreign bodies, dental procedures, systemic granulomatosis, HIV infection, facial trauma and status) recently hospitalized. Acute and chronic salivary gland inflammation is affected by many factors such as age, medical history, surgery, immune status, systemic fluid balance, medications and allergies. In addition, there are other causative factors such as: congenital or acquired duct abnormalities, foreign bodies, dental procedures, systemic granulomatosis, HIV infection, facial trauma and status) recently hospitalized. Acute and chronic salivary gland inflammation is affected by many factors such as age, medical history, surgery, immune status, systemic fluid balance, medications and allergies. In addition, there are other causative factors such as: congenital or acquired duct abnormalities, foreign bodies, dental procedures, systemic granulomatosis, HIV infection, facial trauma and status) recently hospitalized.    

Classification of salivary gland infections

Bacterial infection.

Acute lower jaw gland inflammation.

Acute parotid gland inflammation.

Chronic inflammation of the lower jaw glands.

Chronic parotid gland inflammation.

Chronic parotid gland inflammation in young children.

Acute allergic salivary gland inflammation (inflammation of the parotid gland).

Disease cause Actinomyces.

Cat scratch disease.

Viral infection.

Inflammatory fluid of the parotid gland (mumps).

Benign lympho-epithelial injury (HIV-infected patient).

Antibacterial virus (CMV_Cytomegalovirus).           

Fungal infections.

Infect mycobacterium.

Tuberculosis.

Atypical mycobacteria.

Parasitic infection.

Infections related to the immune system.

Inflammation of the salivary glands due to colloid disease (systemic lupus erythematosus).

Sjogren's syndrome.

Hyperplasia of the necrotic salivary glands.

Sarcoid disease.

General examination

Routine patient examination includes careful examination of medical history and physical examination.

Disease history

History and history can provide useful information as there are many different medical conditions that can lead to swelling of the salivary glands (Table 1). Many cases of acute bacterial parotitis (ABP) occur in hospitalized patients who are depleted, have poor appetite, lack of fluids, or cause fluid imbalances or even dehydration. Patients report swelling and pain in the lower jaw area after eating is almost certainly due to the stone of the lower jaw causing acute obstruction attacks. A history of salivary gland stones itself has diagnostic value. Children with acute swelling of the salivary glands and pain may develop mumps. When examining a patient with acute salivary gland swelling, it is important to ask if they have had previous contact with animals, especially cats.

Risk factors for salivary gland infection

Dehydration.

After anesthesia and surgery.

Chronic illness.

Old age.

Premature babies.

Radiotherapy.

Immunodeficiency states.

Long-term hospital stay.

CKD.

Liver failure.

Congestive heart failure.

Diabetes.

Hypothyroidism.

Malnutrition.

Salivary gland stones.

Stomatitis.

HIV infection.

Sjogren's syndrome.

Depression.

Psychosis.

Anorexia nervosa / bulimia (Anorexia nervosa / bulimia).

Increased blood uric acid.

Increased lipoprotein- blood.

Cystic fibrosis (or viscous mucus disease) (cystic fibrosis / mucoviscidosis).

Lead poisoning.

Cushing's disease.

Medicine.

Another factor.

In patients who have recently had dental work (especially with orthodontic braces) or have a habit of biting the cheeks, retrograde parotid gland inflammation (stasis, retrograde sialadenitis) may occur due to The trauma pushes bacteria into the duct system. Although rare, the possibility of dental gland inflammation should also be ruled out by dental examination, root canal testing and dental X-ray. A facial injury can damage (tear, rupture) the Sténon tube, lead to swelling of the parotid gland due to the formation of a pseudocyst of the salivary gland, or trauma that leaves foreign bodies behind (dirt, calluses, hairs). brushes…) can clog the flow of saliva. Patients with a history of vascular disease - colloidosis or autoimmune disease with a potential obstruction of the ductus gland leading to inflammation of the salivary glands (e.g. there is a link between sarcoidosis and pseudocyst formation in the gland. under the tongue). Final, Taking full advantage of the patient's medical history can help detect a wide range of drugs the patient is taking that are capable of reducing saliva flow leading to retrograde inflammation. These are drugs such as: diuretics, anticholinergic drugs (such as atropine), antihistamines, tricyclic antidepressants, phenothiazines, beta-blockers, saliva-secreting drugs, and some drugs. used in cancer chemotherapy (Table 2). Be aware of systemic symptoms such as fever, irritability, sweating, chills, and vomiting. anti-salivary drugs, and some drugs used in cancer chemotherapy (Table 2). Be aware of systemic symptoms such as fever, irritability, sweating, chills, and vomiting. anti-salivary drugs, and some drugs used in cancer chemotherapy (Table 2). Be aware of systemic symptoms such as fever, irritability, sweating, chills, and vomiting.

Drugs associated with salivary gland infection

Antihistamines.

Diuretics.

Tricyclic antidepressants.

Antihypertensive drugs (beta-blockers).

Barbiturates.

Medications against saliva production.

Antibiotics - cholinergic (atropine).

Drugs used in chemotherapy.      

Physical examination

After fully exploiting the history of the disease, begin a physical examination by first observing for an asymmetry of the shape and size of the glands on both sides before palpation, because A physician's palpation can cause later swelling. Key signs of an infection should be identified, including swelling, heat, redness, and pain. Look for signs of trauma to the face such as a tear, bruise or scratch (eg cat scratches or punctures). Should follow the procedure outside the front in the back mouth. Use both hands to gently feel the main foam glands, glands, and gland opening. Must be carefully observed for saliva flow or puff out spontaneously or by squeezing the gland / duct of the physician. This stream of saliva may carry mucus plugs, small pebbles or leave a small amount of cap in the mouth of the gland.

Careful consideration is required before deciding to use a hole probe and duct. This mechanical probe has diagnostic and / or therapeutic value, for example helping to determine the presence of a stone (diagnosis) or removing mucous nodes, widening the narrowing of the salivary duct. (treatment). But on the other hand, this action can push the bacteria that colonize the cavity into the ducts, causing upstream inflammation. In general, glandular exploration is absolutely contraindicated for mumps in children and should be contraindicated for acute bacterial parotitis (ABP). Tumours or inflammation of the sublingual glands are very rare; The most common lesion of the sublingual gland is an imitation cyst. Finally, palpate the face and neck for signs related to lymphadenopathy.

Image analysation

Based on the medical history and physical examination, the physician will decide to have an X-ray of the saliva and this is a useful test in diagnosing cases of swelling of the salivary glands. A non-formula X-ray can detect parenchymal or ductal stones (Figure 1). However, this method has limitations because only about 80-85% of the contrast stones can be seen on non-milk film. Lower jaw chewing facial film helps to detect lower jaw gland and sublingual. For the parotid gland and especially the Sténon tube, the film should be taken in the "puffed-up" position, which means that the patient holds the air in the mouth as much as possible to push the cheeks outward as much as possible, such as ) of the gravel (if any) is easier to detect due to lack of convolution (contrast) of the tall branch (lower jaw) and the arc.

Computed tomography (CT) scan, although more radioactive but less invasive, allows a clearer distinction between salivary gland tissue from neighboring soft tissue than salivary contrast. CT scan allows to distinguish between internal and external lesions. For example, the clinical picture of an infection of the chewable cavity (caused by teeth) is very similar to an acute parotid gland infection. In this case, the CT image allows to distinguish the two situations above. The CT film can also show sub-jaw umbilical stones, which are difficult to see on non-draft films. Three-dimensional CT imaging helps to examine ductal abnormalities as well as parenchymal structural changes in 3-dimensional space.

 

Ultrasound is a simple and non-invasive diagnostic imaging technique that can be useful in evaluating mass lesions of the parotid glands and the lower jaw glands. Ultrasound can distinguish between solid or cystic (fluid-containing) lesions. Cyst, parotid gland stone, dilated ductus, and abscess can be detected by ultrasound. However, ultrasound images lack the resolution needed for detailed images.    

Magnetic resonance (MRI) provides the best soft tissue images while the patient is not exposed to rays and contrast is not required. The use of MRI in salivary gland infections was limited in the past, but has become more popular recently thanks to the excellent salivary duct anatomy of this technique. Many studies show that the use of fast MR - T2 images is capable of providing detailed images of the structure of the glandular canal to help identify stones.           

In the past decade, salivary gland endoscopy has been a less invasive technique used to diagnose and treat obstructive disorders of the salivary gland. This technique is used in cases where it is difficult to access and / or difficult to remove stones (the stone is located behind the Wharton tube or in the lower umbilical gland); or used to examine the duct system after the stone has been removed or after the stone is discovered based on X-ray or ultrasound; Or used to investigate in cases of recurrent swelling of the gland without diagnosing the cause or pathology. This is a promising technique due to less complications in the treatment of salivary gland removal and in the diagnosis of duct inflammation and scar sequelae causing duct narrowing.   

Sialography used to be considered a "priority indication 1" in diagnostic radiology of the salivary glands. However, in recent years, it has been widely replaced by CT and MRI. Salivary gland contrast is mainly indicated for obstructive or chronic obstructive inflammation. This technique helps to detect about 15% to 20% of cases of luminous stones or obstruction due to mucous nodes, and provides quite detailed images of parenchyma of the salivary gland and glandular system. Contrast also shows the narrowing of the gland, foreign bodies, stones, abscesses in the parenchyma as well as assesses the degree of damage to the glandular and parenchyma due to obstructive and infectious diseases. , trauma and neoplasm caused.

Contrast is done by injecting water or oil-soluble contrast media with an iodine (iodine) concentration between 28-38%. Because the contrast contains high concentrations of iodine, contrast is not recommended during acute glandular inflammation because the contrast can escape the inflamed and damaged gland, causing pain and soft tissue damage. even leading to parenchymal death. Other contraindications to salivary gland contrast include: the patient is hypersensitive to iodine, which should be taken before the patient undergoes thyroid function tests. In addition to the ability to detect stones and fluid nodes, salivary gland contrast also has a therapeutic effect such as expelling small stones or mucous nodes, thereby releasing the blockage, restoring saliva flow. Most contrast agents are considered bacteriostatic (some are a mixture of contrast and antibiotic); however, their bacteriostatic effect in glands has not been proven. Salivary gland contrast can cause transient bacteremia. Contrast helps to determine the extent of tube and parenchymal damage caused by salivary gland inflammation or infection. Long-term infection or inflammation of the glands leads to atrophy of the acinar atrophy, preventing the contrast solution from entering the microscopic tubes, when the contrast film shows incomplete branching of the tree, called is the "pruning" image. Meanwhile, tubular inflammation has the classic image of "sausage knot" on contrast film. The vesicular bulges of the duct system are the result of chronic inflammation that changes the structure of the duct wall, or the constant contraction of the effort to push the saliva past the obstruction loses its character. elasticity of the glandular duct, or due to both of these processes. Abscesses inside the parenchyma gland can be seen by image of the normal structure of the gland, which is deflected and squeezed around a luminous area. Finally, the amount of contrast that remains in the gland after the scan reflects the degree of impaired gland function. More recently, salivary gland contrast has been combined with both CT and MRI to improve image resolution and detail. Abscesses inside the parenchyma gland can be seen visually the normal structure of the gland, which is deflected and squeezed around a luminous area. Finally, the amount of contrast that remains in the gland after the scan reflects the degree of impaired gland function. More recently, salivary gland contrast has been combined with both CT and MRI to improve image resolution and detail. Abscesses inside the parenchyma gland can be seen by image of the normal structure of the gland, which is deflected and squeezed around a luminous area. Finally, the amount of contrast that remains in the gland after the scan reflects the degree of impaired gland function. More recently, salivary gland contrast has been combined with both CT and MRI to improve image resolution and detail.    

Radioisotope scanning or scintigraphy can be helpful in examining the parenchyma of the salivary gland. This technique is based on gland tissue's ability to selectively focus radioactive elements - such as radioactive iodine -. This selectivity is similar to that of the thyroid gland. In general, internal lesions such as mixed tumours, warthin tumours and malignant tumours of the salivary glands can be detected by intravenous administration of a radioisotope (99m Tc pertechnetate). Blinking instead increases accumulation 99m Tc in acute gland inflammation or decreased accumulation in case of impaired gland function due to chronic inflammation and fibrosis. The advantage of a flicker capture is that all salivary glands are visible at the same time; However, the downside is the poor resolution.

Laser test

Laboratory tests also contribute to the diagnosis of salivary gland infection. In acute bacterial salivary gland inflammation there is often peripheral leukocytosis; in viral salivary gland inflammation, leukocytes are decreased and lymphocytes are relatively increased. The salivary gland biochemistry measures the changes in sodium and potassium ions concentrations along with the changes in salivary flow. In general, disorders of the noninflammatory salivary glands (e.g., glandular stones) have a high potassium level (normal potassium level in the parotid gland is 25 mEeq / L; lower jaw gland 20 mEq / L) during inflammation In the salivary glands, the potassium content decreases and the sodium content increases (normal sodium content in the parotid gland is 7 mEq / L; the lower jaw is 5 mEq / L). Recurrent parotid gland inflammation results in increased protein concentrations (> 4oo mg / dL), and salivary gland inflammation in colloid disease (e.g. Systemic lupus erythematosus) causes chloride levels to rise 2 to 3 times higher than normal. Saliva flow can also be reduced during salivary gland inflammation.

  

Microbiology is of particular importance in the diagnosis of salivary gland infection. Pus taken in the routine way (aspirating or draining spontaneously or by incision) is Gram stained, cultured, cultured, anaerobic and antibiotic. Acid-fast staining techniques can also be used in case of suspected mycobacterium.

Differential diagnosis

Before a swollen salivary gland, there can be many different disorders that need to be diagnosed differently (Table 3). In general, it is possible to eliminate tumours and systemic diseases because they do not have any of the underlying signs of infection. Diseases of the salivary glands, or noninfectious swelling of the salivary glands, can be caused by a variety of systemic conditions. A benign gland usually presents as a firm, painless mass that grows slowly while a malignant tumour grows faster, which may have signs of neurological impairment (such as weakness, paralysis of the facial nerve), pain or stick with below organization. Swollen glands and post-meal pain are usually caused by obstructive gland inflammation. Figure 1 proposes a protocol for assessing salivary gland swelling.

Diagnosis and treatment

Inflammation of the salivary glands caused by bacteria

Acute parotid gland inflammation caused by bacteria

The history of acute bactreial parotitis (ABP) accompanies the history of modern medicine. The first ABP case is reported

in 1829 at Hotel Dieu (Paris). In 1834, Brodie differentiated ABP from viral mumps. This pathological entity is also known as purulent parotitis, pyoderma, or surgical mumps (because historically, it was thought to be caused by decreased circulatory flow and loss. postoperative water caused). Before the era of antibiotics and modern medical surgery, ABP was a common complication of abdominal surgery and trauma with a mortality rate of nearly 50%. In the pre-twentieth century, the physiological understanding of the water-electrolyte balance and postoperative dehydration was still very limited. Due to insufficient fluid replacement to replace the estimated and ineffective fluid loss lost during surgery, and to maintain that balance after surgery, The decrease in circulating volume after surgery has led to stagnant inflammation or retrograde inflammation through the Sténon tube. In July 1881, the 20th US President James Garfield was hit by a bullet in the abdomen in an assassination attempt. He had had abdominal surgery to detect, then peritonitis and dehydration. Ten weeks later he died of sepsis, which was probably the result of purulent parotid gland inflammation.

In 1919, 1 report of 7 cases of prolonged exposure to sunlight in the Midwestern United States resulting in dehydration with dry mouth was believed to be associated with ABP. In the late 1930s and during World War II, as intravenous fluids during and after surgery became a routine resuscitation method, the postoperative ABP rate was dramatically reduced. By 1955, with the routine use of preventive antibiotics and cyclical treatment, Robinson thought that ABP was a dying disease. But by 1958, Petersdorf et al reported 7 cases of penicillin-resistant Staphylococcal parotitis, and by the early 1960s a series of ABP cases had been reported.      

Over the past decades, the bacteria that reside in the mouth have changed dramatically. This change occurs mainly due to the increased incidence of nosocomial and opportunistic infections in immunocompromised and critically ill patients located in the special care unit: the patient's mouth becomes the is a resident of many rare bacteria compared to the oral environment of many decades ago. In addition, in addition to using antibiotics to destroy certain resident bacteria (such as streptococci) has created gaps for other types of bacteria to grow in place (like sugar bacteria). gram-negative gut, Escherichia coli, Proteus, Klebsiella, Haemophilus influenzae, diphtheria-causing bacteria, Neisseria gonorrhoeae), the use of antibiotics itself genetically modifies bacteria (such as penicillin-resistant staphylococci. ).  

Infants 2 weeks after birth rarely have ABP. Like adult ABP, most are caused by dehydration. The classic clinical manifestations of neonatal ABP are still swelling, redness of the parotid glands, and discharge of the stenon. Although Staphylococcus aureus is the most common pathogen, E-coli, Pseudomonas aeruginosa, Streptococus pneumoniae and other bacteria can also be isolated. The disease can be controlled with the use of systemic antibiotics and rehydration, but some infants need to have surgical drainage.   

In recent years, ABP has started from two ways: hospital infection and community infection. Most of the previously reported clinical evidence, although the number of cases is a bit sporadic, shows that the majority of cultured bacteria from nosocomial cases of parotitis is S.aureus (accounting for over 50%). In many cases, the inflammation of the parotid glands in depressed or immunocompromised patients is caused by the intestinal gram-negative bacteria Pseudomonas, Klebsiella, E. coli, Proteus, Eikenella corrodens, and H. influenzae. Both aerobic and anaerobic bacteria are present in ABP patients.    

There are many factors that lead to an infection of the parotid gland. Retrograde inflammation is considered the main cause of ABP. Dehydration due to acute illness, surgery, trauma or sepsis reduces saliva flow, thus eliminating the normal “flushing” effect when saliva flows through the Sténon tube. Another theory is that the bacteriostatic effect of parotid saliva is inferior to that of other major salivary glands. In the parotid saliva of healthy patients, high fibronectin content promotes adhesion of Streptococus spp and S. aureus around the mouth of the Sténon canal. In contrast, the low fibronectin content increases the adhesion of the bacteria Pseudomonas and E. coli. This phenomenon explains the clinical condition according to which, Ear gland infection due to dehydration is caused by gram-positive bacteria while infection of the parotid gland in immunocompromised or immunocompromised patients is caused by gram-negative bacteria. There is an increased adhesion of gram-negative rods to cells of the oral mucosa - mostly in critically ill patients. With a decrease in salivary flow, bacteria back up the Sténon tube back into the parotid gland. ABP disease reflects the microbiota that resides in the mouth of immunocompromised patients that are susceptible to attack by opportunistic microorganisms of the hospital and of the Special Care Unit (ICU). bacteria will penetrate back through the Sténon tube into the parotid gland. ABP is a reflection of the microbiota that resides in the mouth of immunocompromised patients that are susceptible to attack by opportunistic microorganisms of the hospital and of the Special Care Unit (ICU). bacteria will penetrate back through the Sténon tube into the parotid gland. ABP disease reflects the microbiota that resides in the mouth of immunocompromised patients that are susceptible to attack by opportunistic microorganisms of the hospital and of the Special Care Unit (ICU). 

Community ABP is more common than hospital ABP. All types of pathogenic bacteria in hospital ABP can cause community ABP, but the most common bacteria in community ABP are the gram-positive coccidiosis Staphylococcus and Stretococcus. Although less prone to blockage by stones than Wharton tubes, Sténon tubes can still become clogged by mucus plugs that form when saliva flow decreases due to dehydration or poor fluid balance. Saliva stagnation can be caused by patients taking medications that have side effects that reduce saliva production such as diuretics, antihistamines, tricyclic antidepressants, blood pressure lowering drugs (beta-blockers), drugs anticholinergics, sedatives and phenothiazines. These drugs can increase the viscosity of saliva, block flow and increase the chances of mucus plug formation. It is unlikely that an infection of the parotid gland is transmitted through the bloodstream. Approximately 5% to 10% of ABPs are due to a Sténon tube injury. Injury to the gland, resulting in peri-duct edema, indirectly partially obstructs the flow of saliva resulting in stagnation. Injuries can be caused by trauma to the teeth, orthodontic appliances, right cheek bites, brush injuries, dental blowouts, and "trumpeter syndrome". Particularly "trumpeter syndrome", with clinical manifestations of the parotid gland enlargement, need differential diagnosis from ABP, because this is just anotropic gland with perforation of tissue and a squeaking sound examination but no systemic symptoms of acute infection. An enlarged parotid gland, however, can lead to subsequent ABP due to saliva stagnation and bacterial infection.

Diagnosis of ABP includes medical history assessment, physical examination, X-rays, and testing. A history of recent surgery or episodes of previous ABP is meant to be diagnosed. In newly-operated patients, disease usually begins on the third day after surgery, followed by fluid redistribution. Careful investigation of immunodeficiency states or the use of drugs with side effects that reduce salivation. ABP starts suddenly and quickly, the area in the front of the ear becomes swollen, red, and painful, especially with meals. The physical signs are often classic (Figure 5): enlarged glands sometimes push the left ear out, pain to the touch. Usually both parotid glands are affected (suggesting this is a systemic disorder), but if it is only one, the right gland is more common than the left. Men are more susceptible to the disease and the average age is 60 years old.    

The manipulation of "squeezing" the parotid gland by pressing both hands along the Sténon tube at the same time both inside and out in a back-to-front direction, can be seen flowing if the duct is not completely blocked (Fig. 12 .6). For ABPs, probing the Sténon tube (with tear duct plants) and catheter flushing are often contraindicated. Although this action can help widen the narrow confines and remove the mucus nodes, the risk of pushing the cap towards the parotid gland must be taken into account. Systemic symptoms such as fever, chills, and sweating appear when an infection is present. Dehydration is indicated by dry mouth or loose skin. The test showed that leukocytes increased in which mainly neutrophils were increased and many young polymorphonuclear leukocytes (bandemia) appeared. Determination of dehydration when the rate of volume of erythrocytes (hematocrit) increases, increases urea-blood, increases urine density, decreased urine output and alkalosis may occur with the electrolyte (ionic) test. Sténon tube stones are rarely seen on non-milk X-rays, while contrast is contraindicated for ABP; This case ultrasound is used to detect stones. CT scans can help detect abscesses (figure 7) or tumours within the gland as well as detect foci of secondary infection (originating from the ABP in the gland) in other compartments (chewable, parietal, butterfly-jaw). MRI provides even more clarity, showing the pathological features of soft tissues (tumours) and visualization of the inter-tissue interfaces. Microbiological testing is essential in the diagnosis of ABP. First of all, gram staining of specimens (purulent secretions) for quick and simple identification of pathogenic bacteria; then to cultivate bacteria and make antibiotics as soon as possible. Bacterial culture results confirmed Gram staining results and identified specific microorganisms, while sensitivity testing (antibiotic mapping) helped physicians to choose the most appropriate antibiotic. While waiting for the results of bacterial cultures and antimicrobials, empirical antibiotics can be used. If the infection does not improve, the antibiotic therapy will be adjusted based on the culture results and the susceptibility of the bacteria. The best method of taking specimens for microbiological testing is through the skin aspiration method or insertion of a small catheter into the Sténon tube for suction. Skin aspiration avoids cross-infection with bacteria that are resident in the oral cavity; however, it is not possible to take the specimens in sufficient quantity for testing in many cases. Besides, The problem of preserving specimens for anaerobic culture is very complex. If surgical drainage is required, the needle can be aspirated directly through the exposed parotid gland surface.  

ABP treatment includes specific and nonspecific therapies.

Nonspecific treatment (which is now more historic than practical) includes discontinuation of drugs with side effects against saliva secretion, increased fluid intake, hot compresses, mouth rinses, saliva-enhancing medicine (such as lemon candy or glycerin gauze), and pain relievers if needed. Radiotherapy used to be the primary therapy and now there is no reason to choose. The effectiveness of radiotherapy in the treatment of ABP from the beginning to the mid-twentieth century actually comes from the simultaneous application of understanding of fluid and electrolyte balance. Hydration remains an important cornerstone of ABP treatment; however, special care should be taken in elderly and debilitated patients who are unable to deliver fluid intake and are therefore at risk of overload heart failure with the result of acute pulmonary edema. To avoid fluid overload, it is necessary to monitor the amount and density of urine. electrolytes and possibly central venous blood pressure. Discontinuation of medications with anti-salivary side effects (or a change in dose) should be made only after consultation with the treating doctor and agreeing to an alternative prescription. These measures (rehydration and drug exchange) will work together to increase saliva flow and reduce saliva viscosity, resulting in a re-established “flushing effect” of the saliva flow. Additionally, improving oral hygiene by rinsing the mouth with Chlorhexidine reduces the number of oral bacteria, thereby reducing the likelihood of an upstream infection continuing. These measures (rehydration and drug exchange) will work together to increase saliva flow and reduce saliva viscosity, resulting in a re-established “flushing effect” of the saliva flow. Additionally, improving oral hygiene by rinsing the mouth with Chlorhexidine reduces the number of oral bacteria, thereby reducing the likelihood of an upstream infection continuing. These measures (rehydration and drug exchange) will work together to increase saliva flow and reduce saliva viscosity, resulting in a re-established “flushing effect” of the saliva flow. Additionally, improving oral hygiene by rinsing the mouth with Chlorhexidine reduces the number of oral bacteria, thereby reducing the likelihood of an upstream infection continuing.

Specific treatment includes removing the cause of a duct blockage such as a mucus plug (inserting the brooch and gently flushing the pump) or glandular stones (duct surgery). Such invasive methods are available only after empirical antibiotic therapy has been used.

Immediate specific antibiotic use is the cornerstone of ABP treatment. Empirical antibiotic therapy may be based on results of Gram staining; or is based on the most recent knowledge of the above mentioned ABP bacteria, penicillinase-producing Staphylococccus and hemolytic Streptococcus. These two types normally still live around the mouth of the gland and are the cause of the disease in up to 40% -50% of ABP cases. In the past, community ABP and some cases of ABP from hospital suspected Staphylococccus, a semi-synthetic staphylococcus-resistant penicillin (methicillin oxacillin, or dicloxacillin) or a first-generation cephalosporin (cephalexin) is a reasonable choice for Empirical antibiotic therapy. If methicillin-resistant Staphylococcus is identified, vancomycine is the antibiotic of choice. Current trends in antibiotic use suggest that beta-lactamase inhibitors such as amoxicillin + clavulanic acid (Augmentin) in oral form for outpatients with mild ABP and ampicillin + sulbactam (Unasyn) injections for inpatients. Severe ABP is a reasonable first-line option for empiric antibiotic therapy. For patients with severe allergies to penicillin, clindamycin can be used instead, but erythromycin should not be used because the drug is very resistant. Newer alternative macrolides, such as azithromycin (Zithromax) and clarithromycin (Biaxin), can be used in outpatients with ABP from the community, since they have an ABP-compatible spectrum and favorable number of dosing. for full patient execution. Combination of antibiotics may become necessary in consultation with the Hospital Infectious Department of hospital ABP cases, community ABP cases in immunocompromised patients, systemic infections or when abnormal bacteria (such as Pseudomonas) are detected. Antibiotic therapy must be continued for at least one week after symptoms of ABP begin to improve. If the ABP is unresponsive or recurrent, cultures should be re-cultured and CT scans should be considered to rule out the possibility of pus formation in the glandular parenchyma.

Despite rehydration with antibiotic therapy, infection can persist and spread to neighboring compartments, causing systemic sepsis, airway obstruction (due to involvement of the paranasal and posterior chambers), exhaustion leads to coma and possibly death.

Therefore, if the nonspecific and specific treatments have not improved clinically within 72 - 96 hours, if pain and swelling persists, if temperature and white blood cell count remain high or if If complications do occur, then a decision to intervene with surgery is necessary to have a chance of saving the patient's life.

Compared to the period without antibiotics, today there is less need for surgical drainage. However, the indiscriminate use of antibiotics gradually led to increasing drug resistance, making incision and drainage not uncommon; surgeons therefore need to master these incision and drainage techniques. The parotid gland is surrounded by a thick fibrous sheath, which makes it difficult for physical examination to detect the "flap" sign of the abscess,

at the same time, spontaneous drainage is also less common. Therefore, surgery is necessary to ensure drainage of all possible purulent foci below the gland. If time allows, a CT should be performed before surgery to confirm the presence of purulent foci. If the parotid gland is so severe that it requires surgical intervention, then using a needle aspirate (similar to an abscess - amygdala) is not enough to drain, and especially at risk of injury. damage the branches to wire VII.

The parotid gland incision and drainage is usually performed under general anesthesia, however, if the patient's health does not allow anesthesia, it can be performed under local anesthesia but requires close monitoring. Drainage is usually done through a retromandibular incision (part of the parotid supernatantal lobe incision), through the skin and the subcutaneous organization exposing the parotid gland (glandular). Through the balance in many different directions with a clamp to stop the bleeding with closed mouth position to avoid damaging the major blood vessels and branches of the VII cord. It should be noted that the upper limit of the parotid gland is related to the posterior arc, so the purulent cavity is sometimes horizontal or higher than the chord. In this case, the incision should be extended upwards to ensure adequate drainage. If the incision has no pus, the inflammatory fluid or serum drains through the holes of the gland to "relieve pressure" for the gland, helping to quickly reduce swelling, pain, fever and white blood cells. The incision is not bandaged, just cover 1 layer of wet gauze (saline solution) and change the gauze two to three times a day. It is also possible to drain with a rubber strip placed deep in the purulent cavity and maintain until no pus drips, fluid, granulation tissue appears and the wound heals on its own.

Incision and drainage are methods that cause less scarring as well as less tissue deformation affecting aesthetics. Complications of the cystic gland or salivary probe are rare.

Bacterial acute lower jaw infection

Acute bacterial submandibular sialadenitis (ABSS) is often caused by blockage of the Wharton tube. Stones usually occur in the lower jaw (85% of cases) for a variety of reasons. 1 / The lower jaw gland is lower than the duct system, so in an upright position, the saliva that wants to flow must overcome gravity. 2 / Wharton tube length increases the time to move saliva inside the tube, facilitates deposition, forms tiny pebbles, then stick together, causing mechanical obstruction of saliva. is ABSS. 3 / Wharton tube is not completely straight but has two bends; once the gland runs behind the talons and two right near the Wharton tube opening in front of the oral cavity. 4 / Wharton tube opening narrows due to the action of a sphincter. 5 / Compared with other major salivary glands, lower jaw saliva is more alkaline due to the concentration of calcium salts (oxalates,

All of these factors contribute to saliva stagnation, crystallization (precipitation and crystallization) of calcium salts that form stones that block saliva flow and infection. The disease occurs in men twice as much as women and the most affected age ranges from 30 to 50. Interestingly, the left side is more common than the right; and bilateral inflammation not due to systemic disorders is rare. It is common to have more than one stone forming in the same gland: 20% of cases have 2 stones and nearly 5% of cases have more than 2 stones. Salivary gland stones rarely occur in the parotid, sublingual, and parotid glands. Stones persist for a long time, leading to ulcers and narrowing of the ducts, causing obstruction due to duct stenosis.

The classic illness of ABSS is pain and swelling in the lower jaw area when eating (Figure 9); This is seen as a response by the body to increase the saliva pressure to fight the blockage. Patient claimed to have suffered many such times. Cervical lymph nodes may be palpable. ABSS is a community infection less related to dehydration and hospitalization than ABP. A little pus can be seen flowing from the opening of the Wharton tube when the lower jaw is pressed, but in many cases pus may not be seen due to complete obstruction. Pus specimens should be sent for Gram staining, culture and antibiotic, but any specimens taken from the oral cavity are contaminated with bacteria that are resident in the mouth. Therefore, the majority of patient cultures from Wharton tubes showed a mixture of gram-positive cocci. As a result, Empirical antibiotic selection is similar to that of ABP and depends on the severity of the condition. The selected antibiotic is an antibiotic of the penicillin family of broad spectrum, first generation cephalospirin, clindamycin, or one of the new macrolide antibiotics. The diagnosis of stone ABSS can be confirmed by imaging of the lower jaw chewable face (Figure 1); however, only 80-85% of the contrast stones can be seen on film unprepared. In theory, CT can be useful in determining whether the stone is located in the part of the glandular canal (the end near the gland) or at the umbilical canal where the chewable facial film cannot show. In fact, in our experience, when taking a film of the chewy face, placing the tip of the clutch to the side of the camera in a slightly back-to-front direction can reveal the gravel at the position of the umbilical gland and parathyroid. Hirtz dimensional films,

Treatment for ABSS includes antibiotic therapy, rehydration, avoiding (or replacing) drugs that work against salivary gland secretion, and sialolithotomy, if any. Anterior stone in the far 1/3 of the duct, can be obtained simply in the clinic under local anesthesia. Gravel can be removed by opening the mouth of the Sténon tube with the tear gland aspirator, and then squeezing it along the tube from near to far (or back to front) to push the stone out. One stitch should be stitched near the side of the suspected gravel site to prevent the stone from moving toward the umbilical gland. If unsuccessful, perform surgery to remove stones by slitting the mucosa, opening directly into the duct, and gently removing the stone through the incision. After the stone is removed, sew the edge of the gland to the edge of the upper mucosa (sialodochoplasty). This brings a number of anatomically beneficial changes to the gland to help prevent the stone from coming back. The above tubular shaping just helps to shorten the wharton tube, and at the same time eliminates the sphincter and kink in the duct opening; As a result, saliva flows easily and quickly through a new hole with no-co-muscle-circle. After catheterization, insert a plastic catheter (catheter) into the catheter through the new opening to ensure flow and new path formation. Encourage patients to use 'salivary stimulant letters such as lemon candies, glycerin pads, citrus fruits ... to increase saliva flow after surgery. Put a plastic catheter (catheter) into the duct through the new opening to ensure flow and new path formation. Encourage patients to use 'salivary stimulant letters such as lemon candies, glycerin pads, citrus fruits ... to increase saliva flow after surgery. Put a plastic catheter (catheter) into the duct through the new opening to ensure flow and new path formation. Encourage patients to use 'salivary stimulant letters such as lemon candies, glycerin pads, citrus fruits ... to increase saliva flow after surgery.

In case the stone is in the middle 1/3 or 1/3 later, it is more difficult to remove the stone, so it should be done in the operating room. In case of stones in the umbilical gland or close to the gland, the stone should be taken under anesthesia due to the narrow, deep and irritating field that causes vomiting if it is under local anesthesia. After incision of the oral mucosa of the corresponding area of ​​tooth 7,8, it is necessary to reveal the filament located quite shallow under the mucosa. Then expose the gland based on the following 2 points: 1 / the gland is deeper and inside than the lumbar, 2 / the surgical assistant uses the index finger to push the lower jaw gland upwards to the front so that surgery The primary surgeon may use the stone's touch to locate the stone and gland. There are 2 possibilities. If the stone is not too close to the gland or at the umbilical cord, the location of the gland containing the stone can be exposed directly, and an incision is made directly above the stone. If the stone is closer to the gland, should expose the gland in the far side of the gravel, then open the canal and use a brooch to probe the duct system towards the route. When inserting, the movement should be gentle to avoid pushing the gravel further back. The feeling of the brooch touching the gravel helps to locate the stone, using scissors or a knife to slit it along the gland according to the guidance of the brooch to the gravel location. Usually parathyroid stones are large in size due to their long existence and due to infection, the surrounding ductus fibrosis squeezes the stone; so after incision of the upper gland, should use a spoon excavator to "scoop" out gravel. After gravel removal, check the remaining piping system and flush with a catheter to make sure that there are no gravel missing because there may be a lot of gravel or gravel breaking during the gravel removal. The movement should be gentle to avoid pushing the stone further back. The feeling of the brooch touching the gravel helps to locate the stone, using scissors or a knife to slit it along the gland according to the guidance of the brooch to the gravel location. Usually parathyroid stones are large in size due to their long existence and due to infection, the surrounding ductus fibrosis squeezes the stone; so after incision of the upper gland, should use a spoon excavator to "scoop" out gravel. After gravel removal, check the remaining piping system and flush with a catheter to make sure that there are no gravel missing because there may be a lot of gravel or gravel breaking during the gravel removal. The movement should be gentle to avoid pushing the stone further back. The feeling of the brooch touching the gravel helps to locate the stone, using scissors or a knife to slit it along the gland in the direction of the pin to the gravel location. Usually, parathyroid stones are large in size due to their long existence and due to infection, the surrounding ductus fibrosis squeezes the stone; so after incision of the upper gland, should use a spoon excavator to "scoop" out gravel. After gravel removal, check the remaining piping system and flush with a catheter to make sure that there are no gravel missing because there may be a lot of gravel or gravel breaking during the gravel removal. so after incision of the upper gland, should use a spoon excavator to "scoop" out gravel. After gravel removal, check the remaining piping system and flush with a catheter to make sure that there are no gravel missing because there may be a lot of gravel or gravel breaking during the gravel removal. so after incision of the upper gland, should use a spoon excavator to "scoop" out gravel. After gravel removal, check the remaining piping system and flush with a catheter to make sure that there are no gravel missing because there may be a lot of gravel or gravel breaking during the gravel removal.

 In the case that the stone cannot be obtained by sugar in the mouth (usually parenchymal stones), or in the case of the chronic fibrosis inflammatory gland, it is indicated to take the stone along with the oral gland removal. Lower jaw gland removal surgery may have some risks such as leaving scars on the face, damage to the lumbar or lower jaw line VII ... but still much less risky than surgery to remove the parotid gland.

Recurrent bacterial infection of the parotid gland

Chonic recurrent bacterial parotitis (CRBP), also known as chronic bacterial parotitis, is defined as recurrent ABP alternating with period of recovery. The disease is caused by recurrent ABP, but can also be spontaneous, Sjogren's syndrome, congenital duct malformation, duct stenosis, trauma (due to orthodontic devices), foreign bodies inside the tube Stensen (toothbrush bristles, popcorn brow, grass, straw and herringbone) or complications of mumps. Classically, there are two possible CRBPs: 1 in adults and one in children. The adult form is usually caused by S. aureus, while Streptococcus viridans is the main cause of disease in children aged 3 to 6 years. In CRBP children, boys often have more than girls, swelling of one gland, spontaneously resolves during puberty and gland function fully recovers. CT and MRI are indicated to differentiate chronic infection from parotid adenomas in children. Although gram-positive coccidiosis is the most common pathogen, other bacteria - including opportunistic infections in immunocompromised patients - have also been identified in CRBP. During the course of the disease, there are times when the infection does not cause any subclinical symptoms, so the periods of clinical remission are actually the manifestation of the infection. latent. CRBP can damage parenchyma and loss of gland function. Other bacteria - including opportunistic infections in immunocompromised patients - have also been identified in CRBP. During the course of the disease, there are times when the infection does not cause any subclinical symptoms, so the periods of clinical remission are actually the manifestation of the infection. latent. CRBP can damage parenchyma and loss of gland function. Other bacteria - including opportunistic infections in immunocompromised patients - have also been identified in CRBP. During the course of the disease, there are times when the infection does not cause any subclinical symptoms, so the periods of clinical remission are actually the manifestation of the infection. latent. CRBP can damage parenchyma and loss of gland function.

The characteristic sign of CRBP is swelling of the unilateral or bilateral parotid glands that last for days to months with episodes of increasing and decreasing illness. There may be symptoms of systemic, leukocytosis, and an increased sedimentation rate in periods of severe illness. Take photoresist showed excellent system of ducts and compact dye in the route and the system ducts form pockets cystic (Figure Photograph flashing salivary glands with 99m Tc pertechnetate can evaluate and monitor function of the route:

Historically, in the past, people have been treated in the direction of destroying and atrophy of the gland by ligation of the gland, sacrificing the pharynx, or irradiation of the low dose gland.

 In recent times, treatment for CRBP includes specific antibiotic therapy according to the results of culture results and antibiotic therapy. Any foreign bodies detected in the duct system should be removed. For CRBP in children, systemic antibiotics should be administered at intervals until puberty. Similar to ABP treatment, take pain relievers, avoid dehydration, and stop taking anti-salivary medications. An antibiotic pump inside the gland can be helpful in periods of remission, and should only be pumped about 10 days after the attack has passed. This is done by inserting 1 polyethylene tube 50 into Sténon tube. May local anesthesia lidocaine 2% around the tube. The dropper solution contains either tetracycline or erythromycine. In general, for adults, about 3-4 ml of a 15 mg / ml solution; with children about 1.5 - 2.0 ml of a solution of 10 mg / ml. The solution is kept in the system of pipelines for 5 -10 minutes. This method is done every day and lasts from 3 to 5 days.

In summary, conservative therapy for symptom relief during episodes of inflammation includes nonspecific and non-specific (systemic, topical) treatment and no treatment required during remission episodes. The invasive treatment of the total parotid gland with VII cord conservation can be set on the basis of careful consideration of objective and subjective symptoms as well as the patient's concern for cosmetic problems.

Chronic recurrent lower jaw infection     

Chronic recurrent subjunctivitis (CRBSS), also known as chronic bacterial lower jaw gland inflammation (CBSS), often follows episodes of ABSS and is associated with glandular stones. Chronic recurrent subjunctivitis (CRBSS) is more common than recurrent chronic parotid gland inflammation (CRBP). Contrast can help confirm a diagnosis by demonstrating inflammation of the salivary glands and dilation of the salivary duct through a decrease in the rate of contrast expulsion, indicating impaired salivary gland function. Treatment for recurrent chronic lower maxillary salivary gland inflammation includes empirical antibiotic therapy, salivary enhancement pills, rehydration, and stone removal, if indicated. Finally, for a completely dysfunctional or recurrent gland, resection may be indicated. Chronic chronic inflammation of the lower jaw gland can become a firm tumour located in the triangle below the jaw, called Kuttner Tumour. In other words, Kuttner tumour is a chronic sclerosing submandibular sialadenitis. 

Diseases caused by actinomycoces

Very rarely, Actinomyces (A. israelii, A. naeslundii, A.propionicus, A. viscosus, A. odontolyticus, A. meyeri and A. ericksoni) enter the salivary glands and cause infection. Of the salivary glands, the parotid glands are most commonly affected, in up to 10% of the face and neck Actinomyces cases are infected. This bacterium is a member of the oral microflora and can lead to acute or chronic infections that are difficult to distinguish from other types of salivary gland inflammation. Bacterial penetration of the salivary gland parenchyma may have originated from teeth or from amygitis. Diagnosis is based on Gram staining, bacterial culture and antibiotic mapping. Actinomyces is a gram-positive, low-oxygenated, non-acid-resistant, slow growing cultured actinomyces and may have classical "sulfur seeds". These bacteria combine to form fibers. Cultures obtained from the probes are very susceptible to contamination and result in a mixed population of bacteria. Contrast may reveal localized destruction of the sacral gland within the parenchyma. Treatments similar to facial-neck Actinomyces include incision and drainage if indicated, and long-term, high-dose penicillin therapy (6 to 24 months) (other antibiotics have also been used, including: both erythromycin and tetracyclin). Avoiding dehydration is also important in preventing the progression to chronic and irreversible inflammation. long-term (from 6 to 24 months) (other antibiotics have also been used, including erythromycin and tetracyclin). Avoiding dehydration is also important in preventing the progression to chronic and irreversible inflammation. long-term (from 6 to 24 months) (other antibiotics have also been used, including erythromycin and tetracyclin). Avoiding dehydration is also important in preventing the progression to chronic and irreversible inflammation.

Cat scratch disease

The disease is caused by a diverse bacillus Afipia felis gram negative. The disease does not affect directly from the beginning, but usually causes chronic lymphadenitis of the pre-ear and neck lymph nodes and then spreads to the salivary glands, in which the parotid glands are most affected by nearby. The medical history has rarely been documented by a cat scratching or a cat bite. The incubation period lasts from 2 to 8 weeks. Systemic symptoms such as fever, malaise, and headache may appear. Diagnosis is based on the presence of lymphadenitis, hanger-Rose skin test for positive catfish disease, presence of a gateway of entry (site of germination) and specific markers. staining (Warthin-starry silver-catching bacteria on pathological staining of inflamed lymph nodes) as well as excluding other causes. The neck-face course is usually self-limiting and resolves spontaneously after 4 to 6 weeks. Antibiotics such as ciprofloxacin, gentamicin, and trimethoprim-sulfamethoxazole are commonly used, although there are generally no antibiotic indications. Rarely incision and drainage are required but may be necessary to remove necrotic tissue.

Acute allergic salivary gland inflammation / radiation-induced parotid gland inflammation

Very rarely, immune disorders can lead to disorders of the primary salivary gland. But this can happen after radiation therapy to distant organs due to an over-reaction to the metabolic products circulating in the blood.

Although food allergies are rare, allergies to heavy metals or drugs are more common (such as iodine, chloromycetin, terramycin and thiouracil). The medical history is usually acute swelling of the salivary glands (the most common parotid gland) and difficulty breathing following contrast tests such as intravenous nephrology (IVP). Self-limiting progression.

Infection of the salivary gland caused by a virus

Inflammatory fluid of the parotid gland / mumps

Mumps is an acute infectious disease that does not produce primary pus in the parotid gland and usually develops in the spring and winter. Although the disease is common in children aged 6-8, boys and girls suffer the same, but it can still happen at any age, including adults who have never had it as a child. It is usually caused by a type of paramyxovirus. This is a viral RNA that is associated with influenza and sub-influenza viruses. A variant of the nonparamyxovirus that can cause mumps, includes coxackie viruses A and B, Ebstein-Barr virus, influenza and paracrofluoric virus (types 1 and 3), entaric cytopathic human orphan virus ( ECHO), virus that causes lymphocytic choriomeningitis and HIV (see next section). The virus is spread through saliva and urine. The incubation period from exposure to evidence is 15 to 18 days. The disease also has an aura stage lasting 24 to 48 hours with systemic symptoms such as fever, chills, headache and pain in front of the ear. It is characterized by rapid swelling of the parotid gland on one or both sides, pain, not redness. The swelling can be so large that it pushes out the left ear. Pus discharge from Sténon tube is rarely observed. Since influenza virus as well as other viruses can cause diseases of the parotid gland, determining serum viral load helps confirm the diagnosis. Laboratory tests are usually of no specific value, but may show leukopenia with a relative increase in lymphocytes. Serum amylase levels may also increase with or without associated pancreatitis. To eradicate the disease, efforts have been made to routinely vaccinate 12-month-old children with the measles, mumps, and measles vaccines. rubella (MMR; measles-mumps-rubella). The disease usually resolves on its own within 5 -10 days; Therefore, it is es