Cysts of the salivary glands
Last reviewed: 23.04.2024
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Cystic lesions occur more often in small salivary glands, less often in the parotid and submandibular jelly. A provoking factor may be trauma to the gland duct, leading to its atresia and accumulation of contents. The accumulation, increasing, presses on the walls of the cavity, increases the cavity of the cyst of the salivary glands.
[Symptoms
In the small glands located in the submucous tissue of the lips, cheeks, and the sublingual region, the formed cystic formations manifest themselves as a clearly delimited formation that has an elastic consistency during palpation, and their contents are felt under the fingers. Under the influence of a trauma during a meal, with a bite of the mucous membrane of the cyst of the salivary glands can be emptied with the secretion of a mucous transparent secret. Subsequently, the cystic cavity is again filled with contents, and in the area of the mucosa of its surface, cicatricial changes are formed in the form of whitish spots. After trauma, especially chronic, the retention cysts of salivary glands can become inflamed; when a collateral swelling is formed in the circumference, the mucous membrane turns red, palpation feels painful.
Cyst of the parotid salivary gland
Characterized by the presence of limited formation of soft-elastic consistency in the thickness of the gland. Education can be located in the superficial or deep sections of the gland. The skin above the gland is enclosed in it, the cyst is of normal color, freely collected in the fold. In the oral cavity the opening of the usual shape, from it saliva of normal color and consistency is allocated.
Diagnosis is based on the data of the clinical picture, and with deep localization in the gland thick - on the data of the cytological examination of the puncture material.
Histologically, the membrane on the outside has a connective tissue base, inside it is lined with multilayered flat epithelium. The contents of the salivary gland cyst are presented by a mucous fluid with separate inclusions of more dense mucus
Cystic formations should be differentiated from adenoma, branhiogenic cyst of salivary glands and other tumors originating from connective tissue.
Treatment operative. Carry out the removal of cystic education. When located in the superficial parts of the parotid gland, external access is performed, taking into account the location of the trunk and branches of the trigeminal nerve. In cases of localization in the lower pole of the gland, removal is effected by access from the submandibular triangle. With a deep location in the thickness of the parotid salivary gland, operative access depends on the size of the cyst. With its small size and palpation under the mucosa, it is possible to excrete intraoral access with mandatory fixation of the duct. At considerable sizes, external access is used. It is quite difficult to prepare branches of the facial nerve when approaching the cyst. In all cases, the cyst is removed with the parenchyma of the gland attached to it.
The forecast is favorable. In some cases, localization in the deep sections of the gland may injure the middle branches of the facial nerve, and then the innervation of the individual facial muscles is violated, and aesthetic disturbances are created. The patient should be warned about this before the operation.
Cyst of submandibular salivary gland
Characterized by the presence of a soft limited formation in the thickness of the submandibular salivary gland. If the cystic formation is large, its upper section spreads through the slit of the maxillofacial muscle into the sublingual region, manifesting itself in the form of bulging. The bulging is covered with a thin mucous membrane. From the duct saliva of normal color and consistency is allocated.
Diagnosis and differential diagnosis are based on clinical data, cytological studies and. In some cases, on sialografii with contrast medium. When diagnosing it is necessary to bimanualically palpate the cyst, in order to differentiate from the cyst of the sublingual salivary gland. It should also be differentiated from other tumors originating from soft tissues (lipomas, hemangiomas, lymphangiomas, etc.). The results of puncture, sialography and radiopaque studies of cystic education are considered as fundamental.
Treatment is operative and consists in removing the cyst of salivary glands along with the submaxillary gland. Certain difficulties can arise when removing cystic formation that grows into the hyoid area. In such cases, a method is used to isolate a part of the gland by access from the oral cavity and, separating it from adjacent tissues, is moved to the submandibular region. Wearing a wound in the hyoid area, in the second stage, access from the submandibular region removes the cystic formation along with the gland.
The forecast is favorable.
Cyst of the sublingual salivary gland (the so-called wound salivary glands)
The salivary gland cyst originates from the sublingual salivary gland and is localized in the anterior part of the hyoid area. In clinical studies in the sublingual region, the bulging of a round or oval firm is determined, covered with a thin mucous membrane, often transparent, and sometimes bluish. With growth, the cystic formation extends into the distal parts of the hyoid space, creating difficulties in eating and talking. Palpation of education establishes fluctuation due to the swelling of the contents of the cyst of the salivary glands. If there is a layer of connective tissue above the skin of the cystic formation, it has an elastic consistency. Quite often, especially at considerable sizes, its shell breaks with the discharge of mucous contents. The salivary gland cyst collapses and gradually re-filled with a secret and can extend from the sublingual region through the slit in the maxillofacial muscle down to the submandibular triangle, forming a figure in the form of an hourglass.
Diagnosis is based on the data of the clinical picture and, if the cystic formation is emptied during the examination, then on the study of its contents and cytology data.
Microscopically, the cyst of the salivary gland cyst is a granulation and fibrous tissue originating from interlobular connective tissue glands of the gland. The inner lining also consists of fibrous tissue, but there may be areas covered with cubic or cylindrical epithelium.
Differential diagnosis is carried out with a cyst of the submandibular gland, using bimanulnuyu palpation, sialografiyu. Also differentiate from hemangioma, lymphangioma, dermoid cyst of salivary glands.
Treatment operative. Cystic formation is excised, very carefully separating the membrane from the mucous membrane. It should be fixed on the saliva probe duct of the submandibular salivary gland. Having allocated a cyst, remove it together with the hyoid gland. The wound is layer-by-layer closed. In the case of sprouting of salivary gland cysts beyond the hyoid area, at first access from the submandibular triangle is separated by the lower section of cystic formation and excised. Access from the oral cavity separates the remainder of the cyst and the hyoid gland. The wound is sutured. A polyvinyl catheter is left in the duct for 1-3 days.
The forecast is favorable.
Diagnostics
Cysts of the salivary glands are diagnosed on the basis of a characteristic clinical picture.
The retention cyst is differentiated from tumors. The latter have a dense consistency, their surface is often tuberous, they are mobile when palpated. Morphologically, the envelope of cystic formation is represented by a connective tissue, often in places denser, fibrous. The inner surface is lined with multilayer flat epithelium. In some cases, the inner lining of the epithelium is represented by a connective tissue.
Treatment is prompt and consists in the cystic education. On the bulging outer surface of the formation, two semi-oval convergent incisions are made through the mucosa. Carefully fix a portion of the mucous membrane with a "mosquito", separate the cystic envelope from adjacent tissues. If separate small salivary glands adhere to the skin of the cystic formation, they are removed bluntly along with the cystic formation. The edges of the wound are brought together and sealed using either chrome-plated catgut or polyamide thread. If the size of the cyst of the salivary glands is 1.5-2 cm in diameter, it may be necessary to apply immersion sutures from a thin catgut for better approach of the edges of the wound and then - seams on the mucous membrane. When applying the suture seams with a needle, only a loose submucosa base should be fixed and the glands not injured, which can lead to a recurrence of cystic formation. With the wrong technique of removing the retention cyst of the salivary glands, a rupture of its membrane can occur, which makes it difficult to completely excise it and can also cause a relapse.
The forecast is favorable.