Sialometry
Last reviewed: 23.04.2024
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To study the secretory activity of the salivary glands, sialometry of large and small salivary glands is performed. Usually, secretion is determined by collecting parotid saliva or collecting secret from the submaxillary glands. Sialometry allows you to evaluate the functions of each gland.
In some cases, the study of the functional activity of the salivary glands is carried out on the basis of the collection of mixed saliva of the oral cavity. In this case, they judge the total secretion of all glands, without taking into account the contribution to the total amount of salivation of each gland.
To investigate the function of parotid salivary glands, Lashley-Yushchenko-Krasnogorsky capsules are used. These capsules "suck" to the mucous membrane of the cheek in such a way that the papilla of the parotid duct is turned into its center. Next, the parotid secret is collected for 20 minutes. The method is preferred in that the measurement can be carried out in the presence of fibrinous inclusions in secret or in the presence of viscous saliva. However, with the help of capsules it is difficult to collect saliva simultaneously from two parotid glands, and also in the case of a close location of the stone to the mouth of the duct. The method can not be used for sialometry of the submaxillary glands due to the presence of a tongue bridle.
It is more convenient to carry out the sialometry of large salivary glands using the method of TB. Andreeva (1965), who proposed special metal cannulas for these purposes. Metal cannulas are injection needles with a blunt and polished end, they have a length of 85-97 mm and a diameter of 0.8-1.0 mm. For functional examination of the parotid gland, cannulas can be used with a solder in the form of an olive, located at a distance of 3 mm from the blunt end; the diameter of the olive is 1.6-2.0 mm. This allows for a strong retention of the cannula in the parotid duct. To study the function of the submaxillary glands, cannulas without olive are used. Now, instead of the cannula, plastic catheters can be used (a standard anesthetic catheter with a diameter of 0.6-1.0 mm, the end of which is stretched above the flame). V.V. Afanasyev proposed a special set of salivary probes of various diameters from titanium and metal cannulas.
[How is sialometry carried out?
Sialometry is carried out in the morning and on an empty stomach from 9:00 to 10:00. The patient takes in 8 drops of 1% solution of pilocarpine hydrochloride, diluted in 1 / 3-1 / 2 cups with water, after which the cannula (or plastic catheter) is introduced into the excretory duct of the salivary gland to a depth of 3-5 mm. The end of the cannula is lowered into a graduated test tube. It is necessary to dazzle that the end of the cannula does not rest against the duct wall, which can lead to false negative results. For 20 minutes from the moment of the appearance of the first drop of secret, it is collected into a tube and the amount is determined.
Sialometry allows you to determine the degree of impaired salivary gland function , provided that the secret is liquid and there are no mucous and fibrinous inclusions, that is, the physical properties of the secret are not violated. In practically healthy people, the amount of saliva released within 20 minutes from the OSWS is 0.9-5.1 ml, more often 1.1-2.5 ml, from PHCF - 0.9-6.8 ml, a cup 1-3 ml. In practical work guided by the parameters of quantitative evaluation of saliva secretion within 1-3 ml for LSW and 1-4 ml for PHC.
Sialometry based on the indicators of mixed saliva, if necessary, assesses the overall salivation during treatment in the dynamics of the process. In this case, the functional state of each large salivary gland does not have preferential deviations in comparison with the pair gland. Usually, this is observed with syndromal lesions ( syndromes of Sjogren, Mikulich, etc.). Mixed saliva is collected by spitting it into a test tube for a period of time on an empty stomach without stimulation of salivation (eg, 5, 10 or 15 minutes). The amount of saliva after treatment is compared with the same amount until the treatment of salivary gland disease.
It is possible to estimate salivating ability of salivary glands in time, necessary for resorption of a standard piece of refined sugar weighing 5 g. Normally this time is 50-60 s.
The secretion of the ICW is examined by counting the amount on the mucosa of the lower lip, which for better visibility is stained with methylene blue (or diamond deer) within a frame of 2x2 cm. The secretion is pre-stimulated with a 1% solution of pilocarpine hydrochloride, which is given per os 5 minutes before the test. Normally, 18-21 small salivary glands function. A modification of this method is known when a special device in the form of a clamp is used to delimit a segment of the mucous membrane of the lower lip, which fixes a square frame on the lower lip.
IN AND. Yakovleva (1980) used the method of "weighing" the secret to study the function of small salivary glands. To this end, an aluminum frame with a window of 3 to 4 cm 2 is placed on a segment of the mucous membrane of lips, insulated with cotton buds , onto which a filter paper, previously dried to a constant weight, is placed. After 1-2 minutes, the paper is removed and the amount of secret secreted by small salivary glands is calculated before and after the difference in the weight of the paper. Then the area under investigation is smeared with 2% solution of methylene blue and the number of functioning small salivary glands is counted. By dividing the secreted secretion by the number of glands, the amount of secret secreted by one gland is determined. Simultaneously, the gland secretion rate is calculated.
L.M. Gaubenstock et al. (1988) measured the number of small salivary glands in the oral mucosa using a template. On the dried mucous membrane of the lip, paper is applied for electrophoresis and chromatography in the form of a template with a diameter of 4 mm, followed by its staining with a histochemical dye and counting the number of glands from a print on paper. The number of secretions emitted small salivary glands, is determined by the paper template weight before and after soaking it secret, and the rate of saliva - by counting the number of glands and their level of secretion from a limited lip portion (1 cm 2 ) six prints in descending interval time (20, 5, 4, 3, 2 and 1 s) from the moment of drying.
THEM. Rabinovich et al. (1991) evaluated the secretory activity of small salivary glands with a rectangular applicator measuring 24x15 mm, which was applied to the dried mucosa of the lower lip for 5 minutes on the paper side. Next, the applicator was weighed and the amount of the secreted ICF secret was calculated before and after the test for the difference in its weight.
L.N. Gorbatova et al. (1997) for the ICA sialometry, the method of estimating the electrical resistance of the circuit was used by the time of its reduction to a stable value. The greatest diagnostic value for assessing the activity of the secretion of ICW is the analysis of the drop in resistance for 40 seconds. In the clinic, this method is rarely used.
According to the results of sialometry in a number of cases, it may be possible to decide whether to perform a particular method of surgical intervention (removal of the salivary gland in the case of late stage of chronic sialadenitis or salivary stone disease, etc.).