Sialometry

To study the secretory activity of the salivary glands, sialometry of the major and minor salivary glands is performed. Secretion is usually determined by collecting parotid saliva or collecting secretion from the submandibular glands. Sialometry allows for the evaluation of the functions of each gland.

In some cases, the functional activity of the salivary glands is studied based on the collection of mixed saliva from the oral cavity. In this case, the total secretion of all glands is judged, without taking into account the contribution of each gland to the total volume of salivation.

To study the function of the parotid salivary glands, the Lashley-Yushchenko-Krasnogorsky capsules are used. These capsules are "sucked" to the mucous membrane of the cheek so that the papilla of the parotid duct faces its center. Then the parotid secretion is collected for 20 minutes. The method is preferable because the measurement can be carried out in the case of fibrinous inclusions in the secretion or in the presence of viscous saliva. However, it is difficult to collect saliva from two parotid glands simultaneously using capsules, as well as in the case of a stone located close to the mouth of the duct. The method cannot be used for sialometry of the submandibular glands due to the presence of a frenulum of the tongue.

It is more convenient to conduct sialometry of the major salivary glands using the method of T.B. Andreeva (1965), who proposed special metal cannulas for these purposes. Metal cannulas are injection needles with a blunt and polished end, they are 85-97 mm long and 0.8-1.0 mm in diameter. For a functional study of the parotid gland, you can use cannulas with an olive-shaped soldering located at a distance of 3 mm from the blunt end; the olive diameter is 1.6-2.0 mm. This allows you to achieve a strong hold of the cannula in the parotid duct. To study the function of the submandibular glands, cannulas without an olive are used. Currently, plastic catheters can be used instead of cannulas (a standard anesthetic catheter with a diameter of 0.6-1.0 mm, the end of which is extended above the flame). V.V. Afanasyev proposed a special set of salivary probes of different diameters made of titanium and metal cannulas.

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How is sialometry performed?

Sialometry is performed in the morning and on an empty stomach from 9:00 to 10:00. The patient takes 8 drops of 1% pilocarpine hydrochloride solution orally, diluted in 1/3-1/2 glass of water, after which the cannula (or plastic catheter) is inserted 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 mold so that the end of the cannula does not rest against the wall of the duct, which can lead to false negative results. For 20 minutes from the moment the first drop of secretion appears, it is collected in a test tube and the amount is determined.

Sialometry allows to determine the degree of dysfunction of the salivary glands, provided that the secretion is liquid and does not contain mucous and fibrinous inclusions, i.e. the physical properties of the secretion are not impaired. In practically healthy people, the amount of saliva secreted in 20 minutes from the OGSG is 0.9-5.1 ml, more often 1.1-2.5 ml, from the PCSG - 0.9-6.8 ml, more often 1-3 ml. In practical work, they are guided by the parameters of quantitative assessment of saliva secretion within 1-3 ml for the OGSG and 1-4 ml for the PCSG.

Sialometry based on mixed saliva parameters is performed if it is necessary to assess the overall salivation during treatment in the dynamics of the process. In this case, the functional state of each major salivary gland does not have preferential deviations compared to the paired gland. This is usually observed in syndromic lesions ( Sjogren's syndrome, Mikulicz syndrome, etc.). Mixed saliva is collected by spitting it into a test tube for a certain period of time on an empty stomach without stimulating salivation (for example, 5, 10 or 15 minutes). The amount of saliva after treatment is compared with the same amount before therapy for the disease of the salivary glands.

The salivary capacity of the salivary glands can be assessed by the time required to dissolve a standard piece of refined sugar weighing 5 g. Normally, this time is 50-60 sec.

The secretion of the minor salivary glands is examined by counting their number on the mucous membrane of the lower lip, which is stained with methylene blue (or brilliant deer) for better visibility within a 2x2 cm frame. The secretion is pre-stimulated with a 1% solution of pilocarpine hydrochloride, which is given per os 5 minutes before the examination. Normally, 18-21 minor 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 section of the mucous membrane of the lower lip, which fixes a square frame on the lower lip.

V. I. Yakovleva (1980) used the method of "weighing" the secretion to study the function of minor salivary glands. For this purpose, an aluminum frame with a window of 3-4 cm2 is placed on an isolated area of the mucous membrane of the lips using cotton rolls ^, onto which filter paper, previously dried to a constant mass, is placed. After 1-2 minutes, the paper is removed and the amount of secretion secreted by the minor salivary glands is calculated based on the difference in the mass of the paper before and after the study. Then the area under study is lubricated with a 2% solution of methylene blue and the number of functioning minor salivary glands is counted. By dividing the mass of the secreted secretion by the number of glands, the amount of secretion secreted by one gland is determined. At the same time, the secretion rate of the glands is calculated.

L.M. Gaubenshtok et al. (1988) measured the number of minor salivary glands of the oral mucosa using a template. Paper for electrophoresis and chromatography in the form of a template with a diameter of 4 mm is applied to the dried mucous membrane of the lip, followed by its staining with a histochemical dye and counting the number of glands according to the imprint on the paper. In this case, the amount of secretion secreted by the minor salivary glands is determined by the weight of the paper template before and after its impregnation with the secretion, and the rate of saliva secretion is determined by counting the number of glands and the level of their secretion from a limited area of the lip (area of 1 cm ² ) with six imprints in a decreasing time interval (20, 5, 4, 3, 2 and 1 s) from the moment of drying.

I.M. Rabinovich et al. (1991) assessed the secretory activity of the minor salivary glands using a rectangular applicator measuring 24x15 mm, the paper side of which was applied to the dried mucous membrane of the lower lip for 5 min. The applicator was then weighed and the amount of secreted MSG secretion was calculated based on the difference in its weight before and after the study.

L.N. Gorbatova et al. (1997) used the method of assessing the electrical resistance of a circuit by the time it takes to decrease to a stable value for sialometry of the MCJ. The greatest diagnostic value for assessing the activity of MCJ secretion is the analysis of the drop in resistance over 40 s. This method is rarely used in clinical practice.

Based on the results of sialometry, in a number of cases it is possible to decide on the advisability of performing a particular method of surgical intervention (removal of the salivary gland in the case of late stage chronic sialadenitis or salivary stone disease, etc.).