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Salivary gland tuberculosis
Last reviewed: 07.07.2025
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Tuberculosis of the salivary glands (synonym: tuberculosis) is an infectious disease caused by Mycobacterium tuberculosis and characterized by the formation of specific granulomas in various organs and tissues (most often in the lungs) and a polymorphic clinical picture.
Tuberculosis of the salivary glands is rare and accounts for 0.5% of all salivary gland diseases. It occurs as a result of infection penetrating the salivary glands from tuberculous foci of the body. The routes of spread are lymphogenous, hematogenous, and along the intraparotid or periparotid lymph nodes. Rarely, the infection enters through the excretory duct.
Symptoms of tuberculosis of the salivary glands
According to the clinical course, the following forms of tuberculosis of the salivary glands are distinguished.
- Exudative caseous (limited or diffuse).
- Productive sclerosing (limited or diffuse).
Exudative abscessing tuberculosis of the salivary glands. Pain and swelling in the salivary glands may occur after hypothermia or flu. Inflammatory phenomena slowly increase (weeks, months). The clinical picture resembles an exacerbation of chronic lymphadenitis. Weakness and fatigue appear. Body temperature rises only during an exacerbation. If the process is limited, then the swelling usually persists in the posterior lower parts of the parotid gland. There may be diffuse damage to the gland. In the initial period, the skin is not changed in color and gathers into a fold. As the inflammation increases, the skin becomes hyperemic, fuses with the underlying tissues. Infiltrative foci are palpated in the thickness of the gland, which then soften, fluctuation appears. After opening the foci, caseous decay (crumbly pus) is observed. The inflammation subsides, but the gland infiltration persists for a long time, fistula tracts with purulent discharge are formed. Exacerbations occur when the fistula is closed. The mouth opens freely, no changes are noted in the oral cavity. A decrease in the secretory activity of the affected gland is detected. Sometimes, with abscess formation, there may be pus in the saliva. Cytological examination of smears of secretion fails to detect mycobacterium tuberculosis. Sialography reveals a blurred pattern of ducts. The contrast agent may fill the cavity (cavities) of the cavern, which is typical for focal lesions. The remaining areas of the gland do not change. A characteristic sign is the presence of petrifications in the gland and in adjacent areas.
Diagnosis of tuberculosis of the salivary glands
Histological examination reveals miliary tubercles located in the lobules of the gland, the circumference of the excretory ducts, the stroma, and in areas of lymphoid tissue in the thickness of the gland. Miliary tubercles, merging with each other, form large nodes, the central areas of which are subject to caseous decay. Often, miliary tubercles are formed in the circumference of caverns. In many places, small and then large ducts of the salivary gland are replaced by granulation tissue and caseous decay. Gradually, atrophy of the gland occurs, sometimes with calcification of tuberculous foci.
Productive tuberculosis of the salivary glands differs from exudative tuberculosis in that the disease resembles a tumor. In this case, a node is found in the gland area, pain is not noted. The node slowly and gradually increases, body temperature does not rise. Changes in the oral cavity are not detected. The diagnosis is established based on the pathomorphological examination of the removed node. This occurs especially often in the absence of a primary focus in the lungs and negative Pirquet and Mantoux reactions.
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Treatment of tuberculosis of the salivary glands
Treatment of tuberculosis of the salivary glands should be comprehensive and carried out with the participation of a phthisiatrician. Treatment of sialadenitis is carried out. If necessary, surgical methods are used - opening of abscessing foci, scraping of tuberculous granulomas and removal of the adjacent gland. Positive results were obtained after the use of X-ray therapy in a total dose of 6-10 Gy.