Tuberculosis of the salivary glands
Last reviewed: 23.04.2024
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Tuberculosis of the salivary glands (synonym: tuberculate) is an infectious disease caused by mycobacteria of tuberculosis and characterized by the formation of specific granulomas in various organs and tissues (more often in the lungs) and 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 in the salivary glands from the tuberculous foci of the body. Pathways of distribution are lymphogenous, hematogenous and along the length of the intraparotid or parotapotid lymph nodes. Rarely does the infection get through the excretory duct.
Symptoms of salivary gland tuberculosis
According to the clinical course, the following forms of tuberculosis of the salivary glands differ.
- Exudative caseous (limited or diffuse).
- Productive sclerosing (limited or diffuse).
Exudative abscessing tuberculosis of the salivary glands. Pain and swelling in the salivary glands can occur after hypothermia or influenza. Inflammation slowly builds up (weeks, months). The clinical picture resembles an exacerbation of chronic lymphadenitis. There is weakness, fatigue. Body temperature rises only when exacerbated. If the process is limited, the swelling is usually maintained in the posterior parts of the parotid gland. There may be a diffuse lesion of the gland. In the initial period, the skin in color is not changed and is folded. As the inflammation builds up, the skin becomes hyperemic, soldered to the underlying tissues. Infiltrative foci are palpable in the gland thickening, which then softens, and there is a fluctuation. After opening the foci, a caseous decomposition is observed (crumblike pus). Inflammation subsides, but the infiltration of the gland persists for a long time, fistulous passages with a purulent discharge are formed. Exacerbations occur when the fistula is closed. The mouth opens freely, there are no changes in the oral cavity. There is a decrease in the secretory activity of the affected gland. Sometimes with abscessing in the saliva may be pus. With cytological examination of smears secret, mycobacterium tuberculosis can not be detected. With sialografii, a lubricated pattern of ducts is detected. Contrast substance can fill the cavity (cavity) of the cavity, which is typical for focal lesions. The rest of the gland does not change. A characteristic feature is the presence of petrifications in the gland and adjacent areas.
Diagnosis of salivary gland tuberculosis
Histological examination reveals the miliary tubercles located in the lobules of the gland, the circumference of the excretory ducts, the stroma, and the lymphoid tissue in the gland thick. The miliary tubercles, merging with each other, form large nodes, the central parts of which undergo caseous decay. Quite often, paired bumps 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 comes, sometimes with calcification of tuberculosis foci.
The productive tuberculosis of salivary glands differs from exudative themes. That the disease resembles a tumor. At the same time, a knot is found in the gland, pain is not noted. The node slowly and gradually increases, the body temperature does not increase. Changes in the oral cavity are not detected. The diagnosis is established on the basis of pathomorphological examination of the remote node. Especially often this occurs in the absence of a primary focus in the lungs and negative reactions of Pirke and Mantoux.
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Treatment of salivary gland tuberculosis
Treatment of tuberculosis of salivary glands should be comprehensive and conducted with the participation of a phthisiatrician. Treatment of sialadenitis is under way. If necessary, surgical methods are used - opening of abscessed foci, scraping of tubercle granules and removal of the adjacent gland. Positive results were obtained after the application of X-ray therapy in a total dose of 6-10 Gy.