Sialoses

By Dr. Vishaal Bhat on Sunday 2 December 2007 with 0 comments



Sialoses are a group of diseases characterized by recurring or chronic swelling of large salivary glands (especially the parotid gland - parotidomegaly). Chronic changes affect also small lip glands in about 80% of cases. Sialoses can be divided according to their etiology into the following types:

sialoses of mostly allergic origin (Sjögren-Gougerot-Houwers’ syndrome, Mikulicz’s disease, Mikulicz’s syndrome, Heerford’s syndrome),

sialoses of a hormonal origin (swelling of salivary glands during diabetes mellitus - Charvát’s sign)

neurogenous sialoses (originating from a damage to n. auriculotemporalis during an injury of the parotid gland or after parotitis abscedens)

deficiency sialoses (after a long-term vitamin deficiency during a starvation, so called Terezin sign, Kwashiorkor’s syndrome).

A histological picture is characterized by atrophy of the gland’s acini and huge lymphocytic infiltrates. Upon reduction of the functional parenchyma of a salivary gland, secretion of saliva is lowered (hyposialia or even xerostomia) which allows for an ascendental infection of the gland. Sialoses are marked by a chronic course, local and overall signs and a typical sialographic findings.

Sjögren’s syndrome is marked by various extents of hyposialia as well as reduction of secretion of lacrimal glands and nasal mucosa glands, decreased secretion of synovial fluid, and glands of the alimentary tract mucosa. Patients report dry mouth, difficulties to swallow, pain in joints, digestion problems and dry conjunctivas. Etiology emphasizes an immunopathological origin and hormonal imbalance, since this disease appears at women during a menopause. Therapy is symptomatic and not very successful due to chronic nature and progression of the disorder. Salivary secretion is enhanced by application of pilocarpine and syntostigmine. Lacrysin (methylcellulose) eye drops are recommended at a dry conjunctivitis. It is also recommended to drink the “Karlovarský Mlýnský pramen” mineral water, half a liter a day or more.

Mikulicz’s disease is manifested, similarly as the above described condition, by gradual swelling of the parotid, submaxillar and small salivary glands, and also enlargement of lacrimal glands. The swelling is semi-rigid, not painful, and can extend into a large size. Histological finding shows primarily lymphocytic infiltration and formation of follicles (the benign lymphocytic lymphoma). If the salivary secretion is reduced, the disease may get complicated by an ascendant inflammation of a salivary gland. Therapy by an X-ray irradiation or ligation of a salivary gland ducts show positive results.

Mikulicz’s syndrome has the same clinical picture as the above disease, but the etiology is known. The causes of swelling of salivary or lacrimal glands may be lymphatic system disorders, such as lymphatic leukemia, lymphogranuloma, lymphosarcoma, benign lymphogranuloma, tuberculosis or metastases of a carcinoma.

Heerford’s syndrome is characterized by a non-painful swelling of the parotids, affliction of the uveal tract (uveitis, iridocyclitis), sometimes fevers (febris uveoparotidea) and paralysis of the facial nerve. The disease has a good prognosis. Therapy should be conducted by an ophthalmologist, since ocular complications may arise (synechia at the uveal tract, glaucoma).

Category: Oral Pathology Notes

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