Parotid gland disease
The diseases of the parotid gland can be divided into bacterial or viral infections , stone formation in the gland or gland duct ( sialolithiasis ), non-inflammatory swellings such as sialadenoses or Sjögren's syndrome and benign and malignant tumors . The parotid gland ( glandula parotis ) has almost unprotected access to the oral flora through its gland duct , so that ascending inflammation ( parotitis ) can occur in this way , especially if the flow of saliva is obstructed by stones. But the parotid gland can also be impaired in the bloodstream, metabolic diseases, side effects of drugs or nerve malfunction.
Swelling of the parotid glands can lead to pain and nerve paralysis due to tissue pressure, as the gland is surrounded by a tight tissue capsule and the tissue can hardly move. Visible or palpable swellings or lumps should be clarified by a specialist because they can hide malignant diseases.
Viral infections
With the introduction of vaccination, mumps (epidemic parotitis) has become a rare disease. The inflammation is caused by the mumps virus. As a rule, parotitis heals on its own without permanent change. However, it is feared that the disease could spread to other parts of the body. This can lead to a very painful inflammation of the testicles - orchitis - or it can spread to the brain ( encephalitis ). Infection of the parotid gland by the cytomegalovirus is also common in childhood .
Bacterial infections
Usually in connection with other diseases of the parotid, such as salivary stones or a change in the salivary composition ( dyschyly ), colonization by bacteria can occur. The bacteria that migrate either through the duct or the bloodstream and trigger inflammation ( parotitis ) are mostly staphylo- or streptococci . It can be used to chronicity of infection occur. Therapy with antibiotics and stimulating the flow of saliva, for example by sucking candy or chewing gum, is therefore necessary.
Autoimmunological diseases
When Sjogren's syndrome is a symptom complex of lack of secretion production with dry mouth ( xerostomia ), corneal and conjunctival inflammation in the eye ( keratoconjunctivitis sicca ) and inflammation of the tear glands ( Dacryoadenitis ). Chronic polyarthritis also occurs. In Sjoegren's syndrome there is likely to be a reaction of autoantibodies with the duct epithelium (top layer of cells) of the parotid and lacrimal glands. It mostly affects menopausal women . First there is a swelling of the parotid, which then turns into a reduction ( atrophy ). A biopsy of the oral mucosa is done for diagnosis . With Sjogren's syndrome, the risk of developing non-Hodgkin lymphoma is significantly higher.
Salivary stones
The formation of salivary stones is known as sialolithiasis . Mostly it occurs in the submandibular gland (80%), in rare cases (approx. 20%) it can also affect the parotid gland (glandula parotidea). Salivary stones are a fairly common disease (around 27 to 56 out of a million people) that affects men and women equally often. The cause is usually a disturbed secretion ( dyschyly ), for example a change in the composition of the saliva . The stones are mostly made of calcium phosphate . Clinically, they are usually noticeable through swelling and pain in the affected gland, especially when eating. The stones can be surgically removed depending on their position and size. Recently, ultrasound therapies have also been used therapeutically, which break up the stones and allow them to pass naturally through the canal system. With the so-called salivary duct endoscopy (also sialendoscopy ), small stones can be removed under direct vision with tweezers or baskets.
Non-inflammatory salivary gland swelling
As Sialadenosis or Sialose a mostly painless, non-inflammatory swelling of the salivary gland is called. This mostly affects the parotid gland . The cause here can be a metabolic disease such as diabetes mellitus or an overactive thyroid ( hyperthyroidism ). It can occur as a side effect of taking beta-blockers or of metabolic disorders (such as malnutrition or alcoholism ). As long as there is no functional impairment or pain, this change has a limited disease value, apart from cosmetic impairments.
Benign tumors
| Classification according to ICD-10 | |
|---|---|
| D11.0 | Benign neoplasm of the parotid gland |
| D37.0 | New formation of uncertain or unknown behavior of the lip, oral cavity and pharynx |
| C07 | Malignant neoplasm of the parotid gland |
| ICD-10 online (WHO version 2019) | |
Benign tumors of all salivary glands affect the parotid gland in 80% of cases. They are characterized by slow growth and mobility. Adenomas of the salivary gland are primarily benign, but can degenerate and should therefore be removed. Thorough follow-up care is important after removal , as adenomas can recur (relapse).
Mixed salivary gland tumor
The benign mixed salivary gland tumor, also known as pleomorphic adenoma , is the most common tumor with 65% of all parotid tumors. Women are predominantly affected. Five percent of mixed salivary gland tumors degenerate. Therefore, they should also be removed early on. After surgical removal, relapses occur in 10% of cases . The name mixed tumor is explained by the histological-microscopic examination, which shows a diffuse mixture ("colorful picture") of different cell types and extracellular structures such as hyaline, fibrin, mucosa or cartilage.
Warthin tumor (adenolymphoma)
This benign tumor affects over 95% men over the age of 50. Among the benign tumors of the salivary gland, it is the second most common with a share of 10%. Degeneration and recurrence are extremely rare. It makes up 70% of monomorphic adenomas. 90% of Warthin tumors occur unilaterally. The localization is mostly in the lower part of Eq. parotid .
Malignant tumors
Malignant tumors of the parotid gland may be treated with radiation. In more severe cases, they must be surgically removed. For this purpose, half or all of the salivary gland is usually removed along with the tumor, an operation that is not without risk because of the facial nerve running through the salivary gland .
Web links
Individual evidence
- ↑ Alphabetical index for the ICD-10-WHO version 2019, volume 3. German Institute for Medical Documentation and Information (DIMDI), Cologne, 2019, p. 681
- ↑ Partial or complete removal of the parotid gland
