SALIVARY GLANDS

In the dry mouth consultation (xerostomia) a first distinction is made between the sensation of dry mouth (xerostomia) and the decrease in the amount of saliva (hyposyalia). This can be achieved by direct observation of the oral cavity or by performing sialometry.
The cause of xerostomia or hyposyalia is then sought, and the most frequent causes are a chronic medication and the existence of certain systemic pathologies, respectively.

In either case, there is a first approach through general, dietary and oral hygiene measures.

In the consultation of stones (lithiasis) is first confirmed the diagnosis, and it may be necessary to exclude other causes of obstruction of salivary canals (such as sthesis). In addition to clinical evaluation, imaging tests (such as ultrasound, sialography, or sialoendoscopy) may need to be requested.

The final treatment consists of the removal of the calculus(s), and this is done in the most conservative way possible, with preservation of the gland and canal. The best strategy depends on the location and size of the calculation(s), but almost always involves the use of sialoendoscopy.

In the consultation of inflammatory diseases (sialoadenitis) initial clarification is made as to the type of inflammation: glandular or canalicular, localized or generalized, acute or chronic… There are infectious sialoadenitis (usually acute, due to bacteria), autoimmune (usually chronic, as in Sjögren’s syndrome), obstructive or ischaemic (complications of lithiasis and radiotherapy, respectively).

Since the causes are very varied, the approach is also very variable, from counseling with general measures to surgeries, through the prescription of medications.

In the consultation of tumors (neoplasms) is made, from the outthen, the characterization of the type of tumor, that is, its location and exact dimensions and what its nature (benign or malignant). To do this, it is necessary to request imaging (such as ultrasound or magnetic resonance imaging), as well as to perform biopsy (e.g. BAAF).

Malignant neoplasms require an interdisciplinary approach, while benign tumors can be treated, increasingly, through minimally invasive surgery, with greater preservation of the form and function of the gland and more benefits for the patient.

There are a large number of situations that can affect SGs, from developmental changes (such as abnormal location, accessory canals or vascular malformations), cystic lesions (true cysts, in the parotid or submandibular, or similar to cysts, in the sublingual or in the minor GS), hormonal dysfunctions (such as diabetes, hypothyroidism, hyperthyroidism, pregnancy or menopause), metabolic dysbuliums (such as alcoholism, intestinal malabsorption, vitamin deficits, anorexia or bulimia) or even excess saliva (hypersalivation).

Each with their proper treatment.

It is a complementary noninvasive (or minimally invasive diagnostic means, depending on the technique) consisting of the collection of saliva (from the entire mouth or one or more specific GS). It allows the analysis of one or more saliva constituents, namely hormones, tumor markers or drugs.

It is a procedure performed without anesthesia (or with topical anesthesia, depending on the technique) with a duration usually not exceeding 15 minutes.

It is a complementary noninvasive (or minimally invasive, according to the technique used) that consists of the collection of saliva (from the entire mouth or one or more specific SGs). Since it allows the quantification of salivary flow, it may be important in the diagnosis of secretion alterations, such as xerostomia or sialorrhea.

It is an examination performed without anesthesia (or with topical anesthesia, depending on the technique), lasting no more than 30 minutes.

It is a complementary means of minimally invasive diagnosis consisting of the introduction of a contrast product through the parotid or submandibular canal and the performance of a series of radiographs of the gland to be studied. It allows indirect visualization of the channels of those glands, fundamental in the diagnosis of obstructive pathology, but also important in secretion changes or inflammatory diseases.

It is an examination performed in a room of its own, with topical anesthesia, with a usual duration of not more than 30 minutes.

It is a complementary means of minimally invasive diagnosis that consists of the introduction of a device (endoscope) inside the parotid canal or submandibular Allows direct visualization of the canal system, essential in the diagnosis of obstructive pathology, but also important in secretion changes or inflammatory diseases.

It is a procedure performed in an appropriate room, with topical anesthesia (and, eventually, infiltrative), with a variable duration, usually between 15 and 60 minutes.

It is a complementary means of noninvasive, innocuous diagnosis, which consists in the use of a probe (and gel) that slides on the face and neck. As a rule, it is the first imaging exam to be requested. Allows you to view the main GS and its channels. It is important in the diagnosis of almost any salivary pathology.

It is an examination performed in a room of its own, without the need for anesthesia, with a duration of about 20 minutes. It can be used to perform a fine needle aspiration biopsy or a columnr biopsy.

It is a complementary means of noninvasive diagnosis, although it uses ionizing radiation. Allows you to view the main GS (and possibly your channels). It may be important in the diagnosis of lithiasic pathology or tumor pathology, in the latter especially when it is not possible to perform an MRI.

It is an examination performed in a room of its own, without the need for anesthesia (but it may be necessary to introduce an intravenous contrast product), with a duration usually not exceeding 20 minutes.

It is a complementary means of noninvasive diagnosis, without the use of ionizing radiation. Allows you to view the main GS (and possibly your channels). It is important in the diagnosis of inflammatory or tumor pathology. It may need to be replaced by a CT scan in certain situations.

It is an examination performed in a room of its own, without the need for anesthesia (but it may be necessary to introduce an intravenous contrast product), with a duration usually not exceeding 30 minutes.

It consists of harvesting GS cells.

› Open biopsy (conventional)
It is a complementary means of minimally invasive diagnosis that almost always consists of the removal of some smaller GS from the lower lip. It allows the microscopic collection and analysis of glandular tissue, central in the diagnosis of certain pathologies (e.g. immunological and metabolic and in cases of secretion alterations, such as xerostomia or sialorrhea).

It is a procedure that can be performed in the consultation office, under local anesthesia, with a duration of 5 minutes and a postoperative without problems.

› Fine needle aspiration biopsy (BAAF)
It is a complementary means of minimally invasive diagnosis consisting of the harvesting of some Cells of SG, almost always of nodules or masses in the parotid or submandibular. It allows the obtaining and microscopic analysis of glandular tissue, important in the diagnosis of certain pathologies, especially tumors.

It is a procedure that can be performed in the consultation office, under local anesthesia, in about 5 minutes. In certain cases, it may need to be echo-guided (eco-guided BAAF).

› Core biopsy
It is a complementary means of diagnosis very similar to BAAF, with the same principles and objectives. It is indicated when it is necessary to better characterize a particular lesion (a nodule or a mass) or when baaf fails, most often in tumor pathology.

It is a procedure that can also be performed in the consultation office, under local anesthesia, with a duration of not more than 10 minutes. Like BAAF, in certain situations it may have to be ultrasound-oriented.

The prescription of medications may be necessary in any salivary pathology, but it is more common in inflammatory diseases (infectious or autoimmune) and in secretion changes. It may also be necessary in pre- and/or postoperative situations.

The drugs usually prescribed are antibiotics and anti-inflammatory drugs. However, there may be a need to prescribe cholinergic or alpha-blocking drugs. Salivary stimulating products (sialogogues) or saliva substitutes (artificial saliva) may also be indicated.

The application of drugs is performed in salivary channels, with or without recourse to the sialoendoscopy technique. It is indicated in chronic inflammatory pathologies, in certain obstructive or metabolic pathologies and in secretion alterations.

The drugs commonly used are antibiotics and anti-inflammatory drugs (especially corticosteroids). The application of medicines in salivary channels can become a chronic treatment, according to the basic pathology (such as too much medication in tablets, for chronic diseases).

Botulinum toxin injection is a minimally invasive technique consisting of the introduction of a drug into the parotid or submandibular. It is indicated mainly in salivary secretion changes with hypersalivation.

It is a procedure that can be performed in the consultation office, under local anesthesia, with a duration of not more than 30 minutes. It is a treatment with limited action in time, since the drug is absorbed, metabolized and excreted by the body; therefore, it may have to be repeated.

It consists of the use of an endoscope to treat pathology of salivary canals.

› Removal of stones – Sialolitectomy
In addition to diagnosis, sialoendoscopy is used to remove salivary stones. If certain conditions are met, removal of sialoendoscopy stones is the best therapeutic option. The endoscope is inserted into the salivary canal (from the parotid or submandibular), locates and removes the calculus (through complementary instruments such as baskets or tweezers).

It is a treatment performed in an appropriate place, with topical and infiltrative anesthesia, with a variable duration, usually between 30 and 60 minutes.

› Fragmentation of calculations – Lithothripsia
The calculation may be removed simply, using appropriate aparatology, or it may need to be fragmented using its own device called a calculus fragmenter or lithotripsia apparatus. This device is also inserted into the salivary canal
(from the parotid or submandibular) and, through several repeated percussions, fragments the calculus. By washing or using baskets or tweezers, the fragments are removed.

The fragmentation of calculations can also be carried out with its own manual drill.

› Susther dilation
Sialoendoscopy also allows the treatment of sourosis (grips) of salivary canals, through the introduction of balloons, own devices or the action of specific drills.

This therapy is indicated in situations where there are specific susthesis, but immediate or long-term results are not guaranteed.

› Other procedures
Other procedures that can be performed by sialoendoscopy are the application of drugs and the biopsy or removal of polyps from salivary channels.

Sialoendoscopy can also help in so-called “conventional” surgeries, making them possible to be minimally invasive surgeries.

The so-called “conventional” surgery designates, in almost all cases, the removal (partial or total) of a major SG, usually due to tumor, inflammatory or lithiasic pathology. Although the exeresis of a major SG may be necessary in the existence of a malignant tumor, this approach is no longer recommended when there is a benign tumor, especially in the parotid. On the other hand, using sialoendoscopy, it is possible to treat conservative, medical or surgical, inflammatory or lithiasic pathology.

Conventional surgery is performed under general anesthesia, usually under hospitalization.

“Minimally invasive surgery” designates surgical intervention in a major GS in the most conservative way possible. It is indicated in tumor pathology and lithiasic pathology, using extracapsular dissection techniques, sublingual dissection and adjuvant sialoendoscopy. Sialoendoscopy is essential in less traumatic surgical interventions for the patient, allowing for better and faster recovery.

Since minimally invasive surgery is less traumatic for the gland and the patient, it is usually performed on an outpatient basis, that is, without the need for hospitalization.