Sialadenosis in patients with advanced liver disease

Approach to sialadenitis

OBJECTIVE

To provide family physicians with a practical evidence-based approach to the management of patients with sialadenitis.

SOURCES OF INFORMATION

MEDLINE and PubMed databases were searched for English-language research on sialadenitis and other salivary gland disorders, as well as for relevant review articles and guidelines published between 1981 and 2021.

MAIN MESSAGE

Sialadenitis refers to inflammation or infection of the salivary glands and is a condition that can be caused by a broad range of processes including infectious, obstructive, and autoimmune. History and physical examination play important roles in directing management, while imaging is often useful to establish a diagnosis. Red flags such as suspected abscess formation, signs of respiratory obstruction, facial paresis, and fixation of a mass to underlying tissue should prompt urgent referral to head and neck surgery or a visit to the emergency department.

CONCLUSION

Family physicians can play an important role in the diagnosis and management of sialadenitis. Prompt recognition and treatment of the condition can prevent the development of complications.

Approche de la sialadénite

Objectif

Proposer aux médecins de famille une approche pratique fondée sur des données probantes pour la prise en charge de patients souffrant de sialadénite.

Sources de l’information

Une recension a été effectuée dans les bases de données MEDLINE et PubMed pour trouver des recherches publiées en anglais sur la sialadénite et d’autres troubles des glandes salivaires, ainsi que des revues et des lignes directrices pertinentes, publiées entre 1981 et 2021.

Message principal

La sialadénite désigne une inflammation ou une infection des glandes salivaires; elle peut être causée par un large éventail de processus de nature infectieuse, obstructive et auto-immune. L’anamnèse et l’examen physique jouent un rôle important pour orienter la prise en charge, tandis que l’imagerie est souvent utile pour établir un diagnostic. Des signaux d’alerte comme la formation suspectée d’un abcès, des signes d’obstruction respiratoire, une parésie faciale et la fixation d’une masse aux tissus sous-jacents devraient inciter à faire une demande de consultation urgente en chirurgie de la tête et du cou, ou à recommander une visite au service d’urgence.

Conclusion

Les médecins de famille peuvent jouer un rôle important dans le diagnostic et la prise en charge de la sialadénite. Une reconnaissance et un traitement rapides du problème peuvent prévenir la survenance de complications.

Damage to Oral Mucosae Induced by Weekend Alcohol Consumption: The Role of Gender and Alcohol Concentration

The damage caused by chronic alcohol consumption is frequently reported, but the effects caused by weekend recreational consumption, which is much more frequent than even daily consumption, have not, to our knowledge, been reported. The metabolism of ethanol, once consumed, starts from the mouth, and the biotransformation process follows different routes. In this study, the effect of weekend alcohol consumption on the oral cavity was observed. Methods: Thirty male and female rats were divided into six groups (n = 5), with control groups (male/female) and groups administered with 5% and 40% ethanol solution ad libitum consumption 2 days a week for 3 months. After treatment, the animals were sacrificed, an incisional slice of the cheek and back of the tongue was obtained, and the tissues were processed according to the histological technique and routine staining (hematoxylin-eosin, H&E). Samples were observed using light microscopy. Results: Histological changes were observed in samples of tongue and cheek mucosa including different levels of keratinization of the surface layer. Epithelial dysplasia, acanthosis, and chronic inflammation were also observed. The vascularization level also increased because of the ethanol-induced damage. The results were very similar between female and male groups. Conclusion: Weekend alcohol consumption for a period of 3 months causes oral-cavity tissue alterations that could contribute to tumor growth and the development of cancer in the oral cavity.

The effect of long-term alcohol intoxication on the morphological structures and enzymatic activity of rat salivary glands

BACKGROUND

To study changes in the morphological structures and enzymatic activity of the submandibular salivary gland (SMG) and parotid salivary gland (PG) in rats after prolonged alcohol intoxication.

METHODS

Sexually mature male Wistar rats consumed 20% ethanol (6.9 g/kg/day) for 180 consecutive days. The PG and SMG were collected for morphometric and histochemical analyses (nonparametric Mann-Whitney U test, p < 0.05).

RESULTS

After exposure to ethanol for 180 days, the PG showed a change in the shape of the acini and the secretory cells that formed them, uneven expansion of the interlobular excretory ducts, and moderate fatty infiltration in the stroma. After exposure to ethanol for 180 days, the SMG showed fatty infiltration and stromal edema, and changes in acinar cells, intercalated ducts, and striated ducts. There was a significant decrease in the relative and absolute weight of the SMG. The number of mast cells in the PG and SMG and their degranulation index increased 2-fold after exposure to ethanol. All mast cells were highly active. After ethanol exposure, the activity of alkaline phosphatase increased significantly in the myoepithelial cells of the SMG and PG; the activity of NADPH oxidase increased only in the acini SMG, and the activity of succinate dehydrogenase remained at the control level in the acini of both glands. In the ducts of these glands, the activity of other enzymes did not change.

CONCLUSIONS

Changes in the morphological structures, morphometric parameters, and enzymatic activity of the rat salivary glands after 180 days of ethanol intoxication are shown for the first time. The most pronounced changes were found in the SMG.

Oral Health and Liver Disease: Bidirectional Associations—A Narrative Review

Several links between chronic liver disease and oral health have been described and are discussed in this narrative review. Oral manifestations such as lichen planus, ulcers, xerostomia, erosion and tongue abnormalities seem to be particularly prevalent among patients with chronic liver disease. These may be causal, coincidental, secondary to therapeutic interventions, or attributable to other factors commonly observed in liver disease patients. In addition, findings from both experimental and epidemiological studies suggest that periodontitis can induce liver injury and contribute to the progression of chronic liver disease through periodontitis-induced systemic inflammation, endotoxemia, and gut dysbiosis with increased intestinal translocation. This has brought forward the hypothesis of an oral-gut-liver axis. Preliminary clinical intervention studies indicate that local periodontal treatments may lead to beneficial liver effects, but more human studies are needed to clarify if treatment of periodontitis truly can halt or reverse progression of liver disease and improve liver-related outcomes.

Management Options for Sialadenosis

Sialadenosis (sialosis) is a chronic, noninflammatory, nonneoplastic, bilateral, often painless enlargement of the salivary glands, most frequently affecting the parotid glands. Approximately 50% of cases are associated with an underlying disease process. The pathogenesis of sialadenosis is unknown but likely results from an autonomic neuropathy. The key to management is diagnosis and management of any poorly controlled underlying medical process.

Alcohol use disorder and the gut

Acute and chronic gastrointestinal problems are common in the setting of excessive alcohol use, and excessive alcohol use is associated with injury to all parts of the gastrointestinal tract. There is mounting evidence of gastrointestinal injury and increased cancer risk even from moderate alcohol consumption. The major causes of alcohol-related morbidity and mortality within the gastrointestinal system are liver disease, pancreatitis and gastrointestinal cancer. Other alcohol-related intestinal dysfunction is common but not life-threatening, leading to diarrhoea, malabsorption and nutritional deficiencies. This review describes non-neoplastic and neoplastic alcohol-related disorders of the gastrointestinal tract, omitting the liver, which has been reviewed elsewhere.

Oral Manifestations of Systemic Diseases

Signs and symptoms representative of a systemic condition can manifest in the oral cavity and orofacial region. Such conditions may be previously diagnosed, or the orofacial manifestation may be the presenting sign of an acute or chronic systemic condition not previously diagnosed. Pathologic processes in the mouth, jaws, and contiguous structures could have a direct and indirect impact on the patient's overall systemic condition. Moreover, systemic conditions may result in compromised function of the orofacial region or impact patients' oral health profile. This article reviews selected systemic conditions that present or impact on the oral cavity and orofacial region.

Neurotoxin injection in benign submandibular gland hypertrophy: A first choice treatment

BACKGROUND

Various benign clinical entities with a symptomatology of hypertrophic submandibular glands like sialadenitis, sialadenosis, sialolithiasis, or an ageing neck have been described. Botulinum toxin type A is an elegant tool in the management of these conditions.

METHODS

This article is an original article, describing the Munich Concept of treating persistent submandibular swelling with Botulinum Toxin Type A from aesthetic and functional aspect. To shrink the affected tissue, 15 Units of Botox or Xeomin are applied in a single injection technique and under ultrasound guidance into the glands. Therefore, the 100 Units vial is being diluted with 3.5 of NaCl.

RESULTS

Intraglandular injections, using a specific dilution and dosage of the neurotoxin preparations, are very effective in the management of these swellings, offering safe and long-lasting results, with a high satisfaction rate. Our working group treated in the last 18 months 23 patients with benign, bilateral submandibular gland hypertrophies, which did not have any major complications.

CONCLUSION

As there is not yet described an ideal therapeutic strategy for the management of this symptomatology, we suggest, based on our experience, a concept with very promising results from functional and cosmetic aspect.

Cricopharyngeal dysphagia and phenobarbitone-responsive sialoadenosis in a Miniature Poodle

CASE REPORT

An 11-year-old male neutered Miniature Poodle was investigated for ptyalism, weight loss and anorexia. Cricopharyngeal dysphagia was diagnosed using fluoroscopy, and non-inflammatory salivary disease was diagnosed using a combination of cytology and computed tomography. The dog was successfully managed with phenobarbitone.

CONCLUSION

To the authors' knowledge this is the first time acquired cricopharyngeal dysphagia and phenobarbitone-responsive sialoadenosis have been described together.

Alcoholic Hepatitis: Risk Factors, Pathogenesis, and Approach to Treatment

BACKGROUND

Alcoholic hepatitis (AH) is an inflammatory disorder of the liver characterized clinically by jaundice, hepatomegaly, and abdominal pain, and histologically by macrovesicular steatosis and necroinflammation.

METHODS

This clinical review will cover what is known about the pathogenesis, clinical presentation, current treatments, and novel therapies for AH.

RESULTS

The pathogenesis and treatment of AH remain areas of active research. Although abstinence is the cornerstone of therapy for all stages of alcoholic liver disease, corticosteroids have shown modest short-term benefits in treatment of severe AH.

CONCLUSIONS

Improved understanding of the pathogenesis of AH has expanded the range of potential treatments for this devastating disease. Several novel therapies are also currently in various stages of testing through clinical trials.

Salivary gland disorders: A comprehensive review

Salivary glands are complex in nature. They could be either tubulo acinar, merocrine or exocrine glands secreting mainly saliva. Salivary gland is one of the main soft tissue structures in the maxillofacial area. Saliva is a clear, slightly acidic muco serous fluid that coats the teeth, mucosa and thereby helps to create and maintain a healthy environment in the oral cavity. Salivary glands may be affected by a number of diseases: local and systemic and the prevalence of salivary gland diseases depend on various etiological factors. The glands may be infected by viral, bacterial, rarely fungal or its ductal obstruction which may cause painful swelling or obstruction, affecting their functions. The salivary gland may also be affected by a various benign and malignant tumours. This review article briefly describes about the various salivary gland disorders, diagnostic techniques and their management including the recent advances and the future perspective.

An Algorithm Approach to Diagnosing Bilateral Parotid Enlargement

Objective

This contemporary review aims to categorize the disease entities that cause bilateral parotid enlargement and to develop a question-based algorithm to improve diagnosis of bilateral parotid masses.

Data Sources

A PubMed search for bilateral and parotid showed 818 results. Of these, 68 relevant studies were reviewed to compile a list of disease processes that can cause bilateral parotid enlargement.

Review Methods

A total of 22 diseases entities were reviewed. The disease processes were initially grouped into 6 categories based on etiology: sialadenosis, infection, neoplasm, autoimmune, iatrogenic, and miscellaneous. For each lesion, the incidence, history, and physical examination were compiled in a matrix.

Conclusion

After reviewing the matrix, it was clear that grouping diseases based on specific history and physical findings limits the differential diagnosis. The most important factors included disease incidence, timing of onset, nodular or diffuse, pain, and overlying skin changes. With this algorithm, the differential diagnosis can be limited from 28 to 7 or fewer likely diagnoses for a given presentation.

Implications for Practice

Bilateral parotid disease has a wide differential diagnosis with an expanding number of available tests. An algorithm, based solely on data obtained from the history and physical examination in the first patient encounter, may reduce the differential and aid the clinician in deciding on further workup and treatment. Following the algorithm presented here should allow the clinician to arrive at a diagnosis rapidly without ordering unnecessary tests and wasting resources.