THE SALIVARY APPARATUS.
FOREIGN BODIES IN THE SALIVARY DUCTS.
Foreign bodies occasionally enter the salivary ducts, especially Stenson’s and Wharton’s, where they may set up an inflammation known as sialoductilitis. These may consist of bristles, fish-bones, and the like. Abscess, in consequence, may form in the gland or between it and the foreign body. Calculi also lodge in the ducts, where they remain as foreign bodies, producing sometimes a disproportionate amount of irritation.
FISTULAS OF THE SALIVARY DUCTS.
Fistulas of the salivary ducts involve Stenson’s duct. They open on the inside of the buccinator muscle, back of the orifice of the duct, which is opposite the second upper molar tooth. These fistulas of the parotid gland may be recognized by the passage of a probe from within the mouth. When they open externally they result nearly always from injury, and it is only the external forms which are troublesome. One may resort to the mildest measures first, and experiment with cauterization of the orifice or compression by occlusion. These measures will be ineffective if there be no opening upon the inside of the mouth, in which case one must be made by reëstablishing the original canal or forming a substitute. For this purpose a suture may be passed around the duct, back of the fistula, using a curved needle, and making it come out near the point of entrance. It should hold the duct in its loop. This suture may then be tightened and the distended duct punctured on the inside of the cheek. When once the flow of saliva is diverted to the mouth the edges of an external fistula may be pared and closed. In obstinate cases which have resisted all other methods it has been suggested to remove or destroy the gland which connects with the duct at fault. Even this is not an easy matter, but it can be done in the case of the parotid by careful dissection, with separation of the branches of the facial nerve and removal of the greater portion of the gland itself.
Congenital anomalies of the salivary glands are rare and of small import. Any one of them may be displaced, or either of them may connect with an accessory gland separated from it by an appreciable interval. Abnormal duct openings have also been noted.
INFLAMMATION OF THE SALIVARY GLANDS.
Inflammatory affections of the salivary glands give rise to sialoadenitis. Among these by all means the most common is parotitis (mumps), which often occurs in epidemic form. It is an infectious and probably contagious disease, usually attacking the young, though no age is exempt. The period of incubation is about fourteen days. The condition begins with a stomatitis and with swelling of the affected parotid, with edema of the overlying tissues. It is accompanied by moderate fever. Swelling may be extensive and involve the entire neck region. The parotid on the other side becomes affected within a few days, although usually not to a similar extent. The other salivary glands occasionally participate. The febrile stage lasts for about a week, after which the swelling recedes and is gone within from two to four weeks. Occasionally the affected glands suppurate, in which case the condition may be very serious, since it may simulate Ludwig’s angina, or may be followed by sloughing and gangrene.
Save when abscess threatens the treatment should consist of warm antiseptic mouth-washes and the external application of an ichthyol-mercurial ointment or of Credé’s silver ointment. When suppuration threatens early incision should be made for the relief of tension and prevention of destruction.
A frequent and important complication of parotitis is orchitis, or swelling of the testicle. This is an unexplained feature of these cases, and occurs mainly in sexually mature individuals. It is the testis proper which suffers and not the epididymis. Suppuration here is rare. More or less atrophy is a remote consequence in many cases, estimated at about one-third. When both testicles are affected to a marked degree impotency may follow. Treatment of this orchitis consists in absolute rest in bed, with elevation of the parts affected, often with the application of an ice-bag. Painting the scrotal skin with guaiacol in small amount will often relieve pain. A similar complication occurs in the female, the ovary being involved. Aside from this, other complications may occur in the breast, the vulvovaginal glands, the prostate, the heart, the eye, and the ear.