Apart from this somewhat specific affection the parotid and the other salivary glands may become involved in swelling and inflammation on account of surrounding local infections, or the presence of foreign bodies, stones in the ducts, etc. Metastatic abscesses, especially in the parotid, are not uncommon. Considering the open pathways offered it is surprising that these glands are not oftener involved in septic conditions of the mouth.
MIKULICZ’S DISEASE.
Mikulicz has described a not very infrequent simultaneous affection of two or more of the salivary glands, occurring in middle age, characterized by uniform swelling which may involve even the palatine, labial, and buccal glands. It is spoken of in German literature as Mikulicz’s disease. The swelling progresses slowly, so that the glands reach a varying size in the course of years. Thus the parotid glands may attain the size of the fist, and other glands a corresponding increase. Sometimes the adjoining lymphatics are also involved. The enlargements are not tender, but may interfere with movements of the tongue and jaw. These tumors have been known to recede after an intercurrent acute disease. Nothing is as yet known of the cause or nature of the affection. In its treatment arsenic and potassium iodide have given perhaps the most favorable results.
The salivary glands, especially the parotid, are as likely to be involved in the manifestations of tuberculosis, actinomycosis, and syphilis as are the other structures of the body. Lesions of these various natures will be appreciated without further description.
TUMORS OF THE SALIVARY GLANDS.
Tumors of the salivary glands are not uncommon. The parotid is more frequently affected than either of the others. These tumors may be of cystic character, either large from obstruction of the excretory duct, or small and numerous. Almost all the tumors described in Chapter XXVI may be found in this region. Simple adenomas are common and the parotid especially is often the site of tumors of mixed character, in which the various mesoblastic elements mingle in a confusing manner. Cartilaginous tumors here are frequent. The presence of cartilage is to be explained on Cohnheim’s hypothesis. Endothelioma, sarcoma, and carcinoma are also common, especially as primary tumors in the parotid. Any or all of the glands may also suffer by extension of malignant disease from primary foci in their neighborhood ([Figs. 463] and [464]).
Fig. 463
Mixed tumor of the parotid. (v. Bruns.)
Fig. 464