CORRECTING DISORDERS OF PAROTID GLAND SECRETION IN PATIENTS WITH NEUROGENIC SALIVARY ADENITIS

Abstract

Today, the number of neuropathy patients is growing steadily due to the active development of the technosphere. In fact, extrafocal neuropathy reflects reactions in response to stressful situations and the development of functional disorders in all parenchymal organs as a result of these factors. The research aims to develop a differentiated approach to correcting functional disorders of the parotid glands in patients with elevated psychological responses. Objects and methods of the research. Depending on the intensity of neurogenic salivary adenitis (NSA) clinical signs, the studied patients were divided into 3 groups: group I – patients with mild NSA (44 persons); group II – patients with moderate degree (48 people); group III – patients with severe NSA (21 people). All patients observed hygiene and performed oral cavity sanitation at the dentist’s office. Patients with mild NSA received the following set of treatments: daily bougieurage of ducts of the studied glands for 5 days, massaging them for 5 minutes before and after meals over the course of 5-7 days. Due to increased anxiety patients were additionally prescribed a twoweek course of Persen-forte. They were also prescribed a 5-day course of Drotaverine to relieve the spasm of duct apparatus of the parotid glands in the dosage of 1 pill 3 times a day to be taken 20 minutes before meals. Patients with moderate NSA underwent a 5-7 day course of daily duct bougieurage and 5-minute massage of the studied glands before and after meals. Additionally, ectericide was daily instilled into the ducts of the affected glands over the course of 5-7 days and galvanization of the affected gland areas №5. There were prescribed a 3-week course of Persen-forte, a 7-day course of Drotaverine, and a 14-day course of retinol acetate in the dosage of 5000 IU 1 time per day. All patients with severe NSA were prescribed: daily bougieurage of ducts for 5 days, massaging them for 5 minutes before and after meals over the course of 7-10 days, 5 procedures of ectericide and trypsin instillation into the ducts of the studied glands every other day, gland electrophoresis with 5% ascorbic acid solution № 5. There were prescribed a 4-week course of Persen-forte and a 10-day course of Drotaverine. A complex multivitamin drug Quadevit Active was prescribed in the dosage of 1 pill per day for 1 month. Results of the research. The analysis of treatment outcomes of NSA patients who applied a set of treatment and prevention measures aimed at improving the functional state of the salivary glands and stabilizing oral homeostasis, showed that among 44 patients with mild NSA, 40 patients (90, 91%) have recovered and 4 subjects (9.09%) have improved their condition. This was confirmed by the results of research-specific and specialized studies. Cytological examination of the smears of the affected parotid glands’ secretion revealed a small number of squamous epithelial cells and single neutrophilic leukocytes, which was close to normal. Determining the level of anxiety according to the Taylor Manifest Anxiety Scale (TMAS) in patients with mild NSA found low values of 1.53±0.05 points in 19 people and medium values of 9.27±0.05 points in 3 patients, which signifies decreased anxiety rates in most patients. Of the 48 patients with a moderate severity of the disease, 35 patients (72.91%) have recovered, 11 subjects (22.92%) have improved and 2 people (4.17%) have not changed their condition. Physicochemical parameters of oral fluid and parotid gland secretion were normalized. Cytological examination of the studied parotid gland secretion revealed an increased number of neutrophilic leukocytes, individual lymphoid cells, macrophages, cylindrical epithelial cells. The sialographic picture of parotid glands revealed no abnormalities in only 3 people. In 6 patients, there were various narrowings of the main duct, I-II-III order ducts, bulbous and spherical ectasias of II-V order ducts, impaired filling of II-V order ducts due to almost the entire gland volume being narrowed, which was accompanied by individual sialectasis (3 patients). The level of anxiety tended to decrease. Out of 21 patients with severe NSA, recovery was noted in 13 (61.91%), improvement in 6 (28.57%), and unchanged condition in 2 (9.52%). Cell composition was not numerous according to cytological examination of the parotid gland secretion in 8 people with severe NSA, occasional cells of squamous epithelium have been registered in the samples, as well as sporadic cylindrical epithelium cells with altered structure. A small amount of mucus, reticuloendothelial cells, single macrophages, groups of lymphocytes were noted in 4 patients. Sialography performed on 5 patients revealed unchanged duct system in 3 patients and the presence of II-V order duct narrowing in 2 subjects, as well as some sialectases. Determination of the level of anxiety revealed that 9 people had low values of 2.18±0.05 points and 3 patients had medium values (8.67±0.05 points), which reflects a decrease in anxiety rates in most patients. Thus, the treatment and prevention programs that were prescribed to NSA patients caused the anatomical and functional changes of the parotid glands in the affected salivary glands in most patients, as well as improving the general somatic condition of patients.

Keywords

• neurogenic salivary adenitis
• treatment algorithm.