DISEASES OF THE SALIVARY GLANDS The congenital anomalies and other pathological processes of the salivary glands, on account of their rare occurrence, do not excite the practical interest which is justly directed toward the inflammatory processes of the parotid in childhood.
Without considering the defects and abnormal position of single salivary glands, as well as the rarely observed cases of congenital salivary fistul, a few words may be given to the cysts of the salivary ducts, which are produced by a congenital atresia of the principal duct. Such abnormalities have been observed in Wharton's duct and also in the secretory ducts of the Blandin-Nuhn glands. These congenital cysts may naturally hinder the act of nursing and thus create the necessity of an operation.
A special consideration is merited by the cystic neoplasm called ranula. The term ranula originally was applied to all cystic growths under the tongue; in most cases it arises front the sublingual gland. It must therefore be considered to be a congenital or acquired retention cyst of this gland.
The swelling lies under the tongue, most commonly at both sides of the frenulum, which causes a depression in the centre of the growth. As a result of its position, on growing larger it forces the tongue upward. The growth is given this name on account of its shining, translucent appearance and its grayish red discoloration. The cyst is filled with a tough and sticky content which is usually colorless, but occasionally is tinted yellowish green to brown.
The presence of the growth may occasionally hinder nursing or even respiration. Its treatment is surgical.
Hennig, Mikulicz, and kiimmel described an acute primary inflam mation of the salivary glands in infants, as sialo-adenitis of infants. It is remarkable that it never attacks the parotid but only the submaxillary and the sublingual glands. These &ands become acutely swollen and high fever appears, then pus is discharged from the ducts. The disease ends as a rule with a wide-spread absce.ss formation, but which has a good prognosis on account of its location. Hennig favors the view that the real affection has a connection with puerperal diseases.
While the primary idiopathic parotilis, which is identical with the parotitis epiclemica, is described at another place (see Vol. II), it is ex pedient here to examine more closely the inflammatory changes of the parotid which occur in the course of other diseases.
The secondary paratitis, like the primary form has always an in fectious origin; the infectious agent reaches the gland directly through Steno's duct or inchrectly by way of the circulation in the gland (meta static parotitis). It is clear, therefore, why inflammatory processes in
the neighborhood of the openings of the salivary ducts, the various forms of stomatitis, are the most frequent excitants of a secondary parotids. 'Likewise otitis media is not an infrequent cause of inflammation of the parotid. The pus burrows by the way of the Glaserian fissure into the gland (Gruber).
The local phenomena, which i» general resemble those of parotitis epidemica, are distinguished from this chiefly in that the secondary form usually occurs on one side only, and the swelling of the gland subsides in a few days spontaneously or very rarely suppuration of the gland takes place.
The abscess formation is not easily foretold, as palpation may reveal no fluctuation even when pus is present, since the parotid is covered by a rigid fascia. It is necessary, then, to place a greater sig nificance on the elevation of the temperature and the augmentation of the distress than on the local findings.
The primary expectant treatment (see Epidemic Parotids) must give place to surgical interference when the appearance of pus is evident.
Those forms of secondary parotids which arise during the course of the severe infectious diseases,—especially typhoid and the acute exantheniata—possess a more serious character. With the increase of the glandular swelling the skin over it takes on an inflammatory redness. The course of this inflammatory process is often protracted and is a grave complication to the child already weakened by the febrile disease. Moreover, this inflammation shows a very slight tendency to subside and generally ends in suppuration or occasionally in gangrenous disin tegration of the gland.
Microscopical examination has shown that this form of parotitis also is induced by an infection through the salivary duct. The name metastatic parotitis should, consequently, be reserved for those cases which arise in the course of a septicannia, or possibly a septicinic typhoid, by- a specific hiematogenous infection of the gland.
A rational care of the mouth during the infectious diseases is the most effective prophylactic measure.
At the onset of the inflammation one may try an embrocation of iod-vasogen in order to hasten the absorptive process within the gland; as soon as the presence of pus is manifested a free incision must be made.