CLINICAL AND FUNCTIONAL FEATURES OF CONSERVATIVE TREATMENT PTYALOLITHIASIS

Aliyev S. Z.

CONTENTS

Scentific article

It is known that ptyalolithiasis is the most common disease among the entire pathology of the salivary glands. Surgical treatment is not able to prevent recurrent stone formation, since it is neither etiologic nor pathogenic. Often chronic inflammatory or degenerative processes, developed in the salivary gland after repeated relapses, become an indication for the gland removal. The aim of the study was to make a comparative characterization of novel approaches to non-invasive treatments of ptyalolithiasis. We have reviewed 60 patients with sialolithiasis at the moment of the survery (for the first time or repeatedly). The first subgroup included 23 patients who underwent general conservative treatment, a second subgroup consisted of 37 patients with the complete course intraductal therapy. Technique intraductal therapy (intraductar litholysis) included the infusion of salivary gland duct proteolytic enzymes (trypsin) till moderate feelings of “fullness” in the gland through a vascular catheter (and subsequently – through blunt injection needle). Patients in all groups were identical in terms of age, gender and somatic status. The proposed scheme of general conservative treatment was as follows: 1. Neostigmine 0. 05 solution , 1ml subcutaneously. 2. 3 solution of KI, 1 tablespoon 3 times a day. 3. Compress to the salivary gland with hypertonic solution and Levomekol ointment. After 3 weeks of oral administration 3 KI solution was replaced with its percutaneous administration together with ultrasound (phonophoresis) for another 7 days. Treatment under this scheme was administered to 23 patients within 4 weeks, the course was repeated after 3 and 6 months later on. Follow-up examination of patients after an overall conservative therapy yielded the following results. All 23 patients had the following positive dynamics: lower number on «salivary colic» incidence (painful dis-tention of gland during the meal) by 87, up to a stable remission (for a year or more), the size of the gland reduced in 63 of patients. All patients treated didn’t have any exacerbation during 12 months following the treatment, while it happened almost in half of them before the treatment (48). After a course of general treatment, supplemented with intraduсtar therapy, there was a trend toward smaller stones and moving them to the mouth of the excretory duct. Out of the 37 patients, in 11 cases (29. 7 ) the stones dropped out themselves, in 12 cases (32. 4 ) the stones were removed from the mouth of the duct, 14 patients (37. 9 ) showed a decrease in the size of the stones (on average 23) located in the parenchyma of the gland during the period from 3 to 12 months. Comparison of the results of intraduktar litholysis treatment and common pathogenetic therapy showed better impact of intraductal therapy (decrease in size, facilitation of the movement of the stone towards salivary duct aperture) Preventive treatment of patients with ptyalolithiasis consisted of excessive fluid intake, regardless of the composi-tion of the stones. Liquid evenly consumed throughout the day, and a special attention was paid to moments of fluid excretion. Liquid evenly consumed throughout the day, and a special attention was paid to moments of fluid excretion. Also to avoid excess oxalate intake the consumption of food containing oxalates was reduced or prohibited. Conclusions. Thus, the application of the comprehensive sialolithiasis treatment scheme we developed, con- sisting of common pathogenetic effects in combination with intraduсtar therapy reduces the size of stones and promote them to the mouth of the excretory duct, as well as spontaneous excretion of sialolits into the oral cavity through the natural opening of the duct.

ptyalolithiasis, duct, sialolit

• Абдусаламов М. Р. Малоинвазивный метод лечения больных слюннокаменной болезнью / М. Р. Абдусаламов, А. Ф. Ткаленко // Сб. трудов XXV Итоговой научной конференции молодых ученых МГМСУ. – М., 2003. – С. 68.
• Афанасьев В. В. Этиология слюннокаменной болезни / В. В. Афанасьев, B. C. Никифоров // Стоматология. – 1999. – № 5. – С. 39-41.
• Carlson G. W. The salivary glands / G. W. Carlson // Surgical Clin North America. – 2000, 80. – P. 261.
• Kim R. H. Nonoperative removal of sialoliths and sialodochoplasty of salivary duct strictures / R. H. Kim, A. M. Strimling, T. Grosch [et al. ] // Arch. Otolaryngol. Head Neck Surg. – 1996. – Vol. 122(9). – P. 974-976.
• Rice D. H. Salivary gland disorders. Neoplastic and nonneoplastic / D. H. Rice // Med. Clin. North. Am. – 1999. – Vol. 83(1). – P. 197-218.

«Bulletin of problems biology and medicine» Issue 2 part 1 (107), 2014 year, 054-057 pages, index UDK 616.316-003.7