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A new and interdisciplinary S2k AWMF guideline for the treatment of obstructive sialadenitis has been published. There have been several technical achievements, for instance in the field of ultrasonography, via sialendoscopy, or by MR-sialography, that have increased the possibilities for diagnosis and treatment of patients with obstructive sialadenitis. In the past, the treatment of choice in case of unsuccessful medical treatment was a complete extirpation of the affected salivary gland. Nowadays, using a variety of modern treatment options (like sialendoscopy, or extracorporeal shock-waves lithotripsy sometimes combined with salivary duct incision), it is possible in most patients, especially in cases of sialolithiasis, to preserve the affected gland. A functional recovery after gland-sparing surgery is described but more data is needed to finally evaluate the long-time results. The new guideline describes all relevant steps to diagnose an obstructive sialadenitis and values all diagnostic tools critically. Finally, all recommendable therapy options are described and valued, too., (© Georg Thieme Verlag KG Stuttgart · New York.)

The salivary glands are integrated into the body in such a complex manner that the analysis of the saliva allows conclusions about pathological function of other organ systems. Such interactions between salivary glands and the body as a whole play an important role in the etiology and pathogenesis of the different types of sialadenitis. An etiological classification is a proven method for arriving at a clinical diagnosis. Etiological factors include traumas, bacteria, viruses, ductal obstructions, disturbances of secretion, radiogenic damage, and immunological reactions (immunocomplex, tuberculin, or autoimmune types). Frequently the etiology is influenced by several factors. After a brief discussion of the clinical diagnostic methods, we present the clinical and morphological findings concerning the various types of sialadenitis and their differential diagnosis.

In 196 patients suffering from disease of the cephalic salivary glands and in 57 healthy controls the concentration of albumin in parotid and submandibular saliva was measured by the immunodiffusion technique. To summarize the results, albumin seems to be a reliable marker of inflammations of the salivary glands even in the early stages and is therefore recommended for the primary diagnostic and the follow-up of acute and chronic inflammatory conditions of the major cephalic salivary glands. In combination with the evaluation of the flow rate, other sialochemic parameters like phosphohexose isomerase and kallikrein activity, B-mode sonography and fine needle aspiration biopsy the frequency of x-ray examination of the radiosensitive salivary glands may be reduced.

In order to characterize typical findings in patients (pts.) with secondary Sjögren's Syndrome (SS) associated with rheumatoid arthritis (RA), 173 patients with RA were studied. Pathological screening-test results (Schirmer- and Saxon-test) were followed by ENT- and ophthalmological investigations and examinations in the field of internal medicine. Secondary SS associated with RA was diagnosed in 34 pts. (20%). Immuno-serological SS-A and/or SS-B-antibodies were found in 11 (32%) of 34 patients. 9 pts. (27%) had antinuclear antibodies. Abnormal titers of circulating immune complexes were present in the sera of 24 pts. (71%), salivary gland-antibodies in 3 pts. (9%). In 16 of 34 pts. (47%) minor salivary gland biopsy was performed. Lympho-plasma cell sialadenitis could be verified in all pts. Immuno-histological reactions to anti-IgG and/or anti-IgM and/or anti-IgA were detected in 10 (62%) of 16 pts. We could not find a single criterion to ascertain the diagnosis SS which still has to be made by considering all clinical and serological findings. Immunological findings may provide helpful and interesting diagnostic aspects which by long term observation may even gain importance; however, no differential therapeutic consequences can be seen at the moment.

62 inpatients suffering from an acute suppurative sialadenitis of the parotid and submaxillary glands were treated at the ENT clinic of the University of Homburg/Saar between 1982 and 1988. In general, the anamnesis is short. Typical findings are fully elastic, immobile, painful swellings of the inflamed salivary gland. In most cases, staphylococci could be identified by microbiological examination as the causative germs. As therapy, high-dose antibiotic treatment is necessary. In case of an abscess or a phlegmon, incision and drainage has also been performed. Differential diagnosis of an acute purulent sialadenitis is discussed and listed in tabular form.