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16 Speekselklieraandoeningen en speeksel

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Samenvatting

  • Algemeen voorkomende verschijnselen die gepaard gaan met bacteriële of virale ontstekingen van de speekselklieren zijn pijn, zwellingen en obstructie van de afvoergangen. Als gevolg hiervan treedt vaak verlaagde speekselsecretie op en verandering van de elektrolytconcentraties en eiwitsamenstelling.

  • Bij het syndroom van Sjögren treden als specifieke veranderingen van speeksel op een verhoging van het lipidegehalte, in het bijzonder van fosfolipiden, een verhoging van immuuncomponenten, waaronder IgG en β2-microglobuline en abnormale S-IgA-moleculen met anti-IgG-autoantilichaamactiviteit. Niet-specifieke veranderingen die optreden zijn een relatief sterke Na+- en Cl--toename en daling van de fosfaatconcentratie.

  • De invloed van speekselkliertumoren op speeksel blijft grotendeels beperkt tot voortgaande reductie van de secretiesnelheid en de eiwitconcentratie. Verwijdering van de speekselkliertumor met radiotherapeutische nabehandeling resulteert veelal in een vorm van xerostomie (zie hoofdstuk 22). Ditzelfde geldt, vaak in sterkere mate, voor elke oncologische (na)behandeling in het hoofd-halsgebied waarbij de speekselklieren in het bestralingsveld zijn gelegen en een cumulatieve dosis ontvangen die de herstelcapaciteit van de desbetreffende speekselklier(en) te boven gaat.

  • De gevolgen van chemotherapie voor de mondholte zijn vooral smaakveranderingen, mucositis en xerostomie. In tegenstelling tot de effecten van bestraling zijn de effecten van chemotherapie op de speekselklieren gewoonlijk reversibel.

  • Bestraling van de speekselklieren leidt zowel acuut als op lange termijn tot een daling van de speekselsecretie. De effecten op de orale mucosa en de smaakgewaarwording hebben vaak een meer tijdelijk karakter, hoewel de orale mucosa wel gevoeliger blijft voor invloeden van buitenaf (atrofie) en de patiënten vaak ervaren dat de smaak na herstel is veranderd.

  • Bij het natriumretentiesyndroom treedt zo nu en dan pijnloze unilaterale zwelling op van de gl. parotidea; het parotisspeeksel wordt gekarakteriseerd door een extreem lage Na+- en bicarbonaatconcentratie.

  • Bij sialoadenose treedt pijnloze zwelling op van beide gl. parotideae.

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Copyright information

© Bohn Stafleu van Loghum, onderdeel van Springer Uitgeverij 2008

Authors and Affiliations

  1. 1.Sectie Orale BiochemieAcademisch Centrum Tandheelkunde Amsterdam (ACTA), Vrije Universiteit en Universiteit van AmsterdamAmsterdam

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