Diagnostic algorithm for the juvenile recurrent parotitis

In the structure of chronic inflammatory diseases of the major salivary glands, the juvenile recurrent parotitis occupies a prominent place. Despite the presence of a significant number of private and special examination methods, its diagnosis is difficult. In this regard, we have justified the expedient need to adhere to a certain sequence of diagnostic measures. For this purpose, 50 children aged 2 to 16 years were examined. The scope of the research included general clinical methods, cytogram study of parotid secretion, ultrasound examination of the parotid glands, and sialography. The assessment of the results of the anamnesis of the disease and the nature of the clinical course allowed us to determine that inflammation of the glands on both sides was observed in 24 children (48.0%), and unilateral in 26 (52.0%). At the time of exacerbation, inflammatory cells prevailed in their secretion, the number of which depended on the severity of clinical manifestations. In addition, in 7 children (26.9%) out of 26 who had manifestations of unilateral damage, cytogram studies were able to determine the presence of a latent inflammatory process in the symmetrical gland. On ultrasound examination, the glandular capsule appeared thickened and compacted in all cases, while the parenchyma showed a heterogeneous echotexture due to the presence of sialectases of various sizes surrounded by hyperechoic foci. At the same time, it is challenging to fully clarify the nature of organic disorders directly in all anatomical structures of the gland. The analytical comparison of the features of radiological changes in the parotid glands allowed us to determine in 40.0% of observations the indistinctness of their contours and structure, a moderate number of evenly spaced contrasted cavities from 1 to 2 mm in diameter throughout the parenchyma, and dilation of the ducts in some of their gaps. In 30.0% of cases, the diffuse placement of sialectasis measuring 1-2 mm with signs of differentiation of the excretory ducts of various orders was noted. In 23.3% of patients, small sialectasis occupied only individual lobes of the gland and the anatomical structure of the ductal system was preserved. In 6.7% of cases, dilation and deformation of the main excretory duct, obstruction of second-order ducts, and a small number of sialectases in the proximal portions of the gland were detected. These findings indicate the need to identify the underlying cause of the stenosis by sialendoscopy and, where appropriate, to eliminate the obstruction using specialized equipment. This diagnostic algorithm enables an objective stratification of children according to the clinical characteristics of juvenile recurrent parotitis and facilitates individualized planning of the scope and frequency of therapeutic and preventive measures in the outpatient setting. Further studies are planned to evaluate the effectiveness of this diagnostic algorithm during disease remission.