¿Qué es la submaxilitis aguda?


La submaxilitis aguda es un proceso inflamatorio-infeccioso de reciente aparición que asienta sobre la glándula submaxilar.

¿Qué es la glándula submaxilar?
La glándula submaxilar es una glándula encargada de la producción de saliva.
En el cuerpo humano podemos distinguir dos tipos de glándulas salivares. Por un lado se encuentran las glándulas salivares menores, tenemos cientos de ellas distribuidas por la mucosa oral y paladar blando; estas son responsables del 5-10% de la producción total de saliva, sin embargo puesto que están segregándola continuamente, son responsables de la lubricación oral. Por otro lado, todos poseemos 3 pares de glándulas salivares mayores: parótida, submaxilar y sublingual.
Por lo tanto, la glándula submaxilar es una glándula salivar mayor, de número par, alojada en la celda submaxilar izquierda y derecha, por debajo del borde inferior mandibular. Produce saliva que drena a la boca a través del conducto de Wharton.
 
¿Por qué se puede inflamar?
Las causas que provocan inflamación de la glándula submaxilar suelen ser, principalmente, infecciosas u obstructivas.
Las infecciones pueden ser causadas por bacterias o virus.
Las causas obstructivas se deben a “arenilla” o cálculos en la propia glándula o en su conducto de drenaje, lo que hace que se acumule la saliva en su interior provocando un aumento de tamaño de la glándula.
 
¿Qué síntomas puedo presentar?
El síntoma principal es el aumento de tamaño de la glándula submaxilar, de uno o ambos lados. Lo percibiremos como una masa en la región alta del cuello, bajo el reborde mandibular.
Generalmente, aparecerá sequedad bucal e incluso mal sabor de boca.
En ocasiones puede acompañarse de fiebre, aumento de temperatura local y dolor. Otros síntomas más raros son dificultad para respirar y tragar.
En el caso de que la causa sea obstructiva (cálculo), el aumento de tamaño de la glándula coincidirá con la ingesta de alimentos, en ese momento, de forma fisiológica aumentará la producción de saliva para comenzar la digestión. Si esta saliva encuentra un obstáculo para su paso, se acumulará y provocará dicha inflamación.
 
¿Cómo se diagnostica?
En la mayoría de los casos es suficiente con la exploración física. Se debe palpar a la vez la glándula por dentro y por fuera de la boca, con el fin de identificar cálculos si es que existieran. Asimismo hay que determinar si sale saliva a través del conducto de Warthon y si ésta es clara o por el contrario se acompaña de pus.
En determinados casos puede realizarse una radiografía (Ortopantomografía) que en algunas ocasiones puede evidenciar los cálculos, pero no siempre puesto que estos no presentan siempre la misma densidad radiológica por lo que pueden ser que no se pongan de manifiesto en dicha prueba.
En casos de duda diagnóstica o complicación en el momento agudo, puede ser necesario solicitar una ecografía o un TAC.
 
¿Qué tratamiento debo seguir?
En la mayoría de los casos (siempre y cuando no existan factores de riesgo, salida de pus ni complicaciones) el tratamiento se basa en antiinflamatorios y adecuada hidratación oral, siendo los zumos de limón sin azúcar un pilar básico del tratamiento.
Si existe salida de pus será necesario prescribir un antibiótico además de las medidas comentadas anteriormente.
En algunos casos será necesario el ingreso hospitalario.


Claudia García Sierra 
MIR quinto año Cirugía Maxilofacial, Hospital Universitario Río Hortega

 
REFERENCIAS:

  • Cirugía Oral y Maxilofacial SECOM Sociedad Española de Cirugía Oral y Maxilofacial, Antonio López Davis, Rafael Martín-Granizo López. 3ª ed. Panamericana.

Revisado: marzo 2019

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