Diagnosis and treatment of radiation-induced xerostomia

The purpose of the study was to improve diagnostic approaches and treatment protocols for patients with various forms of xerostomia, including reactive dystrophic changes and radiation-induced lesions of the salivary glands. 64 patients aged 31 to 92 years, divided into two groups, were diagnosed and treated. The Group 1 (n = 33) included patients with salivary gland diseases (sialadenosis, chronic mumps, Sjögren’s syndrome) that developed against the background of concomitant somatic pathology. The Group 2 (n = 31) consisted of patients with radiation-induced xerostomia after radioiodine therapy and remote irradiation for tumours of the maxillofacial region. The diagnosis included dynamic subtraction sialography, sialometry of the large and small salivary glands, analysis of the viscosity and pH of secretions, and biopsy of the small salivary glands. Patients in the Group 1 underwent external blockades according to Vishnevsky with 0.5% procaine solution and 1% Mexidol, injections of 1% galantamine hydrochloride solution, administration of 2-5% potassium iodide solution and compresses with Dimexide. In Group 2, modern salt substitutes (Bioten, Hiposalix, and Xerostom complexes) were prescribed in the form of gels, sprays, chewing gum, etc. Clinical improvement was observed in 22 patients (66.7%) of the Group 1. In Group 2, where the secretion indices were significantly reduced (to 0.1-0.3 ml), the pH of saliva shifted to the acidic side (5.0-6.0), and the viscosity of the secretion reached 12 cm, only 5 people (16%) reported relief of symptoms. Treatment of xerostomia requires a comprehensive, multidisciplinary approach. Due to the irreversible destruction of acinar tissue and fibrosis, restoration of saliva secretion in radiation damage is impossible, and therefore permanent replacement therapy and preventive oral sanitation before starting radiation treatment are priorities