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Laryngorhinootologie 2001; 80(Supplement 1): 1-25
DOI: 10.1055/s-2001-13925
© Georg Thieme Verlag Stuttgart · New York

Ätiopathogenese und Histopathologie der Speicheldrüsenerkrankungen

K. Donath1 , J. Ußmüller2
  • 1Abt. für Oralpathologie, Universitätsklinikum Hamburg-Eppendorf
  • 2Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf
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Publication Date:
31 December 2001 (online)

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1Einleitung

Die Speicheldrüsen des Kopfes bestehen aus den großen paarig angelegten Drüsen und den unpaaren kleinen Speicheldrüsen. Die großen Drüsen sind die Glandula parotis (rein seröse Drüse), die Glandula submandibularis (gemischte oder seromuköse Drüse) und die Glandula sublingualis (rein muköse Drüse). Die kleinen Speicheldrüsen liegen dicht submukös im Mundvorhof und der Mundhöhle, mit Ausnahme des vorderen harten Gaumens und der Gingiva.

Die Sekretion der großen und kleinen Speicheldrüsen wird durch das autonome Nervensystem reguliert. Ohne äußere Einflüsse besteht eine ständige Speichelsekretion („Ruhesekretion”). Kaubewegungen, Geruchsempfindungen und Geschmackssensationen bedingen einen vermehrten Speichelfluss (Reizspeichel). Hormone, hormonähnliche Substanzen und Medikamente beeinflussen die Speichelsekretion. Entzündliche und tumoröse Speicheldrüsenerkrankungen gehen mit einer verminderten Speichelflussrate einher.

Die großen und kleinen Kopfspeicheldrüsen haben einen identischen histologischen Aufbau. Das gemeinsame Bauprinzip besteht aus den Azinuszellen (Endstücken), den Schalt- und Streifenstücken und den Ausführungsgängen. Das gefäß- und nervenfasernführende Bindegewebe dient der Stabilisation der Läppchenstruktur und dem Stofftransport über das zu- und abführende Gefäßsystem. Die autonomen Nervenfasern (Sympathikus und Parasympathikus) in den Speicheldrüsen sind nur postganglionäre Fasern. Die terminalen Axone treten im Abschnitt der Azinuszellen und des Gangsystems in direkten synaptischen Kontakt.

Die Bedeutung des Speichels für die Gesundheit der Mundhöhle und für ihre Funktion, wie Sprachbildung, Gleitbarmachung der Speise, Spülfunktion, Abwehr- und Schutzmechanismus, Pufferung von Säuren, (Re-) Mineralisation des Zahnschmelzes, wie auch die Einleitung der Verdauung, wird offenbar, wenn der Speichelfluss vermindert ist und die Trockenheit der Schleimhäute (Xerostomie) zu Störungen der genannten Funktionen führt.

Inhalt 1Einleitung2 2Nichtentzündliche Speicheldrüsenerkrankungen2 2.1Dysgenetische Speichelzysten und Sialektasien2 2.2Speicheldrüsenzysten2 2.3Sialadenosen2 2.4Nekrotisierende Sialometaplasie (Speicheldrüseninfarkt)2 2.5Onkozytose3 2.6Fokale onkozytäre adenomatöse Hyperplasie3 2.7Sialolithiasis3 3Entzündliche Speicheldrüsenerkrankungen3 3.1Akute Sialadenitis3 3.1.1Bakterielle Sialadenitis3 3.1.2Virus-Sialadenitis3 3.2Chronisch-rezidivierende Parotitis - chronische sialektatische Parotitis3 3.3Chronisch-sklerosierende Sialadenitis der Submandibularis (Küttner-Tumor)3 3.4Obstruktive Sialadenitis (Elektrolytsialadenitis)3 3.5Immunsialadenitis3 3.5.1Myoepitheliale Autoimmun-Sialadenitis (Sjögren-Syndrom)4 3.5.2Epitheloidzellige Sialadenitis (Heerfordt-Syndrom)4 3.6Strahlensialadenitis4 3.7HIV-assoziierte Veränderungen4 3.8Sklerosierende polyzystische Sialoadenopathie4 4Epitheliale Speicheldrüsentumoren4 4.1Ätiologie4 4.2Klassifikation nach den Empfehlungen der Weltgesundheitsorganisation5 4.3Tumorinzidenz5 4.4Multiple Tumoren5 4.5Hybridtumoren6 4.6Prognosefaktoren6 5Speicheldrüsenadenome6 5.1Pleomorphe Adenome6 5.2Myoepitheliome (myoepitheliale Adenome)7 5.3Basalzelladenome7 5.4Warthin-Tumoren (Adenolymphome)7 5.5Kanalikuläre Adenome8 5.6Talgdrüsenadenome8 5.7Duktale Papillome9 5.7.1Invertes duktales Papillom9 5.7.2Intraduktale Papillome9 5.7.3Sialadenoma papilliferum9 5.8Zystadenome9 5.8.1Papilläres Zystadenom9 5.8.2Muzinöse Zystadenome10 6Speicheldrüsenkarzinome10 6.1Azinuszellkarzinome10 6.2Mukoepidermoidkarzinome11 6.3Adenoid-zystisches Karzinom12 6.4Niedrig maligne polymorphe Adenokarzinome12 6.5Epithelial-myoepitheliale Karzinome13 6.6Basalzell-Adenokarzinome13 6.7Talgdrüsenkarzinome14 6.8Papilläre Zystadenokarzinome14 6.9Muzinöse Adenokarzinome14 6.10Onkozytäre Karzinome15 6.11Speichelgangkarzinome15 6.12Myoepitheliale Karzinome15 6.13Karzinome in pleomorphen Adenomen16 6.14Plattenepithelkarzinome16 7Nicht epitheliale Tumoren16 8Maligne Lymphome17 9Sekundäre Tumoren (Metastasen)17 10Literatur17

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Prof. Dr. med. Dr. h. c. mult. Karl Donath

(ehem. Direktor der Abt. für Oralpathologie,
Universitätsklinikum Hamburg-Eppendorf)

Wiehenstraße 73
32289 Rödinghausen

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