Sialadenitis: Difference between revisions

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{{SK}}: [[Sialadenitis]], [[Sialadenitis|salivary gland stones]]
{{SK}}Sialadenitis, salivary gland inflammation


==Overview ==
==Overview ==
Sialadenitis is the [[inflammation]] of a [[salivary gland]]. The causes of sialadenitis include [[Bacteria|bacterial]] and [[Virus|viral]] infections such as [[mumps]] and [[Human Immunodeficiency Virus (HIV)|HIV]], obstruction from stones or [[Radiation therapy|radiation]], and [[autoimmune]] disorders such as [[Sjögren's syndrome|Sjogren's syndrome]]. The complications of sialadenitis include recurrence, [[abscess]], and chronic sialadenitis. Sialadenitis must be differentiated from other diseases that cause swelling in [[Salivary gland|salivary glands]], such as [[sialolithiasis]], [[Human Immunodeficiency Virus (HIV)|human immunodeficiency viru]]<nowiki/>s, [[Radiation therapy|radiation]], and systemic diseases such as, [[sarcoidosis]], and [[sjögren's syndrome]]. History from the patient will reveal symptoms of sialadenitis that include [[fever]], redness of overlying [[skin]], [[pain]], and difficulty in opening the mouth. The diagnosis of choice is a high resolution [[Computed tomography|CT scan]]. Sialoendoscopy can be used in the diagnosis of small stones and differentiate them from [[Polyp|polyps]].  Conservative treatment is the first line of therapy in the most patients and it involves [[Hydration]], applying moist heat, massaging the gland, duct milking, discontinuation of medication that decrease the [[saliva]] flow, such as the [[Tricyclic anti-depressant|TCAs]] because of their [[anticholinergic]] effects, and [[Antibiotic|antibiotics]] usage for the infection. Preferred regimen [[Dicloxacillin]] 500 mg q 6h PO for 7 to 10 days or [[Cephalexin]] 500 mg q 6h PO for 7 to 10 days.
Sialadenitis is the [[inflammation]] of a [[salivary gland]]. The causes of sialadenitis include [[Bacteria|bacterial]] and [[Virus|viral]] infections, such as [[mumps]] and [[Human Immunodeficiency Virus (HIV)|HIV]], obstruction from stones or [[Radiation therapy|radiation]], and [[autoimmune]] disorders such as [[Sjögren's syndrome|Sjogren's syndrome]]. The complications of sialadenitis include recurrence, [[abscess]], and chronic sialadenitis. Sialadenitis must be differentiated from other diseases that can cause swelling in the [[Salivary gland|salivary glands]], such as [[sialolithiasis]], [[Human Immunodeficiency Virus (HIV)|human immunodeficiency viru]]<nowiki/>s, [[Radiation therapy|radiation]], and systemic diseases such as, [[sarcoidosis]], and [[sjögren's syndrome]]. History from the patient will reveal symptoms of sialadenitis that include [[fever]], redness of overlying [[skin]], [[pain]], and difficulty in opening the mouth. The diagnosis of choice is a high resolution [[Computed tomography|CT scan]]. Sialoendoscopy can be used in the diagnosis of small stones and differentiate them from [[Polyp|polyps]].  Conservative treatment is the first line of therapy in the most patients and it involves [[Hydration]], applying moist heat, massaging the gland, duct milking, discontinuation of medication that can decrease the [[saliva]] flow, such as the [[Tricyclic anti-depressant|TCAs]] (because of their [[anticholinergic]] effects). Also, [[Antibiotic|antibiotics]] can be used in the case of superimposed infection. Preferred regimens are [[Dicloxacillin]] 500 mg q 6h PO for 7 to 10 days, or [[Cephalexin]] 500 mg q 6h PO for 7 to 10 days.


==Historical Perspective==
==Historical Perspective==
The historical perspective of sialadenitis is as follows:<ref name="ErkulGillespie2016">{{cite journal|last1=Erkul|first1=Evren|last2=Gillespie|first2=M. Boyd|title=Sialendoscopy for non-stone disorders: The current evidence|journal=Laryngoscope Investigative Otolaryngology|volume=1|issue=5|year=2016|pages=140–145|issn=23788038|doi=10.1002/lio2.33}}</ref>
The historical perspective of sialadenitis is as follows:<ref name="ErkulGillespie2016">{{cite journal|last1=Erkul|first1=Evren|last2=Gillespie|first2=M. Boyd|title=Sialendoscopy for non-stone disorders: The current evidence|journal=Laryngoscope Investigative Otolaryngology|volume=1|issue=5|year=2016|pages=140–145|issn=23788038|doi=10.1002/lio2.33}}</ref>


*In 17th century, major salivary gland ductal system in anatomical [[human]] studies was first reported.
*In 17th century, major salivary gland ductal system in anatomical [[human]] studies was first reported.
*In 1990, , Konigsberger et al. performed the first successful [[Salivary gland enlargement|salivary]] endoscopy.<ref name="LydiattBucher2012">{{cite journal|last1=Lydiatt|first1=Daniel D.|last2=Bucher|first2=Gregory S.|title=The historical evolution of the understanding of the submandibular and sublingual salivary glands|journal=Clinical Anatomy|volume=25|issue=1|year=2012|pages=2–11|issn=08973806|doi=10.1002/ca.22007}}</ref>  
*In 1990, , Konigsberger et al. performed the first successful [[Salivary gland enlargement|salivary]] endoscopy.<ref name="LydiattBucher2012">{{cite journal|last1=Lydiatt|first1=Daniel D.|last2=Bucher|first2=Gregory S.|title=The historical evolution of the understanding of the submandibular and sublingual salivary glands|journal=Clinical Anatomy|volume=25|issue=1|year=2012|pages=2–11|issn=08973806|doi=10.1002/ca.22007}}</ref>  
*In 2004, Zenk et al. reported the use of semirigid sialendoscope in different types of obstructive [[Salivary gland enlargement|salivary]] disorders.<ref name="ZenkKoch2004">{{cite journal|last1=Zenk|first1=J|last2=Koch|first2=M|last3=Bozzato|first3=A|last4=Iro|first4=H|title=Sialoscopy—initial experiences with a new endoscope|journal=British Journal of Oral and Maxillofacial Surgery|volume=42|issue=4|year=2004|pages=293–298|issn=02664356|doi=10.1016/j.bjoms.2004.03.006}}</ref>
*In 2004, Zenk et al. reported the use of semirigid sialendoscope in different types of obstructive [[Salivary gland enlargement|salivary]] disorders.<ref name="ZenkKoch2004">{{cite journal|last1=Zenk|first1=J|last2=Koch|first2=M|last3=Bozzato|first3=A|last4=Iro|first4=H|title=Sialoscopy—initial experiences with a new endoscope|journal=British Journal of Oral and Maxillofacial Surgery|volume=42|issue=4|year=2004|pages=293–298|issn=02664356|doi=10.1016/j.bjoms.2004.03.006}}</ref>
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==Classification==
==Classification==
*There is no established system for the classification of sialadenitis, but may be classified according to location of the stone.<ref name="pmid179578462">{{cite journal |vauthors=Capaccio P, Torretta S, Ottavian F, Sambataro G, Pignataro L |title=Modern management of obstructive salivary diseases |journal=Acta Otorhinolaryngol Ital |volume=27 |issue=4 |pages=161–72 |year=2007 |pmid=17957846 |pmc=2640028 |doi= |url=}}</ref>  
*There is no established system for the classification of sialadenitis, but it can be classified according to location of the stone.<ref name="pmid179578462">{{cite journal |vauthors=Capaccio P, Torretta S, Ottavian F, Sambataro G, Pignataro L |title=Modern management of obstructive salivary diseases |journal=Acta Otorhinolaryngol Ital |volume=27 |issue=4 |pages=161–72 |year=2007 |pmid=17957846 |pmc=2640028 |doi= |url=}}</ref>  
{| class="wikitable"
{| class="wikitable"
!Gland  
!Gland  
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|1 to 2
|1 to 2
|}
|}
* [[Submandibular gland|Submandibular]] stones can be classified further as [[anterior]] or [[posterior]] in relation to the mandibular first [[Molar (tooth)|molar]] teeth.
* [[Submandibular gland|Submandibular]] stones can be classified further as [[anterior]], or [[posterior]] in relation to the mandibular first [[Molar (tooth)|molar]] teeth.
* Stones may be [[radiopaque]], where they be visible on [[Radiograph|radiographs]] or radiolucent where they will not show up on [[radiography]]  
* Stones may be [[radiopaque]], where they can be radiopaque or radiolucent.  
* Stones may also be [[symptomatic]] or [[asymptomatic]].
* Stones may also be [[symptomatic]] or [[asymptomatic]].


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*Sialadenitis is the [[inflammation]] of a [[salivary gland]]. <ref>{{Cite journal|last=Loury|first=MC|date=2006|title=Salivary gland disorder|url=|journal=Advanced Otolaryngology|volume=|pages=|via=}}</ref>
*Sialadenitis is the [[inflammation]] of a [[salivary gland]]. <ref>{{Cite journal|last=Loury|first=MC|date=2006|title=Salivary gland disorder|url=|journal=Advanced Otolaryngology|volume=|pages=|via=}}</ref>
*[[Swelling]] is usually present in this condition.
*[[Swelling]] is usually present in this condition.
*Acute sialadenitis may be caused by viral or bacterial infection<ref name="pmid3318353">{{cite journal |vauthors=McKenna JP, Bostock DJ, McMenamin PG |title=Sialolithiasis |journal=Am Fam Physician |volume=36 |issue=5 |pages=119–25 |year=1987 |pmid=3318353 |doi= |url=}}</ref>
*Acute sialadenitis may be caused by [[Virus|viral]] or bacterial infection<ref name="pmid3318353">{{cite journal |vauthors=McKenna JP, Bostock DJ, McMenamin PG |title=Sialolithiasis |journal=Am Fam Physician |volume=36 |issue=5 |pages=119–25 |year=1987 |pmid=3318353 |doi= |url=}}</ref>
**[[Parotid gland|Parotid]] and [[submandibular gland]]<nowiki/>s are more involved in acute sialadenitis. approximately 10% sialadenitis cases are related to involvement of submandibular gland.
**[[Parotid gland|Parotid]] and [[submandibular gland]]<nowiki/>s are more involved in acute sialadenitis. Approximately 10% sialadenitis cases are related to the involvement of submandibular gland.
*Chronic sialadenitis is caused by repeated episodes of [[inflammation]] and finally it progresses in to salivary gland dysfucntion.
*Chronic sialadenitis is caused by repeated episodes of [[inflammation]] and finally it progresses in to salivary gland dysfunction.


==Causes==
==Causes==
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==Differentiating sialadenitis from Other Diseases==
==Differentiating sialadenitis from Other Diseases==
*Sialadenitis must be differentiated from other diseases that cause swelling in [[Salivary gland|salivary glands]], such as [[sialolithiasis]], [[Human Immunodeficiency Virus (HIV)|human immunodeficiency viru]]<nowiki/>s, [[Radiation therapy|radiation]], and systemic diseases such as, [[sarcoidosis]], and [[sjögren's syndrome]].<ref name="pmid24862601">{{cite journal |vauthors=Delli K, Spijkervet FK, Vissink A |title=Salivary gland diseases: infections, sialolithiasis and mucoceles |journal=Monogr Oral Sci |volume=24 |issue= |pages=135–48 |year=2014 |pmid=24862601 |doi=10.1159/000358794 |url=}}</ref><ref name="pmid248626012">{{cite journal |vauthors=Delli K, Spijkervet FK, Vissink A |title=Salivary gland diseases: infections, sialolithiasis and mucoceles |journal=Monogr Oral Sci |volume=24 |issue= |pages=135–48 |year=2014 |pmid=24862601 |doi=10.1159/000358794 |url=}}</ref><ref name="pmid28516973">{{cite journal |vauthors=Capaccio P, Torretta S, Pignataro L, Koch M |title=Salivary lithotripsy in the era of sialendoscopy |journal=Acta Otorhinolaryngol Ital |volume=37 |issue=2 |pages=113–121 |year=2017 |pmid=28516973 |pmc=5463518 |doi=10.14639/0392-100X-1600 |url=}}</ref><ref name="pmid20824782">{{cite journal |vauthors=Wallace E, Tauzin M, Hagan J, Schaitkin B, Walvekar RR |title=Management of giant sialoliths: review of the literature and preliminary experience with interventional sialendoscopy |journal=Laryngoscope |volume=120 |issue=10 |pages=1974–8 |year=2010 |pmid=20824782 |doi=10.1002/lary.21082 |url=}}</ref><ref name="pmid208247822">{{cite journal |vauthors=Wallace E, Tauzin M, Hagan J, Schaitkin B, Walvekar RR |title=Management of giant sialoliths: review of the literature and preliminary experience with interventional sialendoscopy |journal=Laryngoscope |volume=120 |issue=10 |pages=1974–8 |year=2010 |pmid=20824782 |doi=10.1002/lary.21082 |url=}}</ref><ref>{{Cite journal|last=Loury|first=MC|date=2006|title=Salivary gland disorder|url=|journal=Advanced Otolaryngology|volume=|pages=|via=}}</ref><ref name="pmid2385766">{{cite journal |vauthors=Raad II, Sabbagh MF, Caranasos GJ |title=Acute bacterial sialadenitis: a study of 29 cases and review |journal=Rev. Infect. Dis. |volume=12 |issue=4 |pages=591–601 |year=1990 |pmid=2385766 |doi= |url=}}</ref><ref name="pmid9747195">{{cite journal |vauthors=Silvers AR, Som PM |title=Salivary glands |journal=Radiol. Clin. North Am. |volume=36 |issue=5 |pages=941–66, vi |year=1998 |pmid=9747195 |doi= |url=}}</ref>
*Sialadenitis must be differentiated from other diseases that cause swelling in [[Salivary gland|salivary glands]], such as [[sialolithiasis]], [[Human Immunodeficiency Virus (HIV)|human immunodeficiency viru]]<nowiki/>s, [[Radiation therapy|radiation]], and systemic diseases such as, [[sarcoidosis]], and [[sjögren's syndrome]].<ref name="pmid24862601">{{cite journal |vauthors=Delli K, Spijkervet FK, Vissink A |title=Salivary gland diseases: infections, sialolithiasis and mucoceles |journal=Monogr Oral Sci |volume=24 |issue= |pages=135–48 |year=2014 |pmid=24862601 |doi=10.1159/000358794 |url=}}</ref><ref name="pmid248626012">{{cite journal |vauthors=Delli K, Spijkervet FK, Vissink A |title=Salivary gland diseases: infections, sialolithiasis and mucoceles |journal=Monogr Oral Sci |volume=24 |issue= |pages=135–48 |year=2014 |pmid=24862601 |doi=10.1159/000358794 |url=}}</ref><ref name="pmid28516973">{{cite journal |vauthors=Capaccio P, Torretta S, Pignataro L, Koch M |title=Salivary lithotripsy in the era of sialendoscopy |journal=Acta Otorhinolaryngol Ital |volume=37 |issue=2 |pages=113–121 |year=2017 |pmid=28516973 |pmc=5463518 |doi=10.14639/0392-100X-1600 |url=}}</ref><ref name="pmid20824782">{{cite journal |vauthors=Wallace E, Tauzin M, Hagan J, Schaitkin B, Walvekar RR |title=Management of giant sialoliths: review of the literature and preliminary experience with interventional sialendoscopy |journal=Laryngoscope |volume=120 |issue=10 |pages=1974–8 |year=2010 |pmid=20824782 |doi=10.1002/lary.21082 |url=}}</ref><ref name="pmid208247822">{{cite journal |vauthors=Wallace E, Tauzin M, Hagan J, Schaitkin B, Walvekar RR |title=Management of giant sialoliths: review of the literature and preliminary experience with interventional sialendoscopy |journal=Laryngoscope |volume=120 |issue=10 |pages=1974–8 |year=2010 |pmid=20824782 |doi=10.1002/lary.21082 |url=}}</ref><ref>{{Cite journal|last=Loury|first=MC|date=2006|title=Salivary gland disorder|url=|journal=Advanced Otolaryngology|volume=|pages=|via=}}</ref><ref name="pmid2385766">{{cite journal |vauthors=Raad II, Sabbagh MF, Caranasos GJ |title=Acute bacterial sialadenitis: a study of 29 cases and review |journal=Rev. Infect. Dis. |volume=12 |issue=4 |pages=591–601 |year=1990 |pmid=2385766 |doi= |url=}}</ref><ref name="pmid9747195">{{cite journal |vauthors=Silvers AR, Som PM |title=Salivary glands |journal=Radiol. Clin. North Am. |volume=36 |issue=5 |pages=941–66, vi |year=1998 |pmid=9747195 |doi= |url=}}</ref>
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
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| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Submandibular gland
| style="background: #F5F5F5; padding: 5px;" |[[Submandibular gland]]
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |Radio-opaque in X-ray
| style="background: #F5F5F5; padding: 5px;" |Radio-opaque in [[X-rays|X-ray]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Acute bacterial sialadenitis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sialadenitis|Acute bacterial sialadenitis]]
| style="background: #F5F5F5; padding: 5px;" |Acute
| style="background: #F5F5F5; padding: 5px;" |Acute
| style="background: #F5F5F5; padding: 5px;" |Unilateral
| style="background: #F5F5F5; padding: 5px;" |Unilateral
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| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |Parotid
| style="background: #F5F5F5; padding: 5px;" |[[Parotid gland|Parotid]]
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |Other sign of infection may be present
| style="background: #F5F5F5; padding: 5px;" |Other sign of [[infection]] may be present
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Chronic bacterial sialadenitis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sialadenitis|Chronic bacterial sialadenitis]]
| style="background: #F5F5F5; padding: 5px;" |Chronic
| style="background: #F5F5F5; padding: 5px;" |Chronic
| style="background: #F5F5F5; padding: 5px;" |Unilateral
| style="background: #F5F5F5; padding: 5px;" |Unilateral
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| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |Parotid
| style="background: #F5F5F5; padding: 5px;" |[[Parotid gland|Parotid]]
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |Other sign of infection may be present
| style="background: #F5F5F5; padding: 5px;" |Other sign of [[infection]] may be present
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Viral sialadenitis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sialadenitis|Viral sialadenitis]]
| style="background: #F5F5F5; padding: 5px;" |Acute
| style="background: #F5F5F5; padding: 5px;" |Acute
| style="background: #F5F5F5; padding: 5px;" |Bilateral
| style="background: #F5F5F5; padding: 5px;" |Bilateral
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| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Parotid
| style="background: #F5F5F5; padding: 5px;" |[[Parotid gland|Parotid]]
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |Coryza symptoms
| style="background: #F5F5F5; padding: 5px;" |[[Coryza|Coryza symptoms]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Human immunodeficiency virus
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]]
| style="background: #F5F5F5; padding: 5px;" |Acute
| style="background: #F5F5F5; padding: 5px;" |Acute
| style="background: #F5F5F5; padding: 5px;" |Bilateral
| style="background: #F5F5F5; padding: 5px;" |Bilateral
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| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Parotid  
| style="background: #F5F5F5; padding: 5px;" |[[Parotid gland|Parotid]]
| style="background: #F5F5F5; padding: 5px;" |NL
| style="background: #F5F5F5; padding: 5px;" |NL
| style="background: #F5F5F5; padding: 5px;" |NL
| style="background: #F5F5F5; padding: 5px;" |NL
| style="background: #F5F5F5; padding: 5px;" |Other systemic findings of HIV/ check ELIZA
| style="background: #F5F5F5; padding: 5px;" |Other systemic findings of [[Human Immunodeficiency Virus (HIV)|HIV]]/ check [[ELISA]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Radiation sialadenitis
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Radiation [[sialadenitis]]
| style="background: #F5F5F5; padding: 5px;" |Acute
| style="background: #F5F5F5; padding: 5px;" |Acute
| style="background: #F5F5F5; padding: 5px;" |Unilateral
| style="background: #F5F5F5; padding: 5px;" |Unilateral
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| style="background: #F5F5F5; padding: 5px;" |NL
| style="background: #F5F5F5; padding: 5px;" |NL
| style="background: #F5F5F5; padding: 5px;" |NL
| style="background: #F5F5F5; padding: 5px;" |NL
| style="background: #F5F5F5; padding: 5px;" |History of radiation in the salivary gland site
| style="background: #F5F5F5; padding: 5px;" |History of [[Radiation therapy|radiation]] in the [[salivary gland]] site
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Salivary gland tumors
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Salivary gland tumor|Salivary gland tumors]]
| style="background: #F5F5F5; padding: 5px;" |Subacute
| style="background: #F5F5F5; padding: 5px;" |Subacute
| style="background: #F5F5F5; padding: 5px;" |Unilateral
| style="background: #F5F5F5; padding: 5px;" |Unilateral
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| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Parotid
| style="background: #F5F5F5; padding: 5px;" |[[Parotid gland|Parotid]]
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |Advance age
| style="background: #F5F5F5; padding: 5px;" |Advance age
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Sarcoidosis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sarcoidosis]]
| style="background: #F5F5F5; padding: 5px;" |Gradual
| style="background: #F5F5F5; padding: 5px;" |Gradual
| style="background: #F5F5F5; padding: 5px;" |Bilateral
| style="background: #F5F5F5; padding: 5px;" |Bilateral
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| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Parotid
| style="background: #F5F5F5; padding: 5px;" |[[Parotid gland|Parotid]]
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |Systemic findings in other organs
| style="background: #F5F5F5; padding: 5px;" |Systemic findings in other organs
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Sjögren's syndrome
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sjögren's syndrome]]
| style="background: #F5F5F5; padding: 5px;" |Gradual
| style="background: #F5F5F5; padding: 5px;" |Gradual
| style="background: #F5F5F5; padding: 5px;" |Bilateral
| style="background: #F5F5F5; padding: 5px;" |Bilateral
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| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Parotid or submandibular glands
| style="background: #F5F5F5; padding: 5px;" |[[Parotid gland|Parotid]] or [[Submandibular gland|submandibular glands]]
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |Dry eye/dry mouth
| style="background: #F5F5F5; padding: 5px;" |Dry eye/dry mouth
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Malnutrition
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Malnutrition]]
| style="background: #F5F5F5; padding: 5px;" |Gradual
| style="background: #F5F5F5; padding: 5px;" |Gradual
| style="background: #F5F5F5; padding: 5px;" |Bilateral
| style="background: #F5F5F5; padding: 5px;" |Bilateral
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| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Parotid
| style="background: #F5F5F5; padding: 5px;" |[[Parotid gland|Parotid]]
| style="background: #F5F5F5; padding: 5px;" |NL
| style="background: #F5F5F5; padding: 5px;" |NL
| style="background: #F5F5F5; padding: 5px;" |NL
| style="background: #F5F5F5; padding: 5px;" |NL
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*The exact [[prevalence]] of [[Submandibular gland|submandibular]] sialadenitis is unclear.  
*The exact [[prevalence]] of [[Submandibular gland|submandibular]] sialadenitis is unclear.  


*The incidence of acute sialadenitis is approximately 27.5 per 1,000,000 individuals in United Kingdom.<ref name="pmid10365495">{{cite journal| author=Escudier MP, McGurk M| title=Symptomatic sialoadenitis and sialolithiasis in the English population, an estimate of the cost of hospital treatment. | journal=Br Dent J | year= 1999 | volume= 186 | issue= 9 | pages= 463-6 | pmid=10365495 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10365495  }} </ref>
*The incidence of acute sialadenitis is approximately 275 per 100,000 individuals in United Kingdom.<ref name="pmid10365495">{{cite journal| author=Escudier MP, McGurk M| title=Symptomatic sialoadenitis and sialolithiasis in the English population, an estimate of the cost of hospital treatment. | journal=Br Dent J | year= 1999 | volume= 186 | issue= 9 | pages= 463-6 | pmid=10365495 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10365495  }} </ref>


*Patients of all age groups may develop sialadenitis.
*Patients of all age groups may develop sialadenitis.
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===Prognosis===
===Prognosis===
*Prognosis is generally good with fluid management and [[antimicrobial]] therapy, but [[edema]] in the gland may persist for several weeks. <ref name="pmid2385766">{{cite journal |vauthors=Raad II, Sabbagh MF, Caranasos GJ |title=Acute bacterial sialadenitis: a study of 29 cases and review |journal=Rev. Infect. Dis. |volume=12 |issue=4 |pages=591–601 |year=1990 |pmid=2385766 |doi= |url=}}</ref>
*Prognosis is generally good with fluid management and [[antimicrobial]] therapy, but [[edema]] in the gland may persist for several weeks.<ref name="pmid2385766">{{cite journal |vauthors=Raad II, Sabbagh MF, Caranasos GJ |title=Acute bacterial sialadenitis: a study of 29 cases and review |journal=Rev. Infect. Dis. |volume=12 |issue=4 |pages=591–601 |year=1990 |pmid=2385766 |doi= |url=}}</ref>


==Diagnosis==
==Diagnosis==
===Diagnostic Criteria===
===Diagnostic Criteria===
 
Acute sialadenitis is a clinical diagnosis and presents with [[pain]], [[Edema|swelling]], and redness of [[skin]].<ref name="pmid25077394">{{cite journal| author=Wilson KF, Meier JD, Ward PD| title=Salivary gland disorders. | journal=Am Fam Physician | year= 2014 | volume= 89 | issue= 11 | pages= 882-8 | pmid=25077394 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25077394  }} </ref>
=====Clinical diagnosis =====
Acute sialadenitis is a clinical diagnosis and presents with pain, swelling, and redness of skin.<ref name="pmid25077394">{{cite journal| author=Wilson KF, Meier JD, Ward PD| title=Salivary gland disorders. | journal=Am Fam Physician | year= 2014 | volume= 89 | issue= 11 | pages= 882-8 | pmid=25077394 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25077394  }} </ref>


===History and Symptoms===
===History and Symptoms===
The most common symptoms of sialadenitis include [[fever]] and difficulty in opening the mouth.<ref name="pmid22888457">{{cite journal |vauthors=Chandak R, Degwekar S, Chandak M, Rawlani S |title=Acute submandibular sialadenitis-a case report |journal=Case Rep Dent |volume=2012 |issue= |pages=615375 |year=2012 |pmid=22888457 |pmc=3409526 |doi=10.1155/2012/615375 |url=}}</ref>
The most common symptoms of sialadenitis include [[fever]] and [[pain]].<ref name="pmid22888457">{{cite journal |vauthors=Chandak R, Degwekar S, Chandak M, Rawlani S |title=Acute submandibular sialadenitis-a case report |journal=Case Rep Dent |volume=2012 |issue= |pages=615375 |year=2012 |pmid=22888457 |pmc=3409526 |doi=10.1155/2012/615375 |url=}}</ref>


*A positive history of [[pain]], [[Edema|swelling]], overlying [[Skin changes|skin]] redness, and hard [[lump]] is suggestive of sialadenitis.
*A positive history of [[pain]], [[Edema|swelling]], overlying [[Skin changes|skin]] redness, and hard [[lump]] is suggestive of sialadenitis.
Common symptoms of chronic sialadenitis are similar to acute sialadenitis but with less intensity.
===Physical Examination===
===Physical Examination===
===Vital Signs===
===Vital Signs===
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==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===
*Certain individuals with chronic [[Bacteria|bacterial]] infections who do not respond to appropriate conservative and [[antibiotic]] measures may require either [[Radiation therapy|radiation]] or removal of the affected gland to control its symptoms. Most cases are easily treated with conservative medical management. Acute symptoms resolve within 1 week; however, [[edema]] in the area may last for several weeks.<ref name="ChandakDegwekar2012">{{cite journal|last1=Chandak|first1=Rakhi|last2=Degwekar|first2=Shirish|last3=Chandak|first3=Manoj|last4=Rawlani|first4=Shivlal|title=Acute Submandibular Sialadenitis—A Case Report|journal=Case Reports in Dentistry|volume=2012|year=2012|pages=1–3|issn=2090-6447|doi=10.1155/2012/615375}}</ref>
*Most cases are easily treated with conservative medical management. Acute symptoms resolve within 1 week; however, [[edema]] in the area may last for several weeks.<ref name="ChandakDegwekar2012">{{cite journal|last1=Chandak|first1=Rakhi|last2=Degwekar|first2=Shirish|last3=Chandak|first3=Manoj|last4=Rawlani|first4=Shivlal|title=Acute Submandibular Sialadenitis—A Case Report|journal=Case Reports in Dentistry|volume=2012|year=2012|pages=1–3|issn=2090-6447|doi=10.1155/2012/615375}}</ref>


* [[Antibiotic|Antibiotics]] usage in the case of superimposed infection:<ref name="pmid25077394">{{cite journal| author=Wilson KF, Meier JD, Ward PD| title=Salivary gland disorders. | journal=Am Fam Physician | year= 2014 | volume= 89 | issue= 11 | pages= 882-8 | pmid=25077394 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25077394  }} </ref>  
* [[Antibiotic|Antibiotics]] usage in the case of superimposed infection:<ref name="pmid25077394">{{cite journal| author=Wilson KF, Meier JD, Ward PD| title=Salivary gland disorders. | journal=Am Fam Physician | year= 2014 | volume= 89 | issue= 11 | pages= 882-8 | pmid=25077394 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25077394  }} </ref>  
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===Surgery===
===Surgery===
The mainstay of treatment for acute siladenitis is medical therapy. Surgery is not the first-line treatment option for patients with acute siladenitis. Surgery is usually reserved for patients with [[abscess]] that do not respond to medical therapy.<ref name="RyanPadmakumar2015" />
* Certain individuals with chronic [[Bacteria|bacterial]] infections who do not respond to appropriate conservative and [[antibiotic]] measures may require either [[Radiation therapy|radiation]] or removal of the affected gland to control its symptoms.


Surgical resection of involved gland in chronic [[Bacteria|bacterial]] sialadenitis may be considered if it does not respond to medical therapy. <ref name="pmid22888457" />
* The mainstay of treatment for acute siladenitis is medical therapy. Surgery is not the first-line treatment option for patients with acute siladenitis. Surgery is usually reserved for patients with [[abscess]] that do not respond to medical therapy.<ref name="pmid25077394">{{cite journal| author=Wilson KF, Meier JD, Ward PD| title=Salivary gland disorders. | journal=Am Fam Physician | year= 2014 | volume= 89 | issue= 11 | pages= 882-8 | pmid=25077394 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25077394  }} </ref>
 
* Surgical resection of involved gland in chronic [[Bacteria|bacterial]] sialadenitis may be considered if it does not respond to medical therapy. <ref name="pmid22888457" />


===Surgical intervention ===
===Surgical intervention ===
Line 338: Line 337:


===Primary Prevention===
===Primary Prevention===
*Effective measures for the primary prevention of sialadenitis include:<ref name="pmid23242089">{{cite journal |vauthors=Moghe S, Pillai A, Thomas S, Nair PP |title=Parotid sialolithiasis |journal=BMJ Case Rep |volume=2012 |issue= |pages= |year=2012 |pmid=23242089 |pmc=4543829 |doi=10.1136/bcr-2012-007480 |url=}}</ref><ref name="ChandakDegwekar2012">{{cite journal|last1=Chandak|first1=Rakhi|last2=Degwekar|first2=Shirish|last3=Chandak|first3=Manoj|last4=Rawlani|first4=Shivlal|title=Acute Submandibular Sialadenitis—A Case Report|journal=Case Reports in Dentistry|volume=2012|year=2012|pages=1–3|issn=2090-6447|doi=10.1155/2012/615375}}</ref>
*Effective measures for the primary prevention of sialadenitis include:<ref name="pmid23242089">{{cite journal |vauthors=Moghe S, Pillai A, Thomas S, Nair PP |title=Parotid sialolithiasis |journal=BMJ Case Rep |volume=2012 |issue= |pages= |year=2012 |pmid=23242089 |pmc=4543829 |doi=10.1136/bcr-2012-007480 |url=}}</ref><ref name="ChandakDegwekar2012">{{cite journal|last1=Chandak|first1=Rakhi|last2=Degwekar|first2=Shirish|last3=Chandak|first3=Manoj|last4=Rawlani|first4=Shivlal|title=Acute Submandibular Sialadenitis—A Case Report|journal=Case Reports in Dentistry|volume=2012|year=2012|pages=1–3|issn=2090-6447|doi=10.1155/2012/615375}}</ref><ref name="pmid25077394">{{cite journal| author=Wilson KF, Meier JD, Ward PD| title=Salivary gland disorders. | journal=Am Fam Physician | year= 2014 | volume= 89 | issue= 11 | pages= 882-8 | pmid=25077394 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25077394  }} </ref>
 
**Healthy [[Mouth|oral]] care regimen ( brushing teeth)
**Healthy [[Mouth|oral]] care regimen ( brushing teeth)
**Increased water intake  
**Increased water intake
*There are no available [[Vaccine|vaccines]] against sialolithiasis
*There are no available [[Vaccine|vaccines]] against sialolithiasis


===Secondary Prevention===
===Secondary Prevention===
Effective measures for the secondary prevention of acute sialadenitis include hygiene and repeated massaging of the gland when [[tenderness]] had subsided. <ref name="pmid22888457" /><ref name="pmid9747195">{{cite journal |vauthors=Silvers AR, Som PM |title=Salivary glands |journal=Radiol. Clin. North Am. |volume=36 |issue=5 |pages=941–66, vi |year=1998 |pmid=9747195 |doi= |url=}}</ref><ref name="ErkulGillespie2016">{{cite journal|last1=Erkul|first1=Evren|last2=Gillespie|first2=M. Boyd|title=Sialendoscopy for non-stone disorders: The current evidence|journal=Laryngoscope Investigative Otolaryngology|volume=1|issue=5|year=2016|pages=140–145|issn=23788038|doi=10.1002/lio2.33}}</ref><ref name="ChandakDegwekar2012">{{cite journal|last1=Chandak|first1=Rakhi|last2=Degwekar|first2=Shirish|last3=Chandak|first3=Manoj|last4=Rawlani|first4=Shivlal|title=Acute Submandibular Sialadenitis—A Case Report|journal=Case Reports in Dentistry|volume=2012|year=2012|pages=1–3|issn=2090-6447|doi=10.1155/2012/615375}}</ref>
Effective measures for the secondary prevention of acute sialadenitis include hygiene and repeated massaging of the gland when [[tenderness]] had subsided. <ref name="pmid22888457" /><ref name="pmid9747195">{{cite journal |vauthors=Silvers AR, Som PM |title=Salivary glands |journal=Radiol. Clin. North Am. |volume=36 |issue=5 |pages=941–66, vi |year=1998 |pmid=9747195 |doi= |url=}}</ref><ref name="ErkulGillespie2016">{{cite journal|last1=Erkul|first1=Evren|last2=Gillespie|first2=M. Boyd|title=Sialendoscopy for non-stone disorders: The current evidence|journal=Laryngoscope Investigative Otolaryngology|volume=1|issue=5|year=2016|pages=140–145|issn=23788038|doi=10.1002/lio2.33}}</ref><ref name="ChandakDegwekar2012">{{cite journal|last1=Chandak|first1=Rakhi|last2=Degwekar|first2=Shirish|last3=Chandak|first3=Manoj|last4=Rawlani|first4=Shivlal|title=Acute Submandibular Sialadenitis—A Case Report|journal=Case Reports in Dentistry|volume=2012|year=2012|pages=1–3|issn=2090-6447|doi=10.1155/2012/615375}}</ref><ref name="pmid250773942">{{cite journal| author=Wilson KF, Meier JD, Ward PD| title=Salivary gland disorders. | journal=Am Fam Physician | year= 2014 | volume= 89 | issue= 11 | pages= 882-8 | pmid=25077394 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25077394  }}</ref>
* Prevention of [[dehydration]]
* Prevention of [[dehydration]]
* Healthy [[Mouth|oral]] care regimen (brushing teeth)
* Healthy [[Mouth|oral]] care regimen (brushing teeth)
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{{reflist|2}}
{{reflist|2}}


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https://https://www.youtube.com/watch?v=GzlShSy28uE%7C350}}
Sialadenitis(Sialoadenitis)
Micrograph showing chronic sialadenitis. H&E stain.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2] Mahda Alihashemi M.D. [3]

Synonyms and keywords:Sialadenitis, salivary gland inflammation

Overview

Sialadenitis is the inflammation of a salivary gland. The causes of sialadenitis include bacterial and viral infections, such as mumps and HIV, obstruction from stones or radiation, and autoimmune disorders such as Sjogren's syndrome. The complications of sialadenitis include recurrence, abscess, and chronic sialadenitis. Sialadenitis must be differentiated from other diseases that can cause swelling in the salivary glands, such as sialolithiasis, human immunodeficiency virus, radiation, and systemic diseases such as, sarcoidosis, and sjögren's syndrome. History from the patient will reveal symptoms of sialadenitis that include fever, redness of overlying skin, pain, and difficulty in opening the mouth. The diagnosis of choice is a high resolution CT scan. Sialoendoscopy can be used in the diagnosis of small stones and differentiate them from polyps. Conservative treatment is the first line of therapy in the most patients and it involves Hydration, applying moist heat, massaging the gland, duct milking, discontinuation of medication that can decrease the saliva flow, such as the TCAs (because of their anticholinergic effects). Also, antibiotics can be used in the case of superimposed infection. Preferred regimens are Dicloxacillin 500 mg q 6h PO for 7 to 10 days, or Cephalexin 500 mg q 6h PO for 7 to 10 days.

Historical Perspective

The historical perspective of sialadenitis is as follows:[1]

  • In 17th century, major salivary gland ductal system in anatomical human studies was first reported.
  • In 1990, , Konigsberger et al. performed the first successful salivary endoscopy.[2]
  • In 2004, Zenk et al. reported the use of semirigid sialendoscope in different types of obstructive salivary disorders.[3]
  • In 2006, Nahlieli et al. described sialendoscopy in the management of radioiodine sialadenitis.[4]

Classification

  • There is no established system for the classification of sialadenitis, but it can be classified according to location of the stone.[5]
Gland %
Submandibular glands 80 to 90 
Parotid glands 6 to 20
Sublinguals or minor salivary glands 1 to 2

Pathophysiology

  • Sialadenitis is the inflammation of a salivary gland. [6]
  • Swelling is usually present in this condition.
  • Acute sialadenitis may be caused by viral or bacterial infection[7]
    • Parotid and submandibular glands are more involved in acute sialadenitis. Approximately 10% sialadenitis cases are related to the involvement of submandibular gland.
  • Chronic sialadenitis is caused by repeated episodes of inflammation and finally it progresses in to salivary gland dysfunction.

Causes

Common causes of sialadenitis include the following:

Bacterial and viral infections:[8]

Obstruction:

Autoimmune disorders:

Differentiating sialadenitis from Other Diseases

Diseases Symptoms and sign Laboratory Findings Other Findings
Onset Unilateral/Bilateral Pain Swelling Tenderness Purulent discharge Common site of involvement ESR Leukocytosis
Sialolithiasis Acute Unilateral + + + - Submandibular gland ↑/NL ↑/NL Radio-opaque in X-ray
Acute bacterial sialadenitis Acute Unilateral + + + + Parotid Other sign of infection may be present
Chronic bacterial sialadenitis Chronic Unilateral + + - +/- Parotid Other sign of infection may be present
Viral sialadenitis Acute Bilateral + + + - Parotid Coryza symptoms
Human immunodeficiency virus Acute Bilateral + + - - Parotid NL NL Other systemic findings of HIV/ check ELISA
 Radiation sialadenitis Acute Unilateral + + + - Depends on the treatment field NL NL History of radiation in the salivary gland site
Salivary gland tumors Subacute Unilateral - + - - Parotid ↑/NL ↑/NL Advance age
Sarcoidosis Gradual Bilateral - + - - Parotid Systemic findings in other organs
Sjögren's syndrome Gradual Bilateral +/- + - - Parotid or submandibular glands ↑/NL ↑/NL Dry eye/dry mouth
Malnutrition Gradual Bilateral +/- + - - Parotid NL NL Systemic findings in other organs

Epidemiology and Demographics

  • The incidence of acute sialadenitis is approximately 275 per 100,000 individuals in United Kingdom.[18]
  • Patients of all age groups may develop sialadenitis.
  • Sialadenitis commonly affects older and dehydrated patients.

Risk Factors

Common Risk Factors

Common risk factors in the development of sialolithisis which can lead to sialadenitis include:[19]

Screening

There is insufficient evidence to recommend routine screening for sialadenitis.

Natural History, Complications, and Prognosis

Natural History

  • If left untreated, patients with sialadeitis may progress to develop secondary infection and chronic sialadenitis including gland atrophy.[21]

Complications

Prognosis

  • Prognosis is generally good with fluid management and antimicrobial therapy, but edema in the gland may persist for several weeks.[16]

Diagnosis

Diagnostic Criteria

Acute sialadenitis is a clinical diagnosis and presents with pain, swelling, and redness of skin.[23]

History and Symptoms

The most common symptoms of sialadenitis include fever and pain.[22]

  • A positive history of pain, swelling, overlying skin redness, and hard lump is suggestive of sialadenitis.

Physical Examination

Vital Signs

  • Vital signs are usually normal, but fever may be seen in sialadenititis as a complication of sialolithiasis.[7]

HEENT

Normal salivary gland is spongy.

In sialadenitis:[24][25]

  • Tenderness of the involved gland
  • Palpable hard lump near the end of the involved duct or under the tongue in submandibular duct stone.
    • Stones, sometimes may be felt smooth or irregular.
  • In total obstruction, no saliva is being produced from the duct.
  • Erythema of the floor of the mouth
  • Pus discharging from the duct
  • Stone in the minor salivary glands can be felt as a small nodule
  • Stones are typically rock hard and small; they may be smooth or irregular. They are most commonly felt within the ductal system.

Neck

Laboratory Findings

  • There are no diagnostic laboratory findings associated with sialadenitis. In the case of superimposed inflammation and infection, high ESR or leukocytosis may be seen.
  • Duct discharge should be used for culture.[26]

Electrocardiogram

There are no ECG findings associated with sialadenitis.

X-ray

Ultrasound

  • There are no ultrasound findings associated with acute sialadenitis.

CT scan

  • There are no CT scan findings associated with acute sialadenitis. However, a CT scan may be helpful in the diagnosis of complications of sialadenitis, which include abscess.[28][23]
    • Most stones contain enough calcium, so they can be visible on non-contrast CT scan.
  • The following results are seen in acute obstruction of the salivary duct due to sialadenitis after administration of contrast:
    • The gland may appear enlarged
    • Hyperdensity of gland with stranding
  • In chronic sialadenitis, fat atrophy and reduction in salivary gland parenchymal volume may be seen.

Other Imaging Findings

Sialography is contraindicated in active infection of the involved gland.

Other Diagnostic Studies

  • There are no other diagnostic studies associated with sialadenitis.

Treatment

Medical Therapy

  • Most cases are easily treated with conservative medical management. Acute symptoms resolve within 1 week; however, edema in the area may last for several weeks.[29]
  • Antibiotics usage in the case of superimposed infection:[23]
    • Preferred regimen (1): Dicloxacillin 500 mg q 6h PO for 7 to 10 days.
    • Preferred regimen (2): Cephalexin 500 mg q 6h PO for 7 to 10 days.
  • If the patients clinics did not change in five days of using above antibiotics, change to:
  • Many cases of sialadenitis cannot be cured by using medical therapy alone; invasive, or open surgery methods can be used for salivary gland stones. The interventional methods are discussed in the sialadenitis surgery page.

Surgery

  • Certain individuals with chronic bacterial infections who do not respond to appropriate conservative and antibiotic measures may require either radiation or removal of the affected gland to control its symptoms.
  • The mainstay of treatment for acute siladenitis is medical therapy. Surgery is not the first-line treatment option for patients with acute siladenitis. Surgery is usually reserved for patients with abscess that do not respond to medical therapy.[23]
  • Surgical resection of involved gland in chronic bacterial sialadenitis may be considered if it does not respond to medical therapy. [22]

Surgical intervention 

For surgical intervention of sialolithiasis please click here.

Primary Prevention

  • Effective measures for the primary prevention of sialadenitis include:[19][29][23]
    • Healthy oral care regimen ( brushing teeth)
    • Increased water intake
  • There are no available vaccines against sialolithiasis

Secondary Prevention

Effective measures for the secondary prevention of acute sialadenitis include hygiene and repeated massaging of the gland when tenderness had subsided. [22][17][1][29][30]

References

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  14. Wallace E, Tauzin M, Hagan J, Schaitkin B, Walvekar RR (2010). "Management of giant sialoliths: review of the literature and preliminary experience with interventional sialendoscopy". Laryngoscope. 120 (10): 1974–8. doi:10.1002/lary.21082. PMID 20824782.
  15. Loury, MC (2006). "Salivary gland disorder". Advanced Otolaryngology.
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  20. Ship JA (2002). "Diagnosing, managing, and preventing salivary gland disorders". Oral Dis. 8 (2): 77–89. PMID 11991308.
  21. Briffa NP, Callum KG (1989). "Use of an embolectomy catheter to remove a submandibular duct stone". Br J Surg. 76 (8): 814. PMID 2765834.
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  23. 23.0 23.1 23.2 23.3 23.4 Wilson KF, Meier JD, Ward PD (2014). "Salivary gland disorders". Am Fam Physician. 89 (11): 882–8. PMID 25077394.
  24. Hupp, James (2008). Contemporary oral and maxillofacial surgery. St. Louis, Mo: Mosby Elsevier. ISBN 9780323049030.
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  28. Ellies, Maik; Laskawi, Rainer; Arglebe, Christian; Schott, Anngrit (1996). "Surgical management of nonneoplastic diseases of the submandibular gland". International Journal of Oral and Maxillofacial Surgery. 25 (4): 285–289. doi:10.1016/S0901-5027(06)80058-5. ISSN 0901-5027.
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