Sialadenitis is bacterial infection of a salivary gland, usually due to an obstructing stone or gland hyposecretion. Symptoms are swelling, pain, redness, and. Sialadenitis (sialoadenitis) is inflammation of salivary glands, usually the major ones, the most Causes of sialadenitis are varied, including bacterial (most commonly Staphylococcus Aureus), viral and autoimmune conditions. Antibiotics should be given if bacterial sialadenitis is suspected, with choice of empirical antibiotics based upon local guidelines. Patients are advised to have.
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Salivary gland disorders include inflammatory, bacterial, viral, and neoplastic etiologies. The presentation can be acute, recurrent, or chronic. Acute suppurative sialadenitis presents as rapid-onset pain and swelling and is treated with antibiotics, salivary massage, hydration, and sialagogues such as lemon drops or vitamin C lozenges.
Viral etiologies include mumps and human immunodeficiency virus, and treatment is directed at the underlying disease. Recurrent or chronic sialadenitis is more likely to be inflammatory than infectious; examples include recurrent parotitis of childhood and sialolithiasis.
Inflammation is commonly caused by an obstruction such as a stone bacteral duct stricture. Management is directed at relieving the obstruction. Benign and malignant tumors can occur in the salivary glands and usually present as a painless solitary neck mass.
Diagnosis is made by imaging e. Overall, most salivary gland tumors are sialadenihis and can be treated with surgical excision. Saliva is a complex mixture of fluid, electrolytes, enzymes, and macromolecules that function together to perform several important roles 1: The major salivary glands are the paired parotid, submandibular, and sublingual glands.
The minor salivary glands line the mucosa of the lips, tongue, oral cavity, and pharynx. Patients with chronic sialadenitis should be evaluated with a history, physical examination, and possibly imaging, and the bactrrial pathology should be treated. Sialendoscopy is useful in treating causes of chronic or recurrent sialadenitis, including sialolithiasis and recurrent parotitis of childhood.
Salivary tumors generally should be completely excised to confirm the diagnosis and decrease morbidity and mortality. For information about the SORT evidence rating system, go to https: Diseases of the major salivary glands are occasionally encountered in the primary care setting Table 1. Obstructive sialadenitis from stones or strictures accounts for approximately one-half of benign salivary gland disorders. Antibiotics, gland massage, hydration, sialagogues, warm compresses, oral hygiene.
Swollen or firm bacerial may appear normal on examination; imaging computed tomography or ultrasonography may show calculus or dilated duct. Imaging computed tomography or magnetic resonance imaging ; fine-needle aspiration.
Clinical history; examination and imaging findings are usually normal; parotid gland may be swollen. Information from reference 6. Information from reference 3. Acute sialadenitis is a bacterial sialadeniits of the salivary gland.
It typically affects one major salivary gland, most commonly the parotid, 4 and is common in medically debilitated, hospitalized, or postoperative patients. Retrograde bacterial contamination from the oral cavity is thought to be the saladenitis etiology.
The use of certain medications, especially those with anticholinergic properties, can also reduce salivary flow. Sialolithiasis and duct strictures can impair salivary flow and predispose the patient to acute infection, but more commonly cause chronic or recurrent infections.
Patients with acute sialadenitis typically present with acute onset of pain and swelling of the affected gland.
Physical examination may reveal induration, edema, and extreme localized tenderness. Massage of the gland may express pus from the respective intraoral orifice Figure 2. This should be cultured to direct antibiotic therapy. Intraoral view of purulence emanating from the parotid duct orifice in a patient with bacferial suppurative parotitis. Management involves treating the infection and reversing the underlying medical condition and predisposing factors.
This includes stimulation of salivary flow by application of warm compresses, administration of sialagogues such as lemon drops or vitamin C lozenges, 10 hydration, salivary gland massage, and oral hygiene. Empiric antimicrobial therapy is initially directed at gram-positive and anaerobic organisms, which are often penicillin-resistant, so augmented penicillin that contains beta-lactamase inhibitors e.
Culture-directed therapy is administered, if possible. Rarely, acute suppurative sialadenitis can lead to abscess formation; surgical drainage is indicated in these cases. Recurrent parotitis of childhood is an inflammatory condition of the parotid gland characterized by recurrent episodes of swelling and pain.
The cause of this disorder is not known. Children typically present with recurrent episodes of acute or subacute parotid gland swelling with fever, malaise, and pain Figure 3. The disorder is usually unilateral, but can affect both sides.
Episodes may last days to weeks and occur every few months.
Treatment consists of supportive care with adequate hydration, gland massage, warm compresses, sialagogues, and antibiotics. Sialendoscopy has been shown to decrease the frequency and severity of episodes.
Chronic sialadenitis is characterized by repeated episodes of pain and inflammation caused by decreased salivary flow and salivary stasis. It most often affects the parotid gland. Physical examination may reveal enlargement of the gland early on, but this may reverse in later stages of the disease.
Massaging the gland toward the orifice often does not produce visible saliva. Workup should focus on identifying a predisposing factor, such as a calculus or stricture. If no cause is found, treatment is conservative and should consist of sialagogues, massage, hydration, and anti-inflammatory medications. In severe cases, excision of the gland is safe and effective, 14 with a low incidence of xerostomia. Sialolithiasis is caused by the formation of stones in the ductal system.
Patients with sialolithiasis typically present with postprandial salivary pain and swelling.
They may have a history of recurrent acute suppurative sialadenitis. On examination, bimanual palpation along the course of the duct may reveal the stone.
Ultrasonography and non—contrast-enhanced computed tomography are accurate in detecting the stone Figure 4. Non—contrast-enhanced computed tomography of the neck showing a salivary stone in the left parotid duct arrow with postobstructive ductal dilatation. Initial management consists of treating any acute infection, followed by surgical sialadeniti of the stone Figure 5. The surgical approach depends on the location of the stone. Submandibular stones that can be palpated and are located in the anterior floor of mouth can be excised intraorally, usually under local anesthesia.
Submandibular stones near the hilum of the gland may require gland excision.
Stones in the parotid duct are more difficult to manage and may require parotidectomy. An alternative to open surgery is sialendoscopy, 1819 wherein a small 0. Several studies have demonstrated its superiority over open surgery in stone clearance, symptom resolution, gland preservation, and safety. The parotitis is characterized by local pain and edema, as well as otalgia and trismus.
Most cases are bilateral, though it commonly begins on one side. Diagnosis is confirmed through viral serology. Treatment involves supportive measures, including hydration, oral hygiene, and pain control. Edema typically resolves over several weeks. Human immunodeficiency virus—associated salivary gland disease involves diffuse cystic enlargement of the major glands. It presents with a gradual, sialadebitis enlargement of one or more of the major salivary glands, with the parotid being the most commonly affected.
Imaging generally demonstrates multiple low-attenuation cysts and diffuse lymphadenopathy. Management involves antiretroviral therapy, oral hygiene, and sialagogues.
Benign neoplasms of the salivary glands typically present as painless, asymptomatic, slow-growing neck or parotid masses Figure 6. The most common salivary gland neoplasms in children are hemangiomas, lymphatic malformations, and pleomorphic adenomas. In adults, pleomorphic adenoma is the most common salivary gland neoplasm. With some tumors, particularly pleomorphic adenomas, there is a risk of malignant transformation over time; thus, these radioresistant tumors are typically surgically resected.
Contrast-enhanced computed tomography of the neck showing expansion of the left submandibular gland by a benign-appearing tumor arrow. Surgical excision confirmed a pleomorphic adenoma.
Both types typically present as a painless mass in the gland. Patients who present with nonacute facial weakness should have the parotid gland evaluated with examination and imaging. If a mass is identified, prompt referral to an otolaryngologist is indicated. Most common tumor; usually found in parotid gland; may undergo malignant transformation, so excision is advised. More common in older men; associated with smoking; may be multifocal or bilateral.
Sialadenitis – Symptoms, diagnosis and treatment | BMJ Best Practice
Tends to invade nerves; higher incidence of facial weakness; may recur years after treatment. Information from references 28 and Malignant parotid gland tumor with fixation and inflammation of the overlying skin.
The most common histologic types of malignant salivary gland tumors are mucoepidermoid and adenoid cystic carcinomas. Most salivary gland malignancies are treated surgically, so prompt referral is recommended when one is suspected Table 4. A PubMed search was completed in Clinical Queries using the key terms salivary gland tumors, sialadenitis, and sialolithiasis. The search included systematic reviews, meta-analyses, reviews of clinical trials and other primary sources, and evidence-based guidelines.
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Address correspondence to Kevin F. Reprints are not available from the authors.
Obstructive and inflammatory diseases of the major salivary glands.