Sialadenitis is the inflammation and enlargement of one or several major salivary glands. It most commonly affects parotid and submandibular glands.
Bacterial infection can supervene if salivary flow is diminished by illness or medication, or is obstructed by a sialolith (salivary stone). Most commonly caused by Staphylococcus aureus.
Intermittent painless unilateral or bilateral swellings without accompanying signs of infection may be idiopathic or due to an underlying condition, such as ductal stenosis or autoimmune disease.
Chronic sclerosing sialadenitis presents as a painless unilateral swelling that can mimic tumours. Biopsy is required for diagnosis.
Airway compromise is an important potential consequence of acute glandular swelling.
Sialadenitis denotes inflammation and swelling of the parotid, submandibular, sublingual, or minor salivary glands. Aetiology includes bacterial or viral infection, obstruction, or autoimmune causes. Acute bacterial sialadenitis is characterised by rapid onset of pain and swelling. In contrast, chronic sialadenitis is characterised by intermittent, recurrent episodes of tender swelling. Painless swellings (unless secondarily infected) classically occur in autoimmune sialadenitis (i.e., Sjogren's syndrome) and may be unilateral or bilateral. Chronic sclerosing sialadenitis (Kuttner's tumour) is typically unilateral and may mimic a tumour.
History and exam
Key diagnostic factors
- pain and dysphagia
- facial swelling
- recurrent painful swellings
- exudates of pus from salivary gland opening
- mandibular trismus
- respiratory distress (stridor, use of accessory muscles, nasal flaring, wheeze)
- cranial nerve palsy
Other diagnostic factors
- episodic swelling during eating
- use of xerostomic medications
- recent surgical intervention under general anaesthetic
- dry eyes and mouth
- oral candidiasis
- connective tissue disorder or Sjogren's syndrome
- recurrent painless swellings
- displacement of earlobe
- prodrome of tingling in the affected gland
- swelling on the hard palate
- volume depletion and malnutrition
- Sjogren's syndrome
- connective tissue diseases
- women aged 50 to 60
- general anaesthesia
- xerostomic medications
- chronic mechanical obstruction and/or multiple bouts of acute inflammation
- trauma (cheek biting)
- dental/orthodontic procedures
- sialectasis, diverticuli, and strictures
1st investigations to order
- culture and sensitivities of exudate from duct
- facial radiographs (occlusal and/or soft tissue films)
Investigations to consider
- ultrasound of affected gland
- CT scan
- digital subtraction sialography
- MR sialography
- scintigraphy using radioisotope sodium pertechnetate Tc-99m
- SSA/anti-Ro, SSB/anti-La antibodies
- antinuclear antibodies
- rheumatoid factor
- fine needle aspiration cytology of affected gland
- minor salivary gland biopsy
- IgG4 and IgE
- major salivary gland biopsy
signs of airway compromise
acute bacterial sialadenitis (non-obstructive)
subacute necrotising sialadenitis
chronic sialadenitis: recurrent or sclerosing (< 3 times/year or non-severe)
recurrent sialadenitis: any cause (>3 times/year or severe attacks)
Chris Avery, MD, MChir, FDSRCS, FRCS, FRCS (OMFS)
Consultant Oral and Maxillofacial Surgeon
Honorary Associate Professor Senior Lecturer
University Hospitals of Leicester NHS Trust
CA declares that he has no competing interests.
Dr Chris Avery would like to gratefully acknowledge Dr Alfredo Aguirre, Dr Michael N. Hatton, and Dr Ernesto de Nardin, previous contributors to this topic. AA, MNH, and EDN declare that they have no competing interests.
Issac van der Waal, DDS, PhD
Professor of Oral Pathology
Head of the Department of Oral and Maxillofacial Surgery and Oral Pathology
VU University Medical Centre and Academic Centre for Dentistry
IVDW declares that he has no competing interests.
Michael D. Turner, DDS, MD, FACS
New York University College of Dentistry
Department of Oral and Maxillofacial Surgery
Department of Periodontics and Implant Dentistry
New York University School of Medicine
MDT declares that he has no competing interests.
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