Summary
Definition
History and exam
Key diagnostic factors
- fever
- pain and dysphagia
- facial swelling
- recurrent painful swellings
- exudates of pus from salivary gland opening
- use of xerostomic medications
- mandibular trismus
- respiratory distress (stridor, use of accessory muscles, nasal flaring, wheeze)
- cranial nerve palsy
- connective tissue disorder or Sjogren syndrome
Other diagnostic factors
- episodic swelling during eating
- recent surgical intervention under general anesthetic
- dry eyes and mouth
- oral candidiasis
- iodine contrast exposure
- recurrent painless swellings
- displacement of earlobe
- prodrome of tingling in the affected gland
- swelling on the hard palate
Risk factors
- volume depletion and malnutrition
- immunosuppression
- Sjogren syndrome
- connective tissue diseases
- women aged 50 to 60
- general anesthesia
- xerostomic medications
- sialolithiasis
- chronic mechanical obstruction and/or multiple bouts of acute inflammation
- trauma (cheek biting)
- dental/orthodontic procedures
- sialectasis, diverticuli, and strictures
Diagnostic tests
1st tests to order
- culture and sensitivities of exudate from duct
- CBC
- facial radiographs (occlusal and/or soft tissue films)
Tests 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
- MRI
- minor salivary gland biopsy
- IgG4 and IgE
- major salivary gland biopsy
- sialoendoscopy
Treatment algorithm
signs of airway compromise
acute bacterial sialadenitis (nonobstructive)
obstructive sialadenitis
autoimmune sialadenitis
subacute necrotizing sialadenitis
chronic sialadenitis: recurrent or sclerosing (<3 times/year or nonsevere)
recurrent sialadenitis: any cause (>3 times/year or severe attacks)
Contributors
Authors
Chris Avery, MD, MChir, FDSRCS, FRCS, FRCS (OMFS)
Consultant Oral and Maxillofacial Surgeon
Honorary Associate Professor Senior Lecturer
University Hospitals of Leicester NHS Trust
Leicester
UK
Disclosures
CA declares that he has no competing interests.
Acknowledgements
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.
Peer reviewers
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
Amsterdam
The Netherlands
Disclosures
IVDW declares that he has no competing interests.
Michael D. Turner, DDS, MD, FACS
Assistant Professor
New York University College of Dentistry
Department of Oral and Maxillofacial Surgery
Department of Periodontics and Implant Dentistry
New York University School of Medicine
New York
NY
Disclosures
MDT declares that he has no competing interests.
Differentials
- Mumps
- Sarcoidosis
- Tuberculosis
More DifferentialsGuidelines
- Salivary gland disorders
- Updated S2K AWMF guideline for the diagnosis and follow-up of obstructive sialadenitis - relevance for radiologic imaging
More GuidelinesPatient information
Measles, mumps, and rubella: should my child have the MMR vaccine?
Rheumatoid arthritis
More Patient information- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer