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Sialadenitis

Küttner Tumor

Sialadenitis is the inflammation of a salivary gland.


Presentation

The patients suffering from sialadenitis generally experience redness, swelling and pain in the affected side of the mouth. This occurs due to the enlargement of gland as a result of inflammation caused by bacteria or virus infection. The swelling may become enormously enlarged, sometimes even reaching the size of an orange, with overlying inflamed reddened skin and edema. Mild pain and swelling are usually common before and during meals. Fluctuation test may be positive in the swelling if it is filled with fluid. Other symptoms of sialadenitis include a foul taste in the mouth, decreased mobility in the jaw, dry mouth, skin changes, weight loss, shortness of breath, keratitis, dental pain, skin discharge and lymphadenopathy. The patient may run fever with rigors and chills along with malaise and generalized weakness as a result of septicemia. In severe cases, pus can often be secreted from the duct by compressing the affected gland. The duct orifice is reddened with reduced flow. There may or may not be a visible or palpable stone.

Pain
  • Most of the patients experienced a subjective clinical improvement documented by the statistically significant reductions in the postoperative mean pain VAS (group A P 2 test (P .0173).[ncbi.nlm.nih.gov]
  • MAIN OUTCOMES MEASURES: The number of episodes of sialadenitis three and 6 months before and after sialendoscopy, and their severity assessed by means of a 0-10 pain visual analogue scale.[ncbi.nlm.nih.gov]
  • RESULTS: Three patients presented with a lateral palatal nodule (1 case bilateral, 1 case ulcerated) of 7 to 10 days' duration, 0.8 to 1.0 cm in size, slightly or not painful. No patient was correctly diagnosed prior to undergoing a biopsy.[ncbi.nlm.nih.gov]
  • The presence of a stone makes the gland swollen, inflamed, hard and painful due to the increased viscosity of stored secretions.[symptoma.com]
  • […] sialadenitis conservative management (hydration, pain relief, and sialogogues) salivary substitute and sialogogue treatment of underlying condition subacute necrotizing sialadenitis observation Ongoing chronic sialadenitis: recurrent or sclerosing ([online.epocrates.com]
Fever
  • We present a case of a 37-day-old infant with sialadenitis who presented to the pediatric emergency department with fever and neck swelling. A discussion of this diagnosis and the relevant literature follows.[ncbi.nlm.nih.gov]
  • In this case report, we describe a preterm neonate with NISSS due to infection by S aureus and Klebsiella pneumonia presenting on day 11 of life with submandibular swelling and low-grade fever.[ncbi.nlm.nih.gov]
  • The patient did not have a history of fever, rectal bleeding, skin lesions or arthritis, but did have a history of drug allergy and bronchial asthma.[ncbi.nlm.nih.gov]
  • Abstract A 71-year-old man was admitted with malaise, mild fever, anorexia, body weight loss, lower back pain, thirst, and polydipsia. He showed bilateral swelling of the submandibular glands.[ncbi.nlm.nih.gov]
  • It usually begins approximately 48 hours after the start of other symptoms such as fever and headache.[webmd.com]
Malaise
  • Abstract A 71-year-old man was admitted with malaise, mild fever, anorexia, body weight loss, lower back pain, thirst, and polydipsia. He showed bilateral swelling of the submandibular glands.[ncbi.nlm.nih.gov]
  • The patient may run fever with rigors and chills along with malaise and generalized weakness as a result of septicemia. In severe cases, pus can often be secreted from the duct by compressing the affected gland.[symptoma.com]
  • Some patients develop low grade fever and all of them experience malaise. In case of purulent inflammation, by pressing the inflamed salivary gland one may force out the pus which leaves the gland through its openings.[ic.steadyhealth.com]
  • If the infection spreads, you may have fever, chills and malaise (a general sick feeling). Diagnosis Your dentist will feel the affected gland and see if it is swollen. If the gland discharges pus, this may be tested for bacteria.[colgate.com]
Cerebral Palsy
  • We report the first case in a child with cerebral palsy who developed serious acute sialadenitis with submandibular sialolithiasis after intraglandular botulinum neurotoxin injection for sialorrhea.[ncbi.nlm.nih.gov]
Hyposmia
  • RESULTS: Rhinosinusitis occurred in 58.8% patients, and manifested with the symptoms of nasal obstruction, nasal xerosis, and hyposmia. In addition, 43.1% patients had allergic rhinitis. Lymphadenopathy was identified in 74.5% patients.[ncbi.nlm.nih.gov]
Parotid Swelling
  • We present a case of a patient who developed radiation sialadenitis after radioactive iodide therapy for papillary thyroid cancer resulting in severe parotid swelling and swelling, which resulted in an emergency department visit and had complete resolution[ncbi.nlm.nih.gov]
  • Mumps often cause parotid swelling. Patients with HIV infection often have parotid enlargement secondary to one or more lymphoepithelial cysts. Make sure to check with your dentist for some of these symptoms to receive proper treatment.[propdental.es]
  • Viral sialadenitis Mumps (acute viral sialadenitis, epidemic parotitis) A common acute viral disease that mainly affects the parotid glands, mumps is highly infectious and is the most common cause of acute parotid swelling.[intelligentdental.com]
  • It is the most common cause of acute parotid swelling. Postirradiation Sialadenitis It is a common complication of radiotherapy. It involves infection in highly damaged salivary glands which is often irreversible but causes less damage.[hxbenefit.com]
Parotid Mass
  • We report the case of a man with a parotid mass that exhibited features consistent with an inflammatory process on fine-needle aspiration biopsy.[ncbi.nlm.nih.gov]
  • CASE REPORT: A 52-year-old man presented with a left parotid mass. Fine needle aspiration biopsy was consistent with Warthin's tumor. The mass lesion was excised. DISCUSSION: The lesion measured 2.5   1.5   1.5 cm.[ncbi.nlm.nih.gov]
  • FNAC of palpable lymph node is mandatory for parotid mass where FNAC of parotid is inconclusive.[jhrr.org]
  • Parotid mass due to cat scratch disease . Int J Clin Pract 2006 ; 60: 1679 – 1680 . Google Scholar Medline ISI 27. Razek, AA, Huang, BY. Lesions of the petrous apex: Classification and findings at CT and MR imaging .[journals.sagepub.com]
Salivary Gland Pain
  • Stenson's (parotid glands) Pt will present with postprandial salivary gland pain and swelling.[smartypance.com]
Erythema
  • In case 1, an upper chest and facial erythema and dryness of the mouth accompanied the swelling of the salivary glands. In case 2, a conjunctival erythema accompanied the sialadenitis.[ncbi.nlm.nih.gov]
  • Mucus plugging in the duct of the gland was the most common finding (22 patients) followed by stenosis (18 patients), inflammation (eight patients), and erythema (eight patients). Median follow-up time was 23.4 12.1 months.[ncbi.nlm.nih.gov]
  • […] papillary hyperplasia Stomatitis nicotina Torus palatinus Oral mucosa – Lining of mouth Amalgam tattoo Angina bullosa haemorrhagica Behçet's disease Bohn's nodules Burning mouth syndrome Candidiasis Condyloma acuminatum Darier's disease Epulis fissuratum Erythema[en.wikipedia.org]
  • Patients typically present with erythema over the area, pain, tenderness upon palpation, and swelling. Frank cellulitis and induration of adjacent soft tissues may be present.[emedicine.medscape.com]
  • The gland is firm and diffusely tender, with erythema and edema of the overlying skin. Pus can often be expressed from the duct by compressing the affected gland and should be cultured. Focal enlargement may indicate an abscess.[propdental.es]
Skin Lesion
  • The patient did not have a history of fever, rectal bleeding, skin lesions or arthritis, but did have a history of drug allergy and bronchial asthma.[ncbi.nlm.nih.gov]
Facial Pain
  • Parotitis results in swelling of the face, fever, and facial pain. The salivary glands normally contract to produce saliva during a meal but contraction of an infected gland can also be painful.[ohniww.org]
  • Sialadenitis Symptoms Some of the common symptoms of Sialadenitis include: Facial pain, with pain originating in the entire angle of the jaw or underneath the jaw Tenderness Inflammation over the salivary glands The symptoms of this condition may vary[hxbenefit.com]
  • Facial pain. Facial swelling or swelling in the neck. Presence of swelling or redness over the jaw, anterior to the ears, below the jaw or in the base of the mouth. Fever or chills, signs which indicate infection.[epainassist.com]
Neck Mass
  • Here, we describe a rare case of a 53-year-old male patient who primarily presented with pancreatic body mass, left neck mass and several lumps in his lower lip mimicking pancreatic cancer (PC) and neck metastasis.[ncbi.nlm.nih.gov]
  • Clinically, CSS patients may present with a neck mass, often suggesting a neoplastic process. Fine-needle aspiration (FNA) is frequently used to evaluate these lesions.[ncbi.nlm.nih.gov]
Preauricular Swelling
  • Although the parotitis is very rare in neonates as described it should be suspected in neonates with erythematous preauricular swelling. Delay in diagnosis and treatment may lead to involvement of surrounding glands as in our case.[jcnonweb.com]
Peripheral Neuropathy
  • Carlos.Madrid@hospvd.ch Abstract One 53-year-old male was referred with a history of sensitive peripheral neuropathy and Raynaud disease leading to suspect a Sjögren syndrome (SS).[ncbi.nlm.nih.gov]

Workup

The diagnosis of salivary gland swelling begins with careful thorough history and general physical examination.

  • History: The patient is asked in detail about the onset and duration of symptoms, history of recent operations or recent dental procedures, past medical and surgical history, history of radiation therapy, drug history and immunization history.
  • General physical examination: On physical examination, the gland with its duct should be palpated for the presence of calculi. The floor of mouth as well as the lips, cheek, gums, tongue and neck are also examined. A quick cranial nerve examination should also be done.
  • Laboratory studies for confirmation of the diagnosis include the following.
  • Complete blood count: This should be obtained if the patient experiences septicemia. White blood cell count are elevated in the presence of infection.
  • Blood culture and sensitivities: The exudate from duct is taken to test bacterial growth in the presence of infection.
  • Soft tissue radiographs: These help to diagnose stones in the salivary duct.
  • Ultrasound of gland: It demonstrates a sialolith or a fluid-filled abscess cavity in chronic infections [9].
  • CT scan: It demonstrates enlarged salivary gland in chronic sclerosing sialadenitis [10].
  • Magnetic resonance imaging: It is of little help in sialadenitis or sialolithiasis as it may miss an obstructing stone. However, it is helpful in evaluating suspected neoplasia of the salivary glands.
  • Scintigraphy using radioisotope Tc-99m: It may show the presence of hypo-functioning or non-functioning salivary gland.
  • Sialography: It is used to evaluate sialolithiasis as well as inflammatory or neoplastic diseases [11] [12].
  • Fine needle aspiration and biopsy: It should be undertaken if a solid neoplasm is suspected in subacute sclerosing sialadenitis [13] [14].
  • Sialoendoscopy: It is a new technique to visualize sialoliths, polyps, foreign bodies, anatomic malformations and ductal structures.
  • Moreover, routine electrolytes and serum analysis for antinuclear antibody should be obtained to assess dehydration or systemic infection.
Liver Biopsy
  • Liver biopsy revealed chronic persistent hepatitis. In one second biopsy, RNA was extracted. PCR amplification and southern blot hybridization for HCV-RNA were performed.[ncbi.nlm.nih.gov]

Treatment

Sialadenitis can be treated through proper oral hygiene. If left untreated, it can lead to severe complications and abscess formation. Treatment of sialadenitis includes the following.

  • Home remedies: Some cases can be effectively treated with home remedies like good oral hygiene, drinking plenty of water, warm-water rinses, massaging the area, warm compresses, use of analgesics, topical application of ice cubes and sialogogues like a sour candy or chewing gum to stimulate the secretion of saliva. With conservative management, the symptoms subside over a period of few weeks.
  • Medical management: For acute bacterial infections, general supportive care with broad-spectrum antibiotics is given. Intravenous antibiotics are given for the first 48 hours and then switched to an oral alternative if clinically improved. Beta lactams or vancomycin are generally considered the first-line drugs. Clindamycin or metronidazole are acceptable alternatives. NSAIDS and corticosteroids have also been effective.
  • In case of abscess formation, surgical incision and drainage is required. Care must be taken to avoid injury to the facial nerve. 
  • Surgical management: Operative management is indicated for salivary duct stone. It involves cannulation of salivary duct with stone removal. The procedure can be performed under general anesthesia. In severe cases with more than 3 attacks per year, complete surgical excision of the gland may be recommended. Sialendoscopy is a safe, efficacious and gland-preserving procedure used as a first-line therapy for stones in the distal ducts for both the submandibular and parotid glands. Extracorporeal shock wave lithotripsy under ultrasound guidance can also be used for stones within the glandular ducts. In patients with symptomatic chronic sclerosing sialadenitis, removal of the whole affected gland is recommended. However, the patients with autoimmune sialadenitis often require medical management of the underlying cause such as Sjogren syndrome.

Prognosis

The prognosis depends on the etiology of the inflammation. With prompt diagnosis and appropriate treatment, the outlook is very good. If treated with appropriate antibiotics, acute bacterial sialadenitis should settle within a week; however, mild swelling may persist. If sialoliths are surgically treated, the prognosis is good. Recovery is typically over a 3 to 6 month period and is usually complete. If left untreated, the disease may recur and can lead to chronic sclerosing sialadenitis [7] [8]. Chronic sialadenitis is usually resistant to treatment and can lead to abscess formation.

Etiology

There are many casual factors for sialadenitis but the most common of them is bacterial infection, especially Stapylococcal infection [3]. Other bacteria include streptococci, coliforms and various anaerobic species [4]. The major salivary glands affected are parotid, submandibular and sublingual glands. It typically occurs in elderly people but is also common in infants and adults. It usually affects chronically ill patients with xerostomia, patients with Sjogren syndrome, patients who have had radiation therapy to the oral cavity or radioactive iodine therapy for thyroid cancer and young adults with anorexia [5] [6]. The other predisposing factors include sialolithiasis, decreased salivary flow due to dehydration, post-operative conditions and drugs, poor oral hygiene, malnourishment and exacerbation of low grade chronic sialadenitis.

Epidemiology

The incidence of community-acquired acute bacterial sialadenitis is unknown. However, 0.01% to 0.02% of patients admitted to hospital and 0.02% to 0.04% of post-surgical patients develop this condition. Although the majority of patients are older people, sialadenitis may also affect neonates, premature infants and young children. There is no race or sex predilection. Involvement of the submandibular gland is suggested to constitute approximately 10% of all cases of sialadenitis of the major salivary glands. Salivary stones causing sialadenitis are found with greatest frequency, approximately 63- 95% of cases in the submandibular gland. These are commonly formed between the age of 20 to 50 years. Chronic recurrent sialadenitis occurs ten times more frequently in adults than in children.

Sex distribution
Age distribution

Pathophysiology

There are numerous salivary glands in the oral cavity but the major ones include the parotid gland, submandibular gland and sublingual gland. Each person makes a half to two liters of saliva daily, of which more than 90 percent comes from the major salivary glands. The minor salivary glands are located in the lips, cheeks and throat. They serve numerous functions including lubrication, production of hormones, enzymatic degradation of food substances, mediation of taste, antibody production and antimicrobial protection. A salivary gland is like a cluster of grapes with the “stem” being the duct through which saliva travels into the mouth. The salivary flow is regulated through the autonomic nervous system, most importantly, the parasympathetic division. The saliva is produced in the glandular subunit - the acinus. Upon contraction of myoepithelial cells, located along the periphery of the acinus, the saliva is secreted into the salivary ducts. If the flow is reduced or blocked due to some reason, there is a backflow resulting in accumulation of saliva behind the blockage. Due to bacterial growth, the salivary gland becomes enlarged with overlying skin redness and severe pain. This results into the inflammation of salivary gland, known as sialadenitis.

A salivary duct stone may also reduce the flow of saliva through the duct. The condition is called sialolithiasis. It usually occurs suddenly and unilaterally but can sometimes occur on both sides. It is composed mainly of calcium phosphate and calcium carbonate. A salivary stone may be a few millimeters to about two inches in size. The degree of inflammation depends on the size and location of the stone. The presence of a stone makes the gland swollen, inflamed, hard and painful due to the increased viscosity of stored secretions.

Prevention

The most effective way to prevent sialadenitis and its recurrence is to pay attention to proper dental care and oral hygiene. The disease may not be cured but the symptoms can be controlled with a good oral routine. Patients requiring management should be monitored on a daily basis; preferably twice a day. They should be encouraged to drink plenty of water and fluids during the illness and especially after surgery. Patients with xerostomia should also increase water intake. Moreover, as increased production of saliva can prevent sialadenitis and sialoliths, sour candy and appropriate beverages should be taken to stimulate production of saliva. Salivary stones identified by routine X-rays must be removed immediately. Massaging of the affected gland or dilatation of the duct with lacrimal probe is found to be helpful in removing superficial salivary stones.

Summary

Sialadenitis is the inflammation of a salivary gland. It is caused by a bacterial infection, usually from Staphylococcus aureus. It is characterized by painful swelling of the gland, reddened overlying skin, tenderness, low grade fever, malaise and edema of cheek, periorbital region and neck. It may be classified into acute, chronic and recurrent forms [1]. Submandibular gland is the most commonly affected, usually due to an obstructing stone or hyposecretion of the gland [2]. It is most common among the elderly, although it can affect people of all ages, including infants. It is treated with antibiotics.

Patient Information

Sialadenitis is inflammation of a salivary gland. It most commonly affects parotid and submandibular gland. These glands produce saliva and help in lubrication and digestion of food. Inflammation is caused by bacterial infection or obstruction by a salivary stone. The patients usually present with enlarged, swollen and painful salivary gland. With proper treatment and good oral hygiene, the disease has a good prognosis.

References

Article

  1. King HA, Koerner TA. Chronic sialadenitis. Journal of the American Medical Association. Aug 9 1958;167(15):1813-1817.
  2. Teymoortash A. [Etiopathogenesis of chronic sialadenitis of the submandibular gland]. Laryngo- rhino- otologie. Dec 2004;83(12):856-857.
  3. Seifert G. [Etiology and differential diagnosis of sialadenitis]. Laryngo- rhino- otologie. May 1995;74(5):274-281.
  4. Maier H, Tisch M. [Bacterial sialadenitis]. Hno. Mar 2010;58(3):229-236.
  5. Hayashi Y, Deguchi H, Nakahata A, Kurashima C, Utsuyama M, Hirokawa K. Autoimmune sialadenitis: possible models for Sjogren's syndrome and a common aging phenomenon. Autoimmunity. 1990;5(3):215-228.
  6. White SC, Casarett GW. Effects of irradiation on experimental autoallergic sialadenitis. Radiation research. Feb 1974;57(2):276-287.
  7. Laco J, Ryska A, Celakovsky P, Dolezalova H, Mottl R, Tucek L. Chronic sclerosing sialadenitis as one of the immunoglobulin G4-related diseases: a clinicopathological study of six cases from Central Europe. Histopathology. Jun 2011;58(7):1157-1163.
  8. Geyer JT, Ferry JA, Harris NL, et al. Chronic sclerosing sialadenitis (Kuttner tumor) is an IgG4-associated disease. The American journal of surgical pathology. Feb 2010;34(2):202-210.
  9. Orlandi MA, Pistorio V, Guerra PA. Ultrasound in sialadenitis. Journal of ultrasound. 2013;16(1):3-9.
  10. Zenk J, Iro H, Klintworth N, Lell M. Diagnostic imaging in sialadenitis. Oral and maxillofacial surgery clinics of North America. Aug 2009;21(3):275-292.
  11. Eisenbud L, Cranin N. The Role of Sialography in the Diagnosis and Therapy of Chronic Obstructive Sialadenitis. Oral surgery, oral medicine, and oral pathology. Oct 1963;16:1181-1199.
  12. Gerry RG, Seigman EL. Chronic sialadenitis and sialography. Oral surgery, oral medicine, and oral pathology. May 1955;8(5):453-478.
  13. Afanas'ev VV, Vinogradov VI. [Biopsy of the minor salivary glands in the differential diagnosis of Sjogren's syndrome and chronic sialadenitis]. Terapevticheskii arkhiv. 1988;60(4):38-39.
  14. Chou YH, Tiu CM, Li WY, et al. Chronic sclerosing sialadenitis of the parotid gland: diagnosis using color Doppler sonography and sonographically guided needle biopsy. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. Apr 2005;24(4):551-555.

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Last updated: 2017-08-09 17:28