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.

• Swelling

  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. [bestpractice.bmj.com]

  Patients with recurrent swelling got irrigation for every 2 weeks and adjusted to every 4 weeks once after the swelling has gone down. [bmcoralhealth.biomedcentral.com]

  Iodide sialadenitis is a rare late reaction to intravascular administration of iodine-containing contrast material leading to abnormal swelling of the salivary glands. [revportcardiol.org]

  Chronic sclerosing sialadenitis presents as a painless unilateral swelling that can mimic tumors. Biopsy is required for diagnosis. Airway compromise is an important potential consequence of acute glandular swelling. [online.epocrates.com]

  The other patient also showed bilateral and painless swelling of the submandibular glands, but there was no involvement of any other organs. [ncbi.nlm.nih.gov]

• Pain

  […] 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]

  Stenson's (parotid glands) Pt will present with postprandial salivary gland pain and swelling. [smartypance.com]

  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 [bestpractice.bmj.com]

  The presence of a stone makes the gland swollen, inflamed, hard and painful due to the increased viscosity of stored secretions. [symptoma.com]

  Noninfectious cases typically present with pain upon eating and swallowing. A bacterial infectious etiology is associated with odynophagia, but also includes persistent pain and tenderness. This presents as pain associated with eating. [mdedge.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]

  Penetrating injuries Blunt injuries Radiation injury Swelling, pain, fever, and erythema of the affected gland. [pedemmorsels.com]

  It usually begins approximately 48 hours after the start of other symptoms such as fever and headache. [webmd.com]

• Chills

  She reported no fevers, chills, or any other complaints, and had no pertinent medical history—specifically, no history of recent dental work. Her surgical history included tonsillectomy and cholecystectomy. [mdedge.com]

  Other symptoms include fever and chills, which are general signs of infection. Main symptoms Pain and swelling near the ears, in the mouth, or under the jaw (depending on which glands are involved). Decreased saliva production. Dry mouth. [buoyhealth.com]

  If the infection spreads, you may experience chills or a fever. [empowher.com]

• Malaise

  The influenza A virus has accounted for the majority of influenza infections in the 2017 to 2018 flu season, with the typical clinical presentation including fever, myalgias, malaise, and nonproductive cough. [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]

• 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]

  (J Craniofac Surg 2016;27:e233) 9 year old boy with parotid swelling (Arch Otolaryngol Head Neck Surg 1995;121:1426) 14 year old girl presents with facial swelling after orthodontic treatment (J Orthod 2012;39:314) 50 year old woman develops parotid [pathologyoutlines.com]

  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]

  Sialolithiasis is often present (causing obstructive sialadenitis) and stones are found in ~85% of submandibular ducts and ~15% of parotid ducts 1,7,9. [radiopaedia.org]

• Parotid Mass

  FNAC of palpable lymph node is mandatory for parotid mass where FNAC of parotid is inconclusive. [jhrr.org]

  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]

  Tuberculosis of the parotid gland: Computed tomographic findings. Acta Radiol 2008 ; 49: 458 – 461. Google Scholar | SAGE Journals | ISI 26. Petrogiannopoulos, C, Valla, K, Mikelis, A. Parotid mass due to cat scratch disease. [journals.sagepub.com]

  Neoplasms BENIGN Benign neoplasms of the salivary glands typically present as painless, asymptomatic, slow-growing neck or parotid masses ( Figure 6 ). [aafp.org]

• Malocclusion

  New material also includes the impact of bisphosphonates, and new approaches to the management of Class III malocclusions in the growing child. [doi.org]

  – Jaw joints, chewing muscles and bite abnormalities Bruxism Condylar resorption Mandibular dislocation Malocclusion Crossbite Open bite Overbite Overeruption Overjet Prognathia Retrognathia Scissor bite Maxillary hypoplasia Temporomandibular joint dysfunction [en.wikipedia.org]

• Salivary Gland Pain

  Salivary stones – most common in Wharton's duct (submandibular gland). Stenson's (parotid glands) Pt will present with postprandial salivary gland pain and swelling. [smartypance.com]

• Neck Pain

  She had never experienced pain while swallowing. The pain during swallowing was not in her throat or her esophagus, but rather on the right side of her neck where the swelling was. [cureus.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]

  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]

  Penetrating injuries Blunt injuries Radiation injury Swelling, pain, fever, and erythema of the affected gland. [pedemmorsels.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. [merckmanuals.com]

• 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]

  The symptoms of sialadenitis can include: Swelling in the cheek and neck region, especially after eating Mouth or facial pain Dry mouth Foul taste or gritty feeling in the mouth Fever Chills Redness over the side of the face or upper neck Pus in the mouth [centuryearnosethroat.com]

  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]

  Pain or discomfort when opening the mouth or eating. Mouth dryness is a common sign and symptom of sialadenitis. Pus in the mouth. Pain in the mouth. Facial pain. Facial swelling or swelling in the neck. [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]

  Physical examination:palpable, firm, nontender, 2cm mass in the left submandibular gland. No other neck masses or palpable lymph nodes. [medicine.uiowa.edu]

  Benign and malignant tumors can occur in the salivary glands and usually present as a painless solitary neck mass. [aafp.org]

• Preauricular Swelling

  As in our case the history of initial appearance of swelling and erythema were in the preauricular area which then progressed subsequently to involve the submandibular and submental area. The disease may be unilateral or bilateral. [jcnonweb.com]

• Facial Edema

  Massive facial edema and airway obstruction secondary to acute postoperative sialadenitis or “anesthesia mumps”: A case report. J Med Case Rep 2009;3:7073. 4. Singha SK, Chatterjee N. [ijaweb.org]

• Slurred Speech

  Slurring speech – mild pharynx palsy of left side. No bubbling or pooling of saliva in mouth. No fluid regurgitation of fluid through nose. No hoarseness 12 th nerve Tongue deviates to left side on protrusion. [similima.com]

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.

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.

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.

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.

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.

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.

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.

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.

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.

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