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'''Sialadenitis''' ('''sialoadenitis''') is [[inflammation]] of [[salivary gland|salivary glands]], usually the major ones, the most common being the [[parotid gland]], followed by [[Submandibular gland|submandibular]] and [[Sublingual gland|sublingual glands]].<ref name=":4">{{Cite web|url=https://emedicine.medscape.com/article/882358-overview|title=Submandibular Sialadenitis/Sialadenosis|last=Yoskovitch|first=Adi|date=7th August 2018|website=Medscape eMedicine|archive-url=|archive-date=|dead-url=|access-date=4/12/2018}}</ref> It should not be confused with sialadenosis (sialosis) which is a non-inflammatory enlargement of the major salivary glands.<ref>{{Cite book|url=https://www.worldcat.org/oclc/567351700|title=Clinical oral medicine and pathology|last=M.|first=Bruch, Jean|date=2010|publisher=Humana Press|others=Treister, Nathaniel S.|isbn=9781603275200|location=New York|oclc=567351700}}</ref>
'''Sialadenitis''' ('''sialoadenitis''') is [[inflammation]] of a [[salivary gland]]. It may be subdivided temporally into acute, chronic and recurrent forms.

Sialadenitis can be further classed as acute or chronic. Acute sialadenitis is an acute inflammation of a salivary gland which may present itself as a red, painful swelling that is tender to touch. Chronic sialadenitis is typically less painful but presents as recurrent swellings, usually after meals, without redness.<ref name=":4" />

Causes of sialadenitis are varied, including bacterial (most commonly [[Staphylococcus aureus|Staphylococcus Aureus]]), viral and autoimmune conditions.<ref name=":4" /><ref>{{Cite book|url=http://dx.doi.org/10.1093/med/9780199679850.001.0001|title=Oxford Handbook of Clinical Dentistry|last=Mitchell|first=David|last2=Mitchell|first2=Laura|date=2014-07|publisher=Oxford University Press|isbn=9780199679850}}</ref>


==Acute==
==Acute==

Revision as of 22:23, 4 December 2018

Sialadenitis
SpecialtyOtorhinolaryngology Edit this on Wikidata

Sialadenitis (sialoadenitis) is inflammation of salivary glands, usually the major ones, the most common being the parotid gland, followed by submandibular and sublingual glands.[1] It should not be confused with sialadenosis (sialosis) which is a non-inflammatory enlargement of the major salivary glands.[2]

Sialadenitis can be further classed as acute or chronic. Acute sialadenitis is an acute inflammation of a salivary gland which may present itself as a red, painful swelling that is tender to touch. Chronic sialadenitis is typically less painful but presents as recurrent swellings, usually after meals, without redness.[1]

Causes of sialadenitis are varied, including bacterial (most commonly Staphylococcus Aureus), viral and autoimmune conditions.[1][3]

Acute

Predisposing factors
  • sialolithiasis
  • decreased flow (dehydration, post-operative, drugs)
  • poor oral hygiene
  • exacerbation of low grade chronic sialoadenitis
Clinical features
  • Painful swelling
  • Reddened skin
  • Edema of the cheek, Periorbital region and neck
  • low grade fever
  • malaise
  • raised ESR, CRP, leucocytosis
  • purulent exudate from duct punctum

Chronic

Main article: Chronic sclerosing sialadenitis
Clinical Features
  • unilateral
  • mild pain / swelling
  • common after meals
  • duct orifice is reddened and flow decreases
  • may or may not have visible/palpable stone.
  • Parotid gland
    • Recurrent painful swellings
  • Submandibular gland
Treatment

In chronic recurrent sialadenitis or chronic sclerosing sialadenitis, acute attacks are managed with conservative therapies such as hydration, analgesics (mainly NSAIDs), sialogogues to stimulate salivary secretion, and regular, gentle gland massage.[4] If infection is present, appropriate cultures should be obtained, followed by empirical antibiotic therapy initially,[4] for example amoxicillin/clavulanate or clindamycin which cover oral flora.

If there are attacks more than approximately 3 times per year or severe attacks, surgical excision of the affected gland should be considered.[4]

Aetiology and Causes

Sialadenitis can be caused by malignancy, autoimmune conditions, infective sources such as viruses and bacteria, idiopathic causes or stones formed mainly from calculus.[5] It was thought that morphological characteristics of the salivary ducts could also be a contributing factor, as stagnation of saliva due to these could perhaps cause an increased incidence of sialadenitis.[6] However, one study found no statistically significant difference between the length of ducts or the angles they incorporate within them and the likelihood of developing sialadenitis, although this study only had a small sample size of 106.[6] The study also confirmed that age, gender, side of face and degree of sialadenitis had no impact on the length of the ducts or the angles formed within the ducts.[6]

Viral pathogens more commonly cause sialadenitis in comparison to bacterial pathogens.[5] Mumps is the most common virus that affects the parotid and submandibular glands, with the parotid gland affected most often out of these two.[5] Other viruses that have been shown to cause sialadenitis in both these glands include HIV, coxsackie and parainfluenza[5]. Classically, HIV parotitis is either asymptomatic or a non-painful swelling, which is not characteristic of sialadenitis.[5] Some common bacterial causes are S. Aureus, S. Pyogenus, S. Viridans and H. Influenzae.[5]

Autoimmune conditions that can cause sialadenitis include Sjögren’s syndrome, Sarcoidosis and Wegner’s granulomatosis.[5] Sjögren’s syndrome and Sarcoidosis are the most common causes of chronic sialadenitis and are often closely associated with it, and in many cases are believed to be the primary cause, although often with other contributing factors present also.[5] One well known form of sarcoidosis is known as Heerfordt’s syndrome which is characterised by facial nerve palsy, enlargement of the parotid and anterior uveitis.[5] One study came to the conclusion that the presence of salivary calculi is the main indicator for the removal of the submandibular gland, in patients where neoplasia is absent.[7] This was because 82% of glands removed in an ENT department in Stockholm were found to have salivary calculi within them and all of these cases but one had chronic sialadenitis.[7] A mucous retention cyst was found in one patient, but this was not considered to have contributed to the sialadenitis in this case.[7]

The duration of the sialadenitis was found to be closely linked to atrophy, fibrosis and the degree of the inflammation in another study, which looked primarily at microliths found in the ducts and glands.[8] Liths were also found to be related to the duration that the individual had symptoms of sialadenitis, whereas microliths were found in normal glands and varied with age[8]. Microliths could possibly form reservoirs, thus allowing infection to ascend further towards the glands but this could not be confirmed due to the liths and microliths being distinct in this study.[8] However, many glands did show only very minimal variations, which could allow the opportunity for more conservative treatment instead of the surgical removal of the affected gland in the future.[8]

Signs and Symptoms

Sialadenitits is swelling and inflammation of the parotid, submandibular, or sublingual major salivary glands. It may be acute or chronic, infective or autoimmune.

Acute

  • Acute Sialadentitis secondary to obstruction (sialolithiasis) is characterised by increasingly, painful swelling of 24-72 hours, purulent discharge and systemic manifestations.

Chronic

  • Chronic sialadentitis causes intermittent, recurrent periods of tender swellings.  Chronic sclerosing sialadenitis is commonly unilateral and can mimic a tumour.

Autoimmune

  • Autoimmune sialadentitis (i.e Sjogren’s syndrome) causes unilateral or bilateral painless swellings unless there is a secondary infection[9].

Infection

  • The most common salivary gland infection is mumps. It is characterised by bilateral swelling of the parotid glands, however other major salivary glands may also be affected in around 10% of cases. The swelling persists for about a week, along with low grade fever and general malaise.
  • Recurrent parotitis of childhood is characterised by periods of pain and swelling in the parotid gland accompanied by a fever[10]

See also

References

  1. ^ a b c Yoskovitch, Adi (7th August 2018). "Submandibular Sialadenitis/Sialadenosis". Medscape eMedicine. Retrieved 4/12/2018. {{cite web}}: Check date values in: |access-date= and |date= (help); Cite has empty unknown parameter: |dead-url= (help)
  2. ^ M., Bruch, Jean (2010). Clinical oral medicine and pathology. Treister, Nathaniel S. New York: Humana Press. ISBN 9781603275200. OCLC 567351700.{{cite book}}: CS1 maint: multiple names: authors list (link)
  3. ^ Mitchell, David; Mitchell, Laura (2014-07). Oxford Handbook of Clinical Dentistry. Oxford University Press. ISBN 9780199679850. {{cite book}}: Check date values in: |date= (help)
  4. ^ a b c bestpractice.bmj.com > Sialadenitis Last updated: Sep 08, 2011
  5. ^ a b c d e f g h i "Sialadenitis - Causes - Clinical Features". TeachMeSurgery. Retrieved 2018-12-04T17:45:51Z. {{cite web}}: Check date values in: |access-date= (help)
  6. ^ a b c Horsburgh, A.; Massoud, T. F. (2013-1). "The role of salivary duct morphology in the aetiology of sialadenitis: statistical analysis of sialographic features". International Journal of Oral and Maxillofacial Surgery. 42 (1): 124–128. doi:10.1016/j.ijom.2012.10.006. ISSN 1399-0020. PMID 23137733. {{cite journal}}: Check date values in: |date= (help)
  7. ^ a b c Isacsson, Göran; Lundquist, Per-G. (1982-08-01). "Salivary calculi as an aetiological factor in chronic sialadenitis of the submandibular gland". Clinical Otolaryngology & Allied Sciences. 7 (4): 231–236. doi:10.1111/j.1365-2273.1982.tb01389.x. ISSN 1365-2273.
  8. ^ a b c d scholar.google.co.uk http://scholar.google.co.uk/scholar_url?url=http://www.academia.edu/download/46497427/j.1365-2559.1997.2530856.x20160614-21879-1oot9qv.pdf&hl=en&sa=X&scisig=AAGBfm1ZERo_kVpYCzthf7eLQwK49NNcYw&nossl=1&oi=scholarr. Retrieved 2018-12-04T17:52:28Z. {{cite web}}: Check date values in: |access-date= (help); Missing or empty |title= (help)
  9. ^ Avery, Chris (March 2018). "Sialadenitis". BMJ Best Practice. {{cite web}}: Cite has empty unknown parameter: |dead-url= (help)
  10. ^ Harding, Dr Mary (18 December 2015). "Salivary Gland Disorders". patient.info. {{cite web}}: Cite has empty unknown parameter: |dead-url= (help)
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