Sialadenitis: Difference between revisions

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{{SK}}Sialadenitis, salivary gland inflammation


==Overview ==
==Overview ==
Sialadenitis is a condition of [[inflammation]] of a [[salivary gland]]. The causes of sialadenitis include bacterial and viral infections such as mumps and HIV, obstruction from stones or radiation, and autoimmune disorders such as Sjogren's syndrome. The complications of sialadenitis include recurrence, abscess, and chronic sialadenitis. Sialadenitis must be differentiated from other diseases that cause swelling in [[Salivary gland|salivary glands]], such as [[sialolithiasis]], [[Human Immunodeficiency Virus (HIV)|human immunodeficiency viru]]<nowiki/>s, [[Radiation therapy|radiation]], and systemic diseases such as, [[sarcoidosis]], and [[sjögren's syndrome]]. History from the patient will reveal symptoms of sialadenitis that include fever, and difficulty in opening the mouth. The diagnosis of choice is a high resolution CT scan. Sialoendoscopy can be used in the diagnosis of small stones and differentiate them from polyps.  Conservative treatment is the first line of therapy in the most patients and it involves [[Hydration]], applying moist heat, massaging the gland, duct milking, discontinuation of medication that decrease the saliva flow, such as the [[Tricyclic anti-depressant|TCAs]] because of their [[anticholinergic]] effects, and antibiotics usage for the infection. Preferred regimen [[Dicloxacillin]] 500 mg q 6h PO for 7 to 10 days or [[Cephalexin]] 500 mg q 6h PO for 7 to 10 days.
Sialadenitis is the [[inflammation]] of a [[salivary gland]]. The causes of sialadenitis include [[Bacteria|bacterial]] and [[Virus|viral]] infections, such as [[mumps]] and [[Human Immunodeficiency Virus (HIV)|HIV]], obstruction from stones or [[Radiation therapy|radiation]], and [[autoimmune]] disorders such as [[Sjögren's syndrome|Sjogren's syndrome]]. The complications of sialadenitis include recurrence, [[abscess]], and chronic sialadenitis. Sialadenitis must be differentiated from other diseases that can cause swelling in the [[Salivary gland|salivary glands]], such as [[sialolithiasis]], [[Human Immunodeficiency Virus (HIV)|human immunodeficiency viru]]<nowiki/>s, [[Radiation therapy|radiation]], and systemic diseases such as, [[sarcoidosis]], and [[sjögren's syndrome]]. History from the patient will reveal symptoms of sialadenitis that include [[fever]], redness of overlying [[skin]], [[pain]], and difficulty in opening the mouth. The diagnosis of choice is a high resolution [[Computed tomography|CT scan]]. Sialoendoscopy can be used in the diagnosis of small stones and differentiate them from [[Polyp|polyps]].  Conservative treatment is the first line of therapy in the most patients and it involves [[Hydration]], applying moist heat, massaging the gland, duct milking, discontinuation of medication that can decrease the [[saliva]] flow, such as the [[Tricyclic anti-depressant|TCAs]] (because of their [[anticholinergic]] effects). Also, [[Antibiotic|antibiotics]] can be used in the case of superimposed infection. Preferred regimens are [[Dicloxacillin]] 500 mg q 6h PO for 7 to 10 days, or [[Cephalexin]] 500 mg q 6h PO for 7 to 10 days.


==Historical Perspective==
==Historical Perspective==
The historical perspective of sialadenitis is as follows:<ref name="ErkulGillespie2016">{{cite journal|last1=Erkul|first1=Evren|last2=Gillespie|first2=M. Boyd|title=Sialendoscopy for non-stone disorders: The current evidence|journal=Laryngoscope Investigative Otolaryngology|volume=1|issue=5|year=2016|pages=140–145|issn=23788038|doi=10.1002/lio2.33}}</ref>
The historical perspective of sialadenitis is as follows:<ref name="ErkulGillespie2016">{{cite journal|last1=Erkul|first1=Evren|last2=Gillespie|first2=M. Boyd|title=Sialendoscopy for non-stone disorders: The current evidence|journal=Laryngoscope Investigative Otolaryngology|volume=1|issue=5|year=2016|pages=140–145|issn=23788038|doi=10.1002/lio2.33}}</ref>


*In 17th century, major salivary gland ductal system in anatomical human studies was first reported.
*In 17th century, major salivary gland ductal system in anatomical [[human]] studies was first reported.
*In 1990, , Konigsberger et al. performed the first successful salivary endoscopy.<ref name="LydiattBucher2012">{{cite journal|last1=Lydiatt|first1=Daniel D.|last2=Bucher|first2=Gregory S.|title=The historical evolution of the understanding of the submandibular and sublingual salivary glands|journal=Clinical Anatomy|volume=25|issue=1|year=2012|pages=2–11|issn=08973806|doi=10.1002/ca.22007}}</ref>  
*In 1990, , Konigsberger et al. performed the first successful [[Salivary gland enlargement|salivary]] endoscopy.<ref name="LydiattBucher2012">{{cite journal|last1=Lydiatt|first1=Daniel D.|last2=Bucher|first2=Gregory S.|title=The historical evolution of the understanding of the submandibular and sublingual salivary glands|journal=Clinical Anatomy|volume=25|issue=1|year=2012|pages=2–11|issn=08973806|doi=10.1002/ca.22007}}</ref>  
*In 2004, Zenk et al. reported the use of semirigid sialendoscope in different types of obstructive salivary disorders.<ref name="ZenkKoch2004">{{cite journal|last1=Zenk|first1=J|last2=Koch|first2=M|last3=Bozzato|first3=A|last4=Iro|first4=H|title=Sialoscopy—initial experiences with a new endoscope|journal=British Journal of Oral and Maxillofacial Surgery|volume=42|issue=4|year=2004|pages=293–298|issn=02664356|doi=10.1016/j.bjoms.2004.03.006}}</ref>
*In 2004, Zenk et al. reported the use of semirigid sialendoscope in different types of obstructive [[Salivary gland enlargement|salivary]] disorders.<ref name="ZenkKoch2004">{{cite journal|last1=Zenk|first1=J|last2=Koch|first2=M|last3=Bozzato|first3=A|last4=Iro|first4=H|title=Sialoscopy—initial experiences with a new endoscope|journal=British Journal of Oral and Maxillofacial Surgery|volume=42|issue=4|year=2004|pages=293–298|issn=02664356|doi=10.1016/j.bjoms.2004.03.006}}</ref>
*In 2006, Nahlieli et al. described sialendoscopy in the management of radioiodine sialadenitis.<ref name="pmid7965326">{{cite journal| author=Nahlieli O, Neder A, Baruchin AM| title=Salivary gland endoscopy: a new technique for diagnosis and treatment of sialolithiasis. | journal=J Oral Maxillofac Surg | year= 1994 | volume= 52 | issue= 12 | pages= 1240-2 | pmid=7965326 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7965326  }} </ref>
*In 2006, Nahlieli et al. described sialendoscopy in the management of [[Iodine-131|radioiodine]] sialadenitis.<ref name="pmid7965326">{{cite journal| author=Nahlieli O, Neder A, Baruchin AM| title=Salivary gland endoscopy: a new technique for diagnosis and treatment of sialolithiasis. | journal=J Oral Maxillofac Surg | year= 1994 | volume= 52 | issue= 12 | pages= 1240-2 | pmid=7965326 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7965326  }} </ref>


==Classification==
==Classification==
*There is no established system for the classification of sialadenitis, but may be classified according to location of the stone.<ref name="pmid179578462">{{cite journal |vauthors=Capaccio P, Torretta S, Ottavian F, Sambataro G, Pignataro L |title=Modern management of obstructive salivary diseases |journal=Acta Otorhinolaryngol Ital |volume=27 |issue=4 |pages=161–72 |year=2007 |pmid=17957846 |pmc=2640028 |doi= |url=}}</ref>  
*There is no established system for the classification of sialadenitis, but it can be classified according to location of the stone.<ref name="pmid179578462">{{cite journal |vauthors=Capaccio P, Torretta S, Ottavian F, Sambataro G, Pignataro L |title=Modern management of obstructive salivary diseases |journal=Acta Otorhinolaryngol Ital |volume=27 |issue=4 |pages=161–72 |year=2007 |pmid=17957846 |pmc=2640028 |doi= |url=}}</ref>  
{| class="wikitable"
{| class="wikitable"
!Gland  
!Gland  
!Percent of stones
!%
|-
|-
|[[Submandibular gland|Submandibular glands]]
|[[Submandibular gland|Submandibular glands]]
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|1 to 2
|1 to 2
|}
|}
* [[Submandibular gland|Submandibular]] stones can be classified further as [[anterior]] or [[posterior]] in relation to the mandibular first [[Molar (tooth)|molar]] teeth.
* [[Submandibular gland|Submandibular]] stones can be classified further as [[anterior]], or [[posterior]] in relation to the mandibular first [[Molar (tooth)|molar]] teeth.
* Stones may be [[radiopaque]], where they be visible on [[Radiograph|radiographs]] or radiolucent where they will not show up on [[radiography]]  
* Stones may be [[radiopaque]], where they can be radiopaque or radiolucent.  
* Stones may also be [[symptomatic]] or [[asymptomatic]].
* Stones may also be [[symptomatic]] or [[asymptomatic]].


==Pathophysiology==
==Pathophysiology==
*Sialadenitis is a condition of [[inflammation]] of a [[salivary gland]]. <ref>{{Cite journal|last=Loury|first=MC|date=2006|title=Salivary gland disorder|url=|journal=Advanced Otolaryngology|volume=|pages=|via=}}</ref>
*Sialadenitis is the [[inflammation]] of a [[salivary gland]]. <ref>{{Cite journal|last=Loury|first=MC|date=2006|title=Salivary gland disorder|url=|journal=Advanced Otolaryngology|volume=|pages=|via=}}</ref>
*[[Swelling]] is usually present in this condition.
*[[Swelling]] is usually present in this condition.
*Acute sialadenitis may be caused by viral or bacterial infection<ref name="pmid3318353">{{cite journal |vauthors=McKenna JP, Bostock DJ, McMenamin PG |title=Sialolithiasis |journal=Am Fam Physician |volume=36 |issue=5 |pages=119–25 |year=1987 |pmid=3318353 |doi= |url=}}</ref>
*Acute sialadenitis may be caused by [[Virus|viral]] or bacterial infection<ref name="pmid3318353">{{cite journal |vauthors=McKenna JP, Bostock DJ, McMenamin PG |title=Sialolithiasis |journal=Am Fam Physician |volume=36 |issue=5 |pages=119–25 |year=1987 |pmid=3318353 |doi= |url=}}</ref>
**[[Parotid gland|Parotid]] and [[submandibular gland]]<nowiki/>s are more involved in acute sialadenitis. approximately 10% sialadenitis cases are related to involvement of submandibular gland.
**[[Parotid gland|Parotid]] and [[submandibular gland]]<nowiki/>s are more involved in acute sialadenitis. Approximately 10% sialadenitis cases are related to the involvement of submandibular gland.
*Chronic sialadenitis is caused by repeated episodes of [[inflammation]] and finally it progresses in to salivary gland dysfucntion.
*Chronic sialadenitis is caused by repeated episodes of [[inflammation]] and finally it progresses in to salivary gland dysfunction.


==Causes==
==Causes==
Common causes of sialadenitis include the following:
Common causes of sialadenitis include the following:


Bacterial and viral infections<ref name="pmid20204311">{{cite journal |vauthors=Maier H, Tisch M |title=[Bacterial sialadenitis] |language=German |journal=HNO |volume=58 |issue=3 |pages=229–36 |year=2010 |pmid=20204311 |doi=10.1007/s00106-009-2078-x |url=}}</ref>
[[Bacteria|Bacterial]] and [[viral]] infections:<ref name="pmid20204311">{{cite journal |vauthors=Maier H, Tisch M |title=[Bacterial sialadenitis] |language=German |journal=HNO |volume=58 |issue=3 |pages=229–36 |year=2010 |pmid=20204311 |doi=10.1007/s00106-009-2078-x |url=}}</ref>
*Mumps
*[[Mumps]]
*HIV
*[[Human Immunodeficiency Virus (HIV)|HIV]]
*Staph aureus
*[[Staphylococcus aureus|Staph aureus]]
*Streptococci
*[[Streptococci|Streptococci viridans]]
*Pseudomona aeruginosa
*[[Pseudomonas|Pseudomonas aeruginosa]]
*Escherichia coli
*[[Escherichia coli]]
*Moraxella catarrhalis
*[[Moraxella catarrhalis]]
*Tuberculosis<ref name="pmid202043112">{{cite journal |vauthors=Maier H, Tisch M |title=[Bacterial sialadenitis] |language=German |journal=HNO |volume=58 |issue=3 |pages=229–36 |year=2010 |pmid=20204311 |doi=10.1007/s00106-009-2078-x |url=}}</ref>
*[[Tuberculosis]]<ref name="pmid202043112">{{cite journal |vauthors=Maier H, Tisch M |title=[Bacterial sialadenitis] |language=German |journal=HNO |volume=58 |issue=3 |pages=229–36 |year=2010 |pmid=20204311 |doi=10.1007/s00106-009-2078-x |url=}}</ref>
Obstruction
Obstruction:
*Stones
*Stones
*Radiation
*[[Radiation injury|Radiation]]
*Strictures
*[[Stenosis|Strictures]]
*Sarcoidosis
*[[Sarcoidosis]]
Autoimmune disorders
[[Autoimmunity|Autoimmune]] disorders:
* Sjogrens
* [[Sjögren's syndrome|Sjogren's syndrome]]


==Differentiating sialadenitis from Other Diseases==
==Differentiating sialadenitis from Other Diseases==
*Sialadenitis must be differentiated from other diseases that cause swelling in [[Salivary gland|salivary glands]], such as [[sialolithiasis]], [[Human Immunodeficiency Virus (HIV)|human immunodeficiency viru]]<nowiki/>s, [[Radiation therapy|radiation]], and systemic diseases such as, [[sarcoidosis]], and [[sjögren's syndrome]].<ref name="pmid24862601">{{cite journal |vauthors=Delli K, Spijkervet FK, Vissink A |title=Salivary gland diseases: infections, sialolithiasis and mucoceles |journal=Monogr Oral Sci |volume=24 |issue= |pages=135–48 |year=2014 |pmid=24862601 |doi=10.1159/000358794 |url=}}</ref><ref name="pmid248626012">{{cite journal |vauthors=Delli K, Spijkervet FK, Vissink A |title=Salivary gland diseases: infections, sialolithiasis and mucoceles |journal=Monogr Oral Sci |volume=24 |issue= |pages=135–48 |year=2014 |pmid=24862601 |doi=10.1159/000358794 |url=}}</ref><ref name="pmid28516973">{{cite journal |vauthors=Capaccio P, Torretta S, Pignataro L, Koch M |title=Salivary lithotripsy in the era of sialendoscopy |journal=Acta Otorhinolaryngol Ital |volume=37 |issue=2 |pages=113–121 |year=2017 |pmid=28516973 |pmc=5463518 |doi=10.14639/0392-100X-1600 |url=}}</ref><ref name="pmid20824782">{{cite journal |vauthors=Wallace E, Tauzin M, Hagan J, Schaitkin B, Walvekar RR |title=Management of giant sialoliths: review of the literature and preliminary experience with interventional sialendoscopy |journal=Laryngoscope |volume=120 |issue=10 |pages=1974–8 |year=2010 |pmid=20824782 |doi=10.1002/lary.21082 |url=}}</ref><ref name="pmid208247822">{{cite journal |vauthors=Wallace E, Tauzin M, Hagan J, Schaitkin B, Walvekar RR |title=Management of giant sialoliths: review of the literature and preliminary experience with interventional sialendoscopy |journal=Laryngoscope |volume=120 |issue=10 |pages=1974–8 |year=2010 |pmid=20824782 |doi=10.1002/lary.21082 |url=}}</ref><ref>{{Cite journal|last=Loury|first=MC|date=2006|title=Salivary gland disorder|url=|journal=Advanced Otolaryngology|volume=|pages=|via=}}</ref><ref name="pmid2385766">{{cite journal |vauthors=Raad II, Sabbagh MF, Caranasos GJ |title=Acute bacterial sialadenitis: a study of 29 cases and review |journal=Rev. Infect. Dis. |volume=12 |issue=4 |pages=591–601 |year=1990 |pmid=2385766 |doi= |url=}}</ref><ref name="pmid9747195">{{cite journal |vauthors=Silvers AR, Som PM |title=Salivary glands |journal=Radiol. Clin. North Am. |volume=36 |issue=5 |pages=941–66, vi |year=1998 |pmid=9747195 |doi= |url=}}</ref>
*Sialadenitis must be differentiated from other diseases that cause swelling in [[Salivary gland|salivary glands]], such as [[sialolithiasis]], [[Human Immunodeficiency Virus (HIV)|human immunodeficiency viru]]<nowiki/>s, [[Radiation therapy|radiation]], and systemic diseases such as, [[sarcoidosis]], and [[sjögren's syndrome]].<ref name="pmid24862601">{{cite journal |vauthors=Delli K, Spijkervet FK, Vissink A |title=Salivary gland diseases: infections, sialolithiasis and mucoceles |journal=Monogr Oral Sci |volume=24 |issue= |pages=135–48 |year=2014 |pmid=24862601 |doi=10.1159/000358794 |url=}}</ref><ref name="pmid248626012">{{cite journal |vauthors=Delli K, Spijkervet FK, Vissink A |title=Salivary gland diseases: infections, sialolithiasis and mucoceles |journal=Monogr Oral Sci |volume=24 |issue= |pages=135–48 |year=2014 |pmid=24862601 |doi=10.1159/000358794 |url=}}</ref><ref name="pmid28516973">{{cite journal |vauthors=Capaccio P, Torretta S, Pignataro L, Koch M |title=Salivary lithotripsy in the era of sialendoscopy |journal=Acta Otorhinolaryngol Ital |volume=37 |issue=2 |pages=113–121 |year=2017 |pmid=28516973 |pmc=5463518 |doi=10.14639/0392-100X-1600 |url=}}</ref><ref name="pmid20824782">{{cite journal |vauthors=Wallace E, Tauzin M, Hagan J, Schaitkin B, Walvekar RR |title=Management of giant sialoliths: review of the literature and preliminary experience with interventional sialendoscopy |journal=Laryngoscope |volume=120 |issue=10 |pages=1974–8 |year=2010 |pmid=20824782 |doi=10.1002/lary.21082 |url=}}</ref><ref name="pmid208247822">{{cite journal |vauthors=Wallace E, Tauzin M, Hagan J, Schaitkin B, Walvekar RR |title=Management of giant sialoliths: review of the literature and preliminary experience with interventional sialendoscopy |journal=Laryngoscope |volume=120 |issue=10 |pages=1974–8 |year=2010 |pmid=20824782 |doi=10.1002/lary.21082 |url=}}</ref><ref>{{Cite journal|last=Loury|first=MC|date=2006|title=Salivary gland disorder|url=|journal=Advanced Otolaryngology|volume=|pages=|via=}}</ref><ref name="pmid2385766">{{cite journal |vauthors=Raad II, Sabbagh MF, Caranasos GJ |title=Acute bacterial sialadenitis: a study of 29 cases and review |journal=Rev. Infect. Dis. |volume=12 |issue=4 |pages=591–601 |year=1990 |pmid=2385766 |doi= |url=}}</ref><ref name="pmid9747195">{{cite journal |vauthors=Silvers AR, Som PM |title=Salivary glands |journal=Radiol. Clin. North Am. |volume=36 |issue=5 |pages=941–66, vi |year=1998 |pmid=9747195 |doi= |url=}}</ref>
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
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| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Submandibular gland
| style="background: #F5F5F5; padding: 5px;" |[[Submandibular gland]]
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |Radio-opaque in X-ray
| style="background: #F5F5F5; padding: 5px;" |Radio-opaque in [[X-rays|X-ray]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Acute bacterial sialadenitis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sialadenitis|Acute bacterial sialadenitis]]
| style="background: #F5F5F5; padding: 5px;" |Acute
| style="background: #F5F5F5; padding: 5px;" |Acute
| style="background: #F5F5F5; padding: 5px;" |Unilateral
| style="background: #F5F5F5; padding: 5px;" |Unilateral
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| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |Parotid
| style="background: #F5F5F5; padding: 5px;" |[[Parotid gland|Parotid]]
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |Other sign of infection may be present
| style="background: #F5F5F5; padding: 5px;" |Other sign of [[infection]] may be present
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Chronic bacterial sialadenitis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sialadenitis|Chronic bacterial sialadenitis]]
| style="background: #F5F5F5; padding: 5px;" |Chronic
| style="background: #F5F5F5; padding: 5px;" |Chronic
| style="background: #F5F5F5; padding: 5px;" |Unilateral
| style="background: #F5F5F5; padding: 5px;" |Unilateral
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| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |Parotid
| style="background: #F5F5F5; padding: 5px;" |[[Parotid gland|Parotid]]
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |Other sign of infection may be present
| style="background: #F5F5F5; padding: 5px;" |Other sign of [[infection]] may be present
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Viral sialadenitis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sialadenitis|Viral sialadenitis]]
| style="background: #F5F5F5; padding: 5px;" |Acute
| style="background: #F5F5F5; padding: 5px;" |Acute
| style="background: #F5F5F5; padding: 5px;" |Bilateral
| style="background: #F5F5F5; padding: 5px;" |Bilateral
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| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Parotid
| style="background: #F5F5F5; padding: 5px;" |[[Parotid gland|Parotid]]
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |Coryza symptoms
| style="background: #F5F5F5; padding: 5px;" |[[Coryza|Coryza symptoms]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Human immunodeficiency virus
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]]
| style="background: #F5F5F5; padding: 5px;" |Acute
| style="background: #F5F5F5; padding: 5px;" |Acute
| style="background: #F5F5F5; padding: 5px;" |Bilateral
| style="background: #F5F5F5; padding: 5px;" |Bilateral
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| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Parotid  
| style="background: #F5F5F5; padding: 5px;" |[[Parotid gland|Parotid]]
| style="background: #F5F5F5; padding: 5px;" |NL
| style="background: #F5F5F5; padding: 5px;" |NL
| style="background: #F5F5F5; padding: 5px;" |NL
| style="background: #F5F5F5; padding: 5px;" |NL
| style="background: #F5F5F5; padding: 5px;" |Other systemic findings of HIV/ check ELIZA
| style="background: #F5F5F5; padding: 5px;" |Other systemic findings of [[Human Immunodeficiency Virus (HIV)|HIV]]/ check [[ELISA]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Radiation sialadenitis
| style="background: #DCDCDC; padding: 5px; text-align: center;" | Radiation [[sialadenitis]]
| style="background: #F5F5F5; padding: 5px;" |Acute
| style="background: #F5F5F5; padding: 5px;" |Acute
| style="background: #F5F5F5; padding: 5px;" |Unilateral
| style="background: #F5F5F5; padding: 5px;" |Unilateral
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| style="background: #F5F5F5; padding: 5px;" |NL
| style="background: #F5F5F5; padding: 5px;" |NL
| style="background: #F5F5F5; padding: 5px;" |NL
| style="background: #F5F5F5; padding: 5px;" |NL
| style="background: #F5F5F5; padding: 5px;" |History of radiation in the salivary gland site
| style="background: #F5F5F5; padding: 5px;" |History of [[Radiation therapy|radiation]] in the [[salivary gland]] site
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Salivary gland tumors
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Salivary gland tumor|Salivary gland tumors]]
| style="background: #F5F5F5; padding: 5px;" |Subacute
| style="background: #F5F5F5; padding: 5px;" |Subacute
| style="background: #F5F5F5; padding: 5px;" |Unilateral
| style="background: #F5F5F5; padding: 5px;" |Unilateral
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| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Parotid
| style="background: #F5F5F5; padding: 5px;" |[[Parotid gland|Parotid]]
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |Advance age
| style="background: #F5F5F5; padding: 5px;" |Advance age
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Sarcoidosis
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sarcoidosis]]
| style="background: #F5F5F5; padding: 5px;" |Gradual
| style="background: #F5F5F5; padding: 5px;" |Gradual
| style="background: #F5F5F5; padding: 5px;" |Bilateral
| style="background: #F5F5F5; padding: 5px;" |Bilateral
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| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Parotid
| style="background: #F5F5F5; padding: 5px;" |[[Parotid gland|Parotid]]
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" |Systemic findings in other organs
| style="background: #F5F5F5; padding: 5px;" |Systemic findings in other organs
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Sjögren's syndrome
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sjögren's syndrome]]
| style="background: #F5F5F5; padding: 5px;" |Gradual
| style="background: #F5F5F5; padding: 5px;" |Gradual
| style="background: #F5F5F5; padding: 5px;" |Bilateral
| style="background: #F5F5F5; padding: 5px;" |Bilateral
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| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Parotid or submandibular glands
| style="background: #F5F5F5; padding: 5px;" |[[Parotid gland|Parotid]] or [[Submandibular gland|submandibular glands]]
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |↑/NL
| style="background: #F5F5F5; padding: 5px;" |Dry eye/dry mouth
| style="background: #F5F5F5; padding: 5px;" |Dry eye/dry mouth
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Malnutrition
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Malnutrition]]
| style="background: #F5F5F5; padding: 5px;" |Gradual
| style="background: #F5F5F5; padding: 5px;" |Gradual
| style="background: #F5F5F5; padding: 5px;" |Bilateral
| style="background: #F5F5F5; padding: 5px;" |Bilateral
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| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Parotid
| style="background: #F5F5F5; padding: 5px;" |[[Parotid gland|Parotid]]
| style="background: #F5F5F5; padding: 5px;" |NL
| style="background: #F5F5F5; padding: 5px;" |NL
| style="background: #F5F5F5; padding: 5px;" |NL
| style="background: #F5F5F5; padding: 5px;" |NL
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==Epidemiology and Demographics==
==Epidemiology and Demographics==
*The exact prevalence of submandibular sialadenitis is unclear.  
*The exact [[prevalence]] of [[Submandibular gland|submandibular]] sialadenitis is unclear.  


*The incidence of acute sialadenitis is approximately 27.5 per 1,000,000 individuals in United Kingdom.<ref name="pmid10365495">{{cite journal| author=Escudier MP, McGurk M| title=Symptomatic sialoadenitis and sialolithiasis in the English population, an estimate of the cost of hospital treatment. | journal=Br Dent J | year= 1999 | volume= 186 | issue= 9 | pages= 463-6 | pmid=10365495 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10365495  }} </ref>
*The incidence of acute sialadenitis is approximately 275 per 100,000 individuals in United Kingdom.<ref name="pmid10365495">{{cite journal| author=Escudier MP, McGurk M| title=Symptomatic sialoadenitis and sialolithiasis in the English population, an estimate of the cost of hospital treatment. | journal=Br Dent J | year= 1999 | volume= 186 | issue= 9 | pages= 463-6 | pmid=10365495 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10365495  }} </ref>


*Patients of all age groups may develop sialadenitis.
*Patients of all age groups may develop sialadenitis.


*Sialadenitis commonly affects older, dehydrated patients.
*Sialadenitis commonly affects older and [[Dehydration|dehydrated]] patients.


==Risk Factors==
==Risk Factors==
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*[[Diuretic|Diuretics]]
*[[Diuretic|Diuretics]]
*Local [[trauma]]
*Local [[trauma]]
*[[Sjögren's syndrome|Sjögrens]]
*[[Sjögren's syndrome]]
*[[Gout]]
*[[Gout]]
*[[Anticholinergic]] medications
*[[Anticholinergic]] medications
*Smoking
*[[Smoking]]
*History of [[nephrolithiasis]]
*History of [[nephrolithiasis]]
*Chronic [[periodontal disease]]
*Chronic [[periodontal disease]]
*Head and neck [[radiotherapy]]<ref name="pmid11991308">{{cite journal |vauthors=Ship JA |title=Diagnosing, managing, and preventing salivary gland disorders |journal=Oral Dis |volume=8 |issue=2 |pages=77–89 |year=2002 |pmid=11991308 |doi= |url=}}</ref>
*[[Head]] and [[neck]] [[radiotherapy]]<ref name="pmid11991308">{{cite journal |vauthors=Ship JA |title=Diagnosing, managing, and preventing salivary gland disorders |journal=Oral Dis |volume=8 |issue=2 |pages=77–89 |year=2002 |pmid=11991308 |doi= |url=}}</ref>
===Less Common Risk Factors===
*Less common risk factors in the development of sialolithiasis include:
**[[Hypercalcemia]]<ref name="pmid11328848">{{cite journal |vauthors=Paterson JR, Murphy MJ |title=Bones, groans, moans... and salivary stones? |journal=J. Clin. Pathol. |volume=54 |issue=5 |pages=412 |year=2001 |pmid=11328848 |pmc=1731434 |doi= |url=}}</ref>
**Being elderly<ref name="pmid2945851">{{cite journal |vauthors=Eigner TL, Jastak JT, Bennett WM |title=Achieving oral health in patients with renal failure and renal transplants |journal=J Am Dent Assoc |volume=113 |issue=4 |pages=612–6 |year=1986 |pmid=2945851 |doi= |url=}}</ref>
**[[Renal impairment]]<ref name="pmid7930927">{{cite journal |vauthors=Sharma RK, al-Khalifa S, Paulose KO, Ahmed N |title=Parotid duct stone--removal by a dormia basket |journal=J Laryngol Otol |volume=108 |issue=8 |pages=699–701 |year=1994 |pmid=7930927 |doi= |url=}}</ref>
 
==Screening==
==Screening==
There is insufficient evidence to recommend routine screening for sialadenitis.
There is insufficient evidence to recommend routine screening for sialadenitis.
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==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
===Natural History===
===Natural History===
*If left untreated, patients with sialadeitis may progress to develop secondary infection and chronic sialadenitis including gland atrophy.<ref name="pmid2765834">{{cite journal |vauthors=Briffa NP, Callum KG |title=Use of an embolectomy catheter to remove a submandibular duct stone |journal=Br J Surg |volume=76 |issue=8 |pages=814 |year=1989 |pmid=2765834 |doi= |url=}}</ref>
*If left untreated, patients with sialadeitis may progress to develop secondary [[infection]] and chronic sialadenitis including gland [[atrophy]].<ref name="pmid2765834">{{cite journal |vauthors=Briffa NP, Callum KG |title=Use of an embolectomy catheter to remove a submandibular duct stone |journal=Br J Surg |volume=76 |issue=8 |pages=814 |year=1989 |pmid=2765834 |doi= |url=}}</ref>


===Complications===
===Complications===
*Common complications of sialadenitis include:<ref name="pmid22888457">{{cite journal |vauthors=Chandak R, Degwekar S, Chandak M, Rawlani S |title=Acute submandibular sialadenitis-a case report |journal=Case Rep Dent |volume=2012 |issue= |pages=615375 |year=2012 |pmid=22888457 |pmc=3409526 |doi=10.1155/2012/615375 |url=}}</ref>
*Common complications of sialadenitis include:<ref name="pmid22888457">{{cite journal |vauthors=Chandak R, Degwekar S, Chandak M, Rawlani S |title=Acute submandibular sialadenitis-a case report |journal=Case Rep Dent |volume=2012 |issue= |pages=615375 |year=2012 |pmid=22888457 |pmc=3409526 |doi=10.1155/2012/615375 |url=}}</ref>
**Recurrence
**Recurrence
**Abscess
**[[Abscess]]
**Cellulitis
**[[Cellulitis]]


===Prognosis===
===Prognosis===
*Prognosis is generally good with fluid management and antimicrobial therapy, but edema in the gland may persist for several weeks. <ref name="pmid2385766">{{cite journal |vauthors=Raad II, Sabbagh MF, Caranasos GJ |title=Acute bacterial sialadenitis: a study of 29 cases and review |journal=Rev. Infect. Dis. |volume=12 |issue=4 |pages=591–601 |year=1990 |pmid=2385766 |doi= |url=}}</ref> Very small number of patients with sialadenitis may develop cellulitis, abscess and compromised airway.
*Prognosis is generally good with fluid management and [[antimicrobial]] therapy, but [[edema]] in the gland may persist for several weeks.<ref name="pmid2385766">{{cite journal |vauthors=Raad II, Sabbagh MF, Caranasos GJ |title=Acute bacterial sialadenitis: a study of 29 cases and review |journal=Rev. Infect. Dis. |volume=12 |issue=4 |pages=591–601 |year=1990 |pmid=2385766 |doi= |url=}}</ref>
 
*Acute symptoms resolve within 1 week; however, edema in the area may last for several weeks 


==Diagnosis==
==Diagnosis==
===Diagnostic Criteria===
===Diagnostic Criteria===
 
Acute sialadenitis is a clinical diagnosis and presents with [[pain]], [[Edema|swelling]], and redness of [[skin]].<ref name="pmid25077394">{{cite journal| author=Wilson KF, Meier JD, Ward PD| title=Salivary gland disorders. | journal=Am Fam Physician | year= 2014 | volume= 89 | issue= 11 | pages= 882-8 | pmid=25077394 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25077394  }} </ref>
===== Computed tomography =====
*  High resolution noncontrast computed tomography (CT) scanning is the study of choice for the diagnosis of sialadenitis.<ref name="ElliesLaskawi1996">{{cite journal|last1=Ellies|first1=Maik|last2=Laskawi|first2=Rainer|last3=Arglebe|first3=Christian|last4=Schott|first4=Anngrit|title=Surgical management of nonneoplastic diseases of the submandibular gland|journal=International Journal of Oral and Maxillofacial Surgery|volume=25|issue=4|year=1996|pages=285–289|issn=09015027|doi=10.1016/S0901-5027(06)80058-5}}</ref>
** Most stones contain enough [[calcium]], so they can be visible on noncontrast [[Computed tomography|CT scan]].
 
* The following results are seen in acute obstructive due to sialolithiasis after administration of contrast:
** The gland may appear enlarged
** Hyperdensity of gland with stranding
 
* In chronic sialolithiasis, fatty atrophy and reduction in salivary gland parenchymal volume may be seen.
 
==== The comparison table for diagnostic studies of choice for sialolithiasis ====
The [[Sensitivity (tests)|sensitivity]] and [[Specificity (tests)|specificity]] of CT scan and ultrasonography in a patient with sialolitiasis is given below:<ref name="pmid28457224">{{cite journal |vauthors=Thomas WW, Douglas JE, Rassekh CH |title=Accuracy of Ultrasonography and Computed Tomography in the Evaluation of Patients Undergoing Sialendoscopy for Sialolithiasis |journal=Otolaryngol Head Neck Surg |volume=156 |issue=5 |pages=834–839 |year=2017 |pmid=28457224 |doi=10.1177/0194599817696308 |url=}}</ref>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |CT scan
| style="background: #DCDCDC; padding: 5px; text-align: center;" |98%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |88%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Ultrasound
| style="background: #DCDCDC; padding: 5px; text-align: center;" |65%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |80%
|}


===History and Symptoms===
===History and Symptoms===
A positive history of swelling of the affected gland and pain is suggestive of  acute sialadenitis. The most common symptoms of sialadenitis include fever, and difficulty in opening the mouth.<ref name="pmid22888457">{{cite journal |vauthors=Chandak R, Degwekar S, Chandak M, Rawlani S |title=Acute submandibular sialadenitis-a case report |journal=Case Rep Dent |volume=2012 |issue= |pages=615375 |year=2012 |pmid=22888457 |pmc=3409526 |doi=10.1155/2012/615375 |url=}}</ref>
The most common symptoms of sialadenitis include [[fever]] and [[pain]].<ref name="pmid22888457">{{cite journal |vauthors=Chandak R, Degwekar S, Chandak M, Rawlani S |title=Acute submandibular sialadenitis-a case report |journal=Case Rep Dent |volume=2012 |issue= |pages=615375 |year=2012 |pmid=22888457 |pmc=3409526 |doi=10.1155/2012/615375 |url=}}</ref>
 
Common symptoms of chronic sialadenitis are similar to acute sialadenitis but with less intensity.
 
*A positive history of pain, swelling, overlying skin redness, and hard [[lump]] is suggestive of sialadenitis.


*A positive history of [[pain]], [[Edema|swelling]], overlying [[Skin changes|skin]] redness, and hard [[lump]] is suggestive of sialadenitis.
===Physical Examination===
===Physical Examination===
===Vital Signs===
===Vital Signs===
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===Neck===
===Neck===
* Cervical lymphadenitis in cases of infection
* [[Cervical]] [[Lymphadenopathy|lymphadenitis]] in cases of infection.


===Laboratory Findings===
==Laboratory Findings==
*There are no diagnostic laboratory findings associated with sialadenitis. In the case of superimposed [[inflammation]] and [[infection]], high [[ESR]] or [[leukocytosis]] may be seen.
*There are no diagnostic laboratory findings associated with sialadenitis. In the case of superimposed [[inflammation]] and [[infection]], high [[ESR]] or [[leukocytosis]] may be seen.
*Duct discharge should be used for culture.<ref name="SananCognetti2016">{{cite journal|last1=Sanan|first1=Akshay|last2=Cognetti|first2=David M.|title=Rare Parotid Gland Diseases|journal=Otolaryngologic Clinics of North America|volume=49|issue=2|year=2016|pages=489–500|issn=00306665|doi=10.1016/j.otc.2015.10.009}}</ref>


===Electrocardiogram===
===Electrocardiogram===
There are no ECG findings associated with sialadenitis.  
There are no [[The electrocardiogram|ECG]] findings associated with sialadenitis.  


===X-ray===
===X-ray===
*An x-ray may be helpful in the diagnosis of sialadenitis. Findings on an x-ray suggestive of sialadenitis include:<ref name="pmid25476659">{{cite journal |vauthors=Kraaij S, Karagozoglu KH, Forouzanfar T, Veerman EC, Brand HS |title=Salivary stones: symptoms, aetiology, biochemical composition and treatment |journal=Br Dent J |volume=217 |issue=11 |pages=E23 |year=2014 |pmid=25476659 |doi=10.1038/sj.bdj.2014.1054 |url=}}</ref>
*An [[X-rays|x-ray]] is not diagnostic in sialadenitis.
**Radiopaque stones: 43-60% of the [[Parotid gland|parotid]] stones and 80-95% of the [[Submandibular gland|submandibular]] stones are radiopaque and can be seen in x-ray.
*An [[X-rays|x-ray]] may be helpful in the diagnosis of chronic sialadenitis. Findings on an [[X-rays|x-ray]] suggestive of chronic sialadenitis include:<ref name="pmid25476659">{{cite journal |vauthors=Kraaij S, Karagozoglu KH, Forouzanfar T, Veerman EC, Brand HS |title=Salivary stones: symptoms, aetiology, biochemical composition and treatment |journal=Br Dent J |volume=217 |issue=11 |pages=E23 |year=2014 |pmid=25476659 |doi=10.1038/sj.bdj.2014.1054 |url=}}</ref>
**[[Radiopaque]] stones: 43-60% of the [[Parotid gland|parotid]] stones and 80-95% of the [[Submandibular gland|submandibular]] stones are [[radiopaque]] and can be seen in [[X-rays|x-ray]].


===Ultrasound===
===Ultrasound===


*Ultrasound may be helpful in the diagnosis of sialadenitis. Findings on ultrasound diagnostic of sialadenitis include:<ref name="pmid10966693">{{cite journal |vauthors=Jäger L, Menauer F, Holzknecht N, Scholz V, Grevers G, Reiser M |title=Sialolithiasis: MR sialography of the submandibular duct--an alternative to conventional sialography and US? |journal=Radiology |volume=216 |issue=3 |pages=665–71 |year=2000 |pmid=10966693 |doi=10.1148/radiology.216.3.r00se12665 |url=}}</ref><ref>{{cite book | last = Witt | first = Robert | title = Salivary gland diseases : surgical and medical management | publisher = Thieme | location = New York | year = 2005 | isbn = 1588904148 }}</ref><ref name="pmid2660533">{{cite journal |vauthors=Gritzmann N |title=Sonography of the salivary glands |journal=AJR Am J Roentgenol |volume=153 |issue=1 |pages=161–6 |year=1989 |pmid=2660533 |doi=10.2214/ajr.153.1.161 |url=}}</ref>
*There are no ultrasound findings associated with acute sialadenitis.
**Hyperechoic points or lines with distal acoustic shadowing.
***Small stones less than 2 mm may not have shadow
**Ultrasound can detect stones that are radiolucent
**In acute obstructive cases due to sialolithiasis, ther excretory duct may be dilated.
*Ultrasound is done with intra oral probes.


===CT scan===
===CT scan===
Head and neck CT scan is the study of choice for the diagnosis of sialadenitis.<ref name="ElliesLaskawi1996">{{cite journal|last1=Ellies|first1=Maik|last2=Laskawi|first2=Rainer|last3=Arglebe|first3=Christian|last4=Schott|first4=Anngrit|title=Surgical management of nonneoplastic diseases of the submandibular gland|journal=International Journal of Oral and Maxillofacial Surgery|volume=25|issue=4|year=1996|pages=285–289|issn=09015027|doi=10.1016/S0901-5027(06)80058-5}}</ref><ref name="pmid28457224">{{cite journal |vauthors=Thomas WW, Douglas JE, Rassekh CH |title=Accuracy of Ultrasonography and Computed Tomography in the Evaluation of Patients Undergoing Sialendoscopy for Sialolithiasis |journal=Otolaryngol Head Neck Surg |volume=156 |issue=5 |pages=834–839 |year=2017 |pmid=28457224 |doi=10.1177/0194599817696308 |url=}}</ref><ref name="pmid25476659">{{cite journal |vauthors=Kraaij S, Karagozoglu KH, Forouzanfar T, Veerman EC, Brand HS |title=Salivary stones: symptoms, aetiology, biochemical composition and treatment |journal=Br Dent J |volume=217 |issue=11 |pages=E23 |year=2014 |pmid=25476659 |doi=10.1038/sj.bdj.2014.1054 |url=}}</ref>
*There are no CT scan findings associated with acute sialadenitis. However, a CT scan may be helpful in the diagnosis of complications of sialadenitis, which include abscess.<ref name="ElliesLaskawi1996">{{cite journal|last1=Ellies|first1=Maik|last2=Laskawi|first2=Rainer|last3=Arglebe|first3=Christian|last4=Schott|first4=Anngrit|title=Surgical management of nonneoplastic diseases of the submandibular gland|journal=International Journal of Oral and Maxillofacial Surgery|volume=25|issue=4|year=1996|pages=285–289|issn=09015027|doi=10.1016/S0901-5027(06)80058-5}}</ref><ref name="pmid25077394">{{cite journal| author=Wilson KF, Meier JD, Ward PD| title=Salivary gland disorders. | journal=Am Fam Physician | year= 2014 | volume= 89 | issue= 11 | pages= 882-8 | pmid=25077394 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25077394  }} </ref>
* Most stones contain enough [[calcium]], so they can be visible with noncontrast [[Computed tomography|CT scan]].
** Most stones contain enough [[calcium]], so they can be visible on non-contrast [[Computed tomography|CT scan]].
 
* The following results are seen in acute obstructive due to sialolithiasis after administration of contrast:
** The gland may appear enlarged
** Hyperdensity of gland with stranding
 
* In chronic sialolithiasis, fatty atrophy and reduction in salivary gland parenchymal volume may be seen.


===MRI===
* The following results are seen in acute obstruction of the [[Salivary gland|salivary]] duct due to sialadenitis after administration of [[Contrast medium|contrast]]:
*Magnetic resonance sialography may be helpful in the diagnosis of sialadenitis. Findings on magnetic resonance sialography suggestive of sialadenitisinclude:<ref name="pmid10543651">{{cite journal |vauthors=Sumi M, Izumi M, Yonetsu K, Nakamura T |title=The MR imaging assessment of submandibular gland sialoadenitis secondary to sialolithiasis: correlation with CT and histopathologic findings |journal=AJNR Am J Neuroradiol |volume=20 |issue=9 |pages=1737–43 |year=1999 |pmid=10543651 |doi= |url=}}</ref><ref name="pmid11058627">{{cite journal |vauthors=Becker M, Marchal F, Becker CD, Dulguerov P, Georgakopoulos G, Lehmann W, Terrier F |title=Sialolithiasis and salivary ductal stenosis: diagnostic accuracy of MR sialography with a three-dimensional extended-phase conjugate-symmetry rapid spin-echo sequence |journal=Radiology |volume=217 |issue=2 |pages=347–58 |year=2000 |pmid=11058627 |doi=10.1148/radiology.217.2.r00oc02347 |url=}}</ref><ref name="pmid10966693">{{cite journal |vauthors=Jäger L, Menauer F, Holzknecht N, Scholz V, Grevers G, Reiser M |title=Sialolithiasis: MR sialography of the submandibular duct--an alternative to conventional sialography and US? |journal=Radiology |volume=216 |issue=3 |pages=665–71 |year=2000 |pmid=10966693 |doi=10.1148/radiology.216.3.r00se12665 |url=}}</ref>
** The [[gland]] may appear enlarged
**Stones are visible as low signal regions outlined by saliva (high signal regions) on T2 weighted images.
** Hyperdensity of [[gland]] with stranding


* Acute from chronic obstruction can be distinguished by magnetic resonance sialography on T1 signals:
* In chronic sialadenitis, fat [[atrophy]] and reduction in [[Salivary gland|salivary]] gland parenchymal volume may be seen.
** In acute obstruction, enlargement of the gland and [[inflammatory]] changes may be seen as reduced signal compared to other side.
** In chronic cases, size of the gland is decreased and fatty atrophy may be seen as an increased signal compared to the other side.


===Other Imaging Findings===
===Other Imaging Findings===
Conventional sialography may be helpful in the diagnosis of sialadenitis.  Findings on sialography suggestive of sialadenitis include:<ref name="pmid10966693">{{cite journal |vauthors=Jäger L, Menauer F, Holzknecht N, Scholz V, Grevers G, Reiser M |title=Sialolithiasis: MR sialography of the submandibular duct--an alternative to conventional sialography and US? |journal=Radiology |volume=216 |issue=3 |pages=665–71 |year=2000 |pmid=10966693 |doi=10.1148/radiology.216.3.r00se12665 |url=}}</ref><ref name="pmid12372736">{{cite journal |vauthors=Kalinowski M, Heverhagen JT, Rehberg E, Klose KJ, Wagner HJ |title=Comparative study of MR sialography and digital subtraction sialography for benign salivary gland disorders |journal=AJNR Am J Neuroradiol |volume=23 |issue=9 |pages=1485–92 |year=2002 |pmid=12372736 |doi= |url=}}</ref>
[[Sialography]] is contraindicated in active infection of the involved [[gland]].
* Filling defect within the duct
* In complete obstruction, contrast can not pass beyond the stone
Sialography is contraindicated in active infection of the involved gland.
 
Sialography is replaced by CT scan and ultrasound.


===Other Diagnostic Studies===
===Other Diagnostic Studies===
Line 367: Line 313:


==Treatment==
==Treatment==
===Medical Therapy==
===Medical Therapy===
 
*Most cases are easily treated with conservative medical management. Acute symptoms resolve within 1 week; however, [[edema]] in the area may last for several weeks.<ref name="ChandakDegwekar2012">{{cite journal|last1=Chandak|first1=Rakhi|last2=Degwekar|first2=Shirish|last3=Chandak|first3=Manoj|last4=Rawlani|first4=Shivlal|title=Acute Submandibular Sialadenitis—A Case Report|journal=Case Reports in Dentistry|volume=2012|year=2012|pages=1–3|issn=2090-6447|doi=10.1155/2012/615375}}</ref>
*Certain individuals with chronic bacterial infections not responding to appropriate conservative and antibiotic measures may require either radiation or removal of the affected gland to control its symptoms.The prognosis of acute sialadenitis is very good. Most cases are easily treated with conservative medical management, and admission is the exception, not the rule. Acute symptoms resolve within 1 week; however, edema in the area may last for several weeks  
 
Conservative treatment is the first line of therapy in the most patients. The most commonly used treatment options are:<ref name="pmid24862601">{{cite journal |vauthors=Delli K, Spijkervet FK, Vissink A |title=Salivary gland diseases: infections, sialolithiasis and mucoceles |journal=Monogr Oral Sci |volume=24 |issue= |pages=135–48 |year=2014 |pmid=24862601 |doi=10.1159/000358794 |url=}}</ref>
* [[Hydration]]
* Apply moist heat
* Massage the gland
* Duct milking
* Using agents that increase the saliva flow, such as lemon drops.
* Discontinue of the medication that decrease the saliva flow, such as the [[Tricyclic anti-depressant|TCAs]] because of their [[anticholinergic]] effects.
* Pain control with [[Non-steroidal anti-inflammatory drug|NSAIDs]], or [[Opioid|opioid analgesic]]<nowiki/>s, if needed.


* Antibiotics usage in the case of superimposed infection:  
* [[Antibiotic|Antibiotics]] usage in the case of superimposed infection:<ref name="pmid25077394">{{cite journal| author=Wilson KF, Meier JD, Ward PD| title=Salivary gland disorders. | journal=Am Fam Physician | year= 2014 | volume= 89 | issue= 11 | pages= 882-8 | pmid=25077394 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25077394  }} </ref>
** Preferred regimen(1): [[Dicloxacillin]] 500 mg q 6h PO for 7 to 10 days.
** Preferred regimen (1): [[Dicloxacillin]] 500 mg q 6h PO for 7 to 10 days.
** Preferred regimen(2): [[Cephalexin]] 500 mg q 6h PO for 7 to 10 days.  
** Preferred regimen (2): [[Cephalexin]] 500 mg q 6h PO for 7 to 10 days.  


* If the patients clinics did not change in five days of using above antibiotics, change to:
* If the patients clinics did not change in five days of using above antibiotics, change to:
** Preferred regimen(1): [[Amoxicillin-Clavulanate|Amoxicillin/clavulanate]] 625 mg q 8h PO for 7 to 10 days.
** Preferred regimen (1): [[Amoxicillin-Clavulanate|Amoxicillin/clavulanate]] 625 mg q 8h PO for 7 to 10 days.
** Preferred regimen(2): [[Clindamycin]] 300 mg q 8h PO for 7 to 10 days.
** Preferred regimen (2): [[Clindamycin]] 300 mg q 8h PO for 7 to 10 days.\


* Duct discharge should be used for culture.
*Many cases of sialadenitis cannot be cured by using medical therapy alone; invasive, or open [[surgery]] methods can be used for [[salivary gland]] stones. The interventional methods are discussed in the sialadenitis [[surgery]] page.
 
*Many cases of sialadenitis can not be cured by using medical therapy alone; invasive, or open [[surgery]] methods can be used for [[salivary gland]] stones. The interventional methods are discussed in the sialadenitis [[surgery]] page.


===Surgery===
===Surgery===
The mainstay of treatment for acute siladenitis is medical therapy. Surgery is not the first-line treatment option for patients with acute siladenitis. Surgery is usually reserved for patients with abscess that do not respond to medical therapy.<ref name="RyanPadmakumar2015" />
* Certain individuals with chronic [[Bacteria|bacterial]] infections who do not respond to appropriate conservative and [[antibiotic]] measures may require either [[Radiation therapy|radiation]] or removal of the affected gland to control its symptoms.
 
Surgical resection of involved gland in chronic bacterial sialadenitis may be considered if it does not respond to medical therapy. <ref name="pmid22888457" />
 
===Minimally invasive management===
====Sialoendoscopy====
*Sialoendoscopy can be used in the diagnosis of small stones, and differentiate them from polyps.<ref name="pmid26824208">{{cite journal |vauthors=Gallo A, Benazzo M, Capaccio P, De Campora L, De Vincentiis M, Fusconi M, Martellucci S, Paludetti G, Pasquini E, Puxeddu R, Speciale R |title=Sialoendoscopy: state of the art, challenges and further perspectives. Round Table, 101(st) SIO National Congress, Catania 2014 |journal=Acta Otorhinolaryngol Ital |volume=35 |issue=4 |pages=217–33 |year=2015 |pmid=26824208 |pmc=4731883 |doi= |url=}}</ref>


*In the case of no response to medical management, sialoendoscopy can be done. The treatment result using sialoendoscopy, mostly depends on the size of the stone.
* The mainstay of treatment for acute siladenitis is medical therapy. Surgery is not the first-line treatment option for patients with acute siladenitis. Surgery is usually reserved for patients with [[abscess]] that do not respond to medical therapy.<ref name="pmid25077394">{{cite journal| author=Wilson KF, Meier JD, Ward PD| title=Salivary gland disorders. | journal=Am Fam Physician | year= 2014 | volume= 89 | issue= 11 | pages= 882-8 | pmid=25077394 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25077394  }} </ref>


====Laser lithotripsy====
* Surgical resection of involved gland in chronic [[Bacteria|bacterial]] sialadenitis may be considered if it does not respond to medical therapy. <ref name="pmid22888457" />
*Can be used before sialoendoscopy in order to fragment salivary stones.<ref name="pmid28516973">{{cite journal |vauthors=Capaccio P, Torretta S, Pignataro L, Koch M |title=Salivary lithotripsy in the era of sialendoscopy |journal=Acta Otorhinolaryngol Ital |volume=37 |issue=2 |pages=113–121 |year=2017 |pmid=28516973 |pmc=5463518 |doi=10.14639/0392-100X-1600 |url=}}</ref>
 
==== Stone removal with wire baske ====
*Removal of stones using a wire basket extractor under fluoroscopic guidance.<ref name="pmid10644113">{{cite journal |vauthors=Drage NA, Brown JE, Escudier MP, McGurk M |title=Interventional radiology in the removal of salivary calculi |journal=Radiology |volume=214 |issue=1 |pages=139–42 |year=2000 |pmid=10644113 |doi=10.1148/radiology.214.1.r00ja02139 |url=}}</ref>


===Surgical intervention ===
===Surgical intervention ===
If all of above methods fails, surgical intervention can be used.<ref name="pmid20824782">{{cite journal |vauthors=Wallace E, Tauzin M, Hagan J, Schaitkin B, Walvekar RR |title=Management of giant sialoliths: review of the literature and preliminary experience with interventional sialendoscopy |journal=Laryngoscope |volume=120 |issue=10 |pages=1974–8 |year=2010 |pmid=20824782 |doi=10.1002/lary.21082 |url=}}</ref>
For surgical intervention of sialolithiasis please [[Sialolithiasis surgery|click here]].
* For the [[submandibular]] stones, a transoral approach can be used.
* In some proximal [[submandibular]] stones, a combination of sialoendoscopic and open intraoral techniques, may be used.
* For [[Parotid gland|parotid]] stones, if sialoendoscopy did not worked, open [[surgery]] should be done.


===Primary Prevention===
===Primary Prevention===
*Effective measures for the primary prevention of sialadenitis include:<ref name="pmid23242089">{{cite journal |vauthors=Moghe S, Pillai A, Thomas S, Nair PP |title=Parotid sialolithiasis |journal=BMJ Case Rep |volume=2012 |issue= |pages= |year=2012 |pmid=23242089 |pmc=4543829 |doi=10.1136/bcr-2012-007480 |url=}}</ref>
*Effective measures for the primary prevention of sialadenitis include:<ref name="pmid23242089">{{cite journal |vauthors=Moghe S, Pillai A, Thomas S, Nair PP |title=Parotid sialolithiasis |journal=BMJ Case Rep |volume=2012 |issue= |pages= |year=2012 |pmid=23242089 |pmc=4543829 |doi=10.1136/bcr-2012-007480 |url=}}</ref><ref name="ChandakDegwekar2012">{{cite journal|last1=Chandak|first1=Rakhi|last2=Degwekar|first2=Shirish|last3=Chandak|first3=Manoj|last4=Rawlani|first4=Shivlal|title=Acute Submandibular Sialadenitis—A Case Report|journal=Case Reports in Dentistry|volume=2012|year=2012|pages=1–3|issn=2090-6447|doi=10.1155/2012/615375}}</ref><ref name="pmid25077394">{{cite journal| author=Wilson KF, Meier JD, Ward PD| title=Salivary gland disorders. | journal=Am Fam Physician | year= 2014 | volume= 89 | issue= 11 | pages= 882-8 | pmid=25077394 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25077394  }} </ref>
**Healthy oral care regimen ( brushing teeth)
**Healthy [[Mouth|oral]] care regimen ( brushing teeth)
**Increased water intake  
**Increased water intake
*There are no available vaccines against sialolithiasis
*There are no available [[Vaccine|vaccines]] against sialolithiasis


===Secondary Prevention===
===Secondary Prevention===
Effective measures for the secondary prevention of acute sialadenitis include hygiene and repeated massaging of the gland when tenderness had subsided. <ref name="pmid22888457" /><ref name="pmid9747195">{{cite journal |vauthors=Silvers AR, Som PM |title=Salivary glands |journal=Radiol. Clin. North Am. |volume=36 |issue=5 |pages=941–66, vi |year=1998 |pmid=9747195 |doi= |url=}}</ref>[[Sialolithiasis risk factors#cite note-pmid23242089-1|[1]]]
Effective measures for the secondary prevention of acute sialadenitis include hygiene and repeated massaging of the gland when [[tenderness]] had subsided. <ref name="pmid22888457" /><ref name="pmid9747195">{{cite journal |vauthors=Silvers AR, Som PM |title=Salivary glands |journal=Radiol. Clin. North Am. |volume=36 |issue=5 |pages=941–66, vi |year=1998 |pmid=9747195 |doi= |url=}}</ref><ref name="ErkulGillespie2016">{{cite journal|last1=Erkul|first1=Evren|last2=Gillespie|first2=M. Boyd|title=Sialendoscopy for non-stone disorders: The current evidence|journal=Laryngoscope Investigative Otolaryngology|volume=1|issue=5|year=2016|pages=140–145|issn=23788038|doi=10.1002/lio2.33}}</ref><ref name="ChandakDegwekar2012">{{cite journal|last1=Chandak|first1=Rakhi|last2=Degwekar|first2=Shirish|last3=Chandak|first3=Manoj|last4=Rawlani|first4=Shivlal|title=Acute Submandibular Sialadenitis—A Case Report|journal=Case Reports in Dentistry|volume=2012|year=2012|pages=1–3|issn=2090-6447|doi=10.1155/2012/615375}}</ref><ref name="pmid250773942">{{cite journal| author=Wilson KF, Meier JD, Ward PD| title=Salivary gland disorders. | journal=Am Fam Physician | year= 2014 | volume= 89 | issue= 11 | pages= 882-8 | pmid=25077394 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25077394  }}</ref>
**Prevention of [[dehydration]]  
* Prevention of [[dehydration]]
**Healthy oral care regimen ( brushing teeth)
* Healthy [[Mouth|oral]] care regimen (brushing teeth)
**Treatment of underlying disease such as [[Sjögren's syndrome|sjögrens]], [[gout]]
* Treatment of underlying disease such as [[Sjögren's syndrome]] and [[gout]]
**Avoid [[anticholinergic]] and [[diuretic]] medications
* Avoid [[anticholinergic]] and [[diuretic]] medications


==References==
==References==
{{reflist|2}}
{{reflist|2}}


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Sialadenitis(Sialoadenitis)
Micrograph showing chronic sialadenitis. H&E stain.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2] Mahda Alihashemi M.D. [3]

Synonyms and keywords:Sialadenitis, salivary gland inflammation

Overview

Sialadenitis is the inflammation of a salivary gland. The causes of sialadenitis include bacterial and viral infections, such as mumps and HIV, obstruction from stones or radiation, and autoimmune disorders such as Sjogren's syndrome. The complications of sialadenitis include recurrence, abscess, and chronic sialadenitis. Sialadenitis must be differentiated from other diseases that can cause swelling in the salivary glands, such as sialolithiasis, human immunodeficiency virus, radiation, and systemic diseases such as, sarcoidosis, and sjögren's syndrome. History from the patient will reveal symptoms of sialadenitis that include fever, redness of overlying skin, pain, and difficulty in opening the mouth. The diagnosis of choice is a high resolution CT scan. Sialoendoscopy can be used in the diagnosis of small stones and differentiate them from polyps. Conservative treatment is the first line of therapy in the most patients and it involves Hydration, applying moist heat, massaging the gland, duct milking, discontinuation of medication that can decrease the saliva flow, such as the TCAs (because of their anticholinergic effects). Also, antibiotics can be used in the case of superimposed infection. Preferred regimens are Dicloxacillin 500 mg q 6h PO for 7 to 10 days, or Cephalexin 500 mg q 6h PO for 7 to 10 days.

Historical Perspective

The historical perspective of sialadenitis is as follows:[1]

  • In 17th century, major salivary gland ductal system in anatomical human studies was first reported.
  • In 1990, , Konigsberger et al. performed the first successful salivary endoscopy.[2]
  • In 2004, Zenk et al. reported the use of semirigid sialendoscope in different types of obstructive salivary disorders.[3]
  • In 2006, Nahlieli et al. described sialendoscopy in the management of radioiodine sialadenitis.[4]

Classification

  • There is no established system for the classification of sialadenitis, but it can be classified according to location of the stone.[5]
Gland %
Submandibular glands 80 to 90 
Parotid glands 6 to 20
Sublinguals or minor salivary glands 1 to 2

Pathophysiology

  • Sialadenitis is the inflammation of a salivary gland. [6]
  • Swelling is usually present in this condition.
  • Acute sialadenitis may be caused by viral or bacterial infection[7]
    • Parotid and submandibular glands are more involved in acute sialadenitis. Approximately 10% sialadenitis cases are related to the involvement of submandibular gland.
  • Chronic sialadenitis is caused by repeated episodes of inflammation and finally it progresses in to salivary gland dysfunction.

Causes

Common causes of sialadenitis include the following:

Bacterial and viral infections:[8]

Obstruction:

Autoimmune disorders:

Differentiating sialadenitis from Other Diseases

Diseases Symptoms and sign Laboratory Findings Other Findings
Onset Unilateral/Bilateral Pain Swelling Tenderness Purulent discharge Common site of involvement ESR Leukocytosis
Sialolithiasis Acute Unilateral + + + - Submandibular gland ↑/NL ↑/NL Radio-opaque in X-ray
Acute bacterial sialadenitis Acute Unilateral + + + + Parotid ↑ ↑ Other sign of infection may be present
Chronic bacterial sialadenitis Chronic Unilateral + + - +/- Parotid ↑ ↑ Other sign of infection may be present
Viral sialadenitis Acute Bilateral + + + - Parotid ↑ ↑ Coryza symptoms
Human immunodeficiency virus Acute Bilateral + + - - Parotid NL NL Other systemic findings of HIV/ check ELISA
 Radiation sialadenitis Acute Unilateral + + + - Depends on the treatment field NL NL History of radiation in the salivary gland site
Salivary gland tumors Subacute Unilateral - + - - Parotid ↑/NL ↑/NL Advance age
Sarcoidosis Gradual Bilateral - + - - Parotid ↑ ↑ Systemic findings in other organs
Sjögren's syndrome Gradual Bilateral +/- + - - Parotid or submandibular glands ↑/NL ↑/NL Dry eye/dry mouth
Malnutrition Gradual Bilateral +/- + - - Parotid NL NL Systemic findings in other organs

Epidemiology and Demographics

  • The incidence of acute sialadenitis is approximately 275 per 100,000 individuals in United Kingdom.[18]
  • Patients of all age groups may develop sialadenitis.
  • Sialadenitis commonly affects older and dehydrated patients.

Risk Factors

Common Risk Factors

Common risk factors in the development of sialolithisis which can lead to sialadenitis include:[19]

Screening

There is insufficient evidence to recommend routine screening for sialadenitis.

Natural History, Complications, and Prognosis

Natural History

  • If left untreated, patients with sialadeitis may progress to develop secondary infection and chronic sialadenitis including gland atrophy.[21]

Complications

Prognosis

  • Prognosis is generally good with fluid management and antimicrobial therapy, but edema in the gland may persist for several weeks.[16]

Diagnosis

Diagnostic Criteria

Acute sialadenitis is a clinical diagnosis and presents with pain, swelling, and redness of skin.[23]

History and Symptoms

The most common symptoms of sialadenitis include fever and pain.[22]

  • A positive history of pain, swelling, overlying skin redness, and hard lump is suggestive of sialadenitis.

Physical Examination

Vital Signs

  • Vital signs are usually normal, but fever may be seen in sialadenititis as a complication of sialolithiasis.[7]

HEENT

Normal salivary gland is spongy.

In sialadenitis:[24][25]

  • Tenderness of the involved gland
  • Palpable hard lump near the end of the involved duct or under the tongue in submandibular duct stone.
    • Stones, sometimes may be felt smooth or irregular.
  • In total obstruction, no saliva is being produced from the duct.
  • Erythema of the floor of the mouth
  • Pus discharging from the duct
  • Stone in the minor salivary glands can be felt as a small nodule
  • Stones are typically rock hard and small; they may be smooth or irregular. They are most commonly felt within the ductal system.

Neck

Laboratory Findings

  • There are no diagnostic laboratory findings associated with sialadenitis. In the case of superimposed inflammation and infection, high ESR or leukocytosis may be seen.
  • Duct discharge should be used for culture.[26]

Electrocardiogram

There are no ECG findings associated with sialadenitis.

X-ray

Ultrasound

  • There are no ultrasound findings associated with acute sialadenitis.

CT scan

  • There are no CT scan findings associated with acute sialadenitis. However, a CT scan may be helpful in the diagnosis of complications of sialadenitis, which include abscess.[28][23]
    • Most stones contain enough calcium, so they can be visible on non-contrast CT scan.
  • The following results are seen in acute obstruction of the salivary duct due to sialadenitis after administration of contrast:
    • The gland may appear enlarged
    • Hyperdensity of gland with stranding
  • In chronic sialadenitis, fat atrophy and reduction in salivary gland parenchymal volume may be seen.

Other Imaging Findings

Sialography is contraindicated in active infection of the involved gland.

Other Diagnostic Studies

  • There are no other diagnostic studies associated with sialadenitis.

Treatment

Medical Therapy

  • Most cases are easily treated with conservative medical management. Acute symptoms resolve within 1 week; however, edema in the area may last for several weeks.[29]
  • Antibiotics usage in the case of superimposed infection:[23]
    • Preferred regimen (1): Dicloxacillin 500 mg q 6h PO for 7 to 10 days.
    • Preferred regimen (2): Cephalexin 500 mg q 6h PO for 7 to 10 days.
  • If the patients clinics did not change in five days of using above antibiotics, change to:
  • Many cases of sialadenitis cannot be cured by using medical therapy alone; invasive, or open surgery methods can be used for salivary gland stones. The interventional methods are discussed in the sialadenitis surgery page.

Surgery

  • Certain individuals with chronic bacterial infections who do not respond to appropriate conservative and antibiotic measures may require either radiation or removal of the affected gland to control its symptoms.
  • The mainstay of treatment for acute siladenitis is medical therapy. Surgery is not the first-line treatment option for patients with acute siladenitis. Surgery is usually reserved for patients with abscess that do not respond to medical therapy.[23]
  • Surgical resection of involved gland in chronic bacterial sialadenitis may be considered if it does not respond to medical therapy. [22]

Surgical intervention 

For surgical intervention of sialolithiasis please click here.

Primary Prevention

  • Effective measures for the primary prevention of sialadenitis include:[19][29][23]
    • Healthy oral care regimen ( brushing teeth)
    • Increased water intake
  • There are no available vaccines against sialolithiasis

Secondary Prevention

Effective measures for the secondary prevention of acute sialadenitis include hygiene and repeated massaging of the gland when tenderness had subsided. [22][17][1][29][30]

References

  1. ↑ 1.0 1.1 Erkul, Evren; Gillespie, M. Boyd (2016). "Sialendoscopy for non-stone disorders: The current evidence". Laryngoscope Investigative Otolaryngology. 1 (5): 140–145. doi:10.1002/lio2.33. ISSN 2378-8038.
  2. ↑ Lydiatt, Daniel D.; Bucher, Gregory S. (2012). "The historical evolution of the understanding of the submandibular and sublingual salivary glands". Clinical Anatomy. 25 (1): 2–11. doi:10.1002/ca.22007. ISSN 0897-3806.
  3. ↑ Zenk, J; Koch, M; Bozzato, A; Iro, H (2004). "Sialoscopy—initial experiences with a new endoscope". British Journal of Oral and Maxillofacial Surgery. 42 (4): 293–298. doi:10.1016/j.bjoms.2004.03.006. ISSN 0266-4356.
  4. ↑ Nahlieli O, Neder A, Baruchin AM (1994). "Salivary gland endoscopy: a new technique for diagnosis and treatment of sialolithiasis". J Oral Maxillofac Surg. 52 (12): 1240–2. PMID 7965326.
  5. ↑ Capaccio P, Torretta S, Ottavian F, Sambataro G, Pignataro L (2007). "Modern management of obstructive salivary diseases". Acta Otorhinolaryngol Ital. 27 (4): 161–72. PMC 2640028. PMID 17957846.
  6. ↑ Loury, MC (2006). "Salivary gland disorder". Advanced Otolaryngology.
  7. ↑ 7.0 7.1 McKenna JP, Bostock DJ, McMenamin PG (1987). "Sialolithiasis". Am Fam Physician. 36 (5): 119–25. PMID 3318353.
  8. ↑ Maier H, Tisch M (2010). "[Bacterial sialadenitis]". HNO (in German). 58 (3): 229–36. doi:10.1007/s00106-009-2078-x. PMID 20204311.
  9. ↑ Maier H, Tisch M (2010). "[Bacterial sialadenitis]". HNO (in German). 58 (3): 229–36. doi:10.1007/s00106-009-2078-x. PMID 20204311.
  10. ↑ Delli K, Spijkervet FK, Vissink A (2014). "Salivary gland diseases: infections, sialolithiasis and mucoceles". Monogr Oral Sci. 24: 135–48. doi:10.1159/000358794. PMID 24862601.
  11. ↑ Delli K, Spijkervet FK, Vissink A (2014). "Salivary gland diseases: infections, sialolithiasis and mucoceles". Monogr Oral Sci. 24: 135–48. doi:10.1159/000358794. PMID 24862601.
  12. ↑ Capaccio P, Torretta S, Pignataro L, Koch M (2017). "Salivary lithotripsy in the era of sialendoscopy". Acta Otorhinolaryngol Ital. 37 (2): 113–121. doi:10.14639/0392-100X-1600. PMC 5463518. PMID 28516973.
  13. ↑ Wallace E, Tauzin M, Hagan J, Schaitkin B, Walvekar RR (2010). "Management of giant sialoliths: review of the literature and preliminary experience with interventional sialendoscopy". Laryngoscope. 120 (10): 1974–8. doi:10.1002/lary.21082. PMID 20824782.
  14. ↑ Wallace E, Tauzin M, Hagan J, Schaitkin B, Walvekar RR (2010). "Management of giant sialoliths: review of the literature and preliminary experience with interventional sialendoscopy". Laryngoscope. 120 (10): 1974–8. doi:10.1002/lary.21082. PMID 20824782.
  15. ↑ Loury, MC (2006). "Salivary gland disorder". Advanced Otolaryngology.
  16. ↑ 16.0 16.1 Raad II, Sabbagh MF, Caranasos GJ (1990). "Acute bacterial sialadenitis: a study of 29 cases and review". Rev. Infect. Dis. 12 (4): 591–601. PMID 2385766.
  17. ↑ 17.0 17.1 Silvers AR, Som PM (1998). "Salivary glands". Radiol. Clin. North Am. 36 (5): 941–66, vi. PMID 9747195.
  18. ↑ Escudier MP, McGurk M (1999). "Symptomatic sialoadenitis and sialolithiasis in the English population, an estimate of the cost of hospital treatment". Br Dent J. 186 (9): 463–6. PMID 10365495.
  19. ↑ 19.0 19.1 Moghe S, Pillai A, Thomas S, Nair PP (2012). "Parotid sialolithiasis". BMJ Case Rep. 2012. doi:10.1136/bcr-2012-007480. PMC 4543829. PMID 23242089.
  20. ↑ Ship JA (2002). "Diagnosing, managing, and preventing salivary gland disorders". Oral Dis. 8 (2): 77–89. PMID 11991308.
  21. ↑ Briffa NP, Callum KG (1989). "Use of an embolectomy catheter to remove a submandibular duct stone". Br J Surg. 76 (8): 814. PMID 2765834.
  22. ↑ 22.0 22.1 22.2 22.3 Chandak R, Degwekar S, Chandak M, Rawlani S (2012). "Acute submandibular sialadenitis-a case report". Case Rep Dent. 2012: 615375. doi:10.1155/2012/615375. PMC 3409526. PMID 22888457.
  23. ↑ 23.0 23.1 23.2 23.3 23.4 Wilson KF, Meier JD, Ward PD (2014). "Salivary gland disorders". Am Fam Physician. 89 (11): 882–8. PMID 25077394.
  24. ↑ Hupp, James (2008). Contemporary oral and maxillofacial surgery. St. Louis, Mo: Mosby Elsevier. ISBN 9780323049030.
  25. ↑ Neville, Brad (2002). Oral & maxillofacial pathology. Philadelphia: W.B. Saunders. ISBN 0721690033.
  26. ↑ Sanan, Akshay; Cognetti, David M. (2016). "Rare Parotid Gland Diseases". Otolaryngologic Clinics of North America. 49 (2): 489–500. doi:10.1016/j.otc.2015.10.009. ISSN 0030-6665.
  27. ↑ Kraaij S, Karagozoglu KH, Forouzanfar T, Veerman EC, Brand HS (2014). "Salivary stones: symptoms, aetiology, biochemical composition and treatment". Br Dent J. 217 (11): E23. doi:10.1038/sj.bdj.2014.1054. PMID 25476659.
  28. ↑ Ellies, Maik; Laskawi, Rainer; Arglebe, Christian; Schott, Anngrit (1996). "Surgical management of nonneoplastic diseases of the submandibular gland". International Journal of Oral and Maxillofacial Surgery. 25 (4): 285–289. doi:10.1016/S0901-5027(06)80058-5. ISSN 0901-5027.
  29. ↑ 29.0 29.1 29.2 Chandak, Rakhi; Degwekar, Shirish; Chandak, Manoj; Rawlani, Shivlal (2012). "Acute Submandibular Sialadenitis—A Case Report". Case Reports in Dentistry. 2012: 1–3. doi:10.1155/2012/615375. ISSN 2090-6447.
  30. ↑ Wilson KF, Meier JD, Ward PD (2014). "Salivary gland disorders". Am Fam Physician. 89 (11): 882–8. PMID 25077394.

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