Sialadenitis: Difference between revisions
Hamid Qazi (talk | contribs) |
m (Bot: Removing from Primary care) |
||
(31 intermediate revisions by 3 users not shown) | |||
Line 12: | Line 12: | ||
}} | }} | ||
{{SI}} | {{SI}} | ||
{{CMG}}; {{AE}} {{HQ}} | {{CMG}}; {{AE}} {{HQ}} {{MA}} | ||
{{SK}} | {{SK}}Sialadenitis, salivary gland inflammation | ||
==Overview == | ==Overview == | ||
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 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]], 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]], | 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, | *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 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 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 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 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> | ||
Line 28: | Line 28: | ||
==Classification== | ==Classification== | ||
*There is no established system for the classification of sialadenitis, but | *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 | ||
Line 42: | Line 42: | ||
|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 | * 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 | *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. | **[[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 | *Chronic sialadenitis is caused by repeated episodes of [[inflammation]] and finally it progresses in to salivary gland dysfunction. | ||
==Causes== | ==Causes== | ||
Line 75: | Line 75: | ||
==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;" | ||
Line 99: | Line 100: | ||
| 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 | ||
Line 111: | Line 112: | ||
| 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 | ||
Line 123: | Line 124: | ||
| 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 | ||
Line 135: | Line 136: | ||
| 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 | ||
Line 147: | Line 148: | ||
| 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 | | 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 | ||
Line 162: | Line 163: | ||
| 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 | ||
Line 171: | Line 172: | ||
| 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 | ||
Line 183: | Line 184: | ||
| 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 | ||
Line 195: | Line 196: | ||
| 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 | ||
Line 207: | Line 208: | ||
| 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 | ||
Line 216: | Line 217: | ||
*The exact [[prevalence]] of [[Submandibular gland|submandibular]] sialadenitis is unclear. | *The exact [[prevalence]] of [[Submandibular gland|submandibular]] sialadenitis is unclear. | ||
*The incidence of acute sialadenitis is approximately | *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. | ||
Line 249: | Line 250: | ||
===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> | *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> | ||
==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> | |||
===History and Symptoms=== | ===History and Symptoms=== | ||
The most common symptoms of sialadenitis include [[fever]] and | 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> | ||
*A positive history of [[pain]], [[Edema|swelling]], overlying [[Skin changes|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=== | ||
Line 307: | Line 280: | ||
* [[Cervical]] [[Lymphadenopathy|lymphadenitis]] in cases of infection. | * [[Cervical]] [[Lymphadenopathy|lymphadenitis]] in cases of infection. | ||
==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=== | ||
Line 314: | Line 288: | ||
===X-ray=== | ===X-ray=== | ||
*An [[X-rays|x-ray]] may be helpful in the diagnosis of sialadenitis. Findings on an [[X-rays|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. | ||
*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]]. | **[[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=== | ||
* | *There are no ultrasound findings associated with acute sialadenitis. | ||
===CT scan=== | ===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.<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 | ** Most stones contain enough [[calcium]], so they can be visible on non-contrast [[Computed tomography|CT scan]]. | ||
* The following results are seen in acute | * The following results are seen in acute obstruction of the [[Salivary gland|salivary]] duct due to sialadenitis after administration of [[Contrast medium|contrast]]: | ||
** The [[gland]] may appear enlarged | ** The [[gland]] may appear enlarged | ||
** Hyperdensity of [[gland]] with stranding | ** Hyperdensity of [[gland]] with stranding | ||
* In chronic | * In chronic sialadenitis, fat [[atrophy]] and reduction in [[Salivary gland|salivary]] gland parenchymal volume may be seen. | ||
===Other Imaging Findings=== | ===Other Imaging Findings=== | ||
[[Sialography]] is contraindicated in active infection of the involved [[gland]]. | |||
[[Sialography]] is contraindicated in active infection of the involved [[gland | |||
===Other Diagnostic Studies=== | ===Other Diagnostic Studies=== | ||
Line 349: | Line 314: | ||
==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> | ||
* [[Antibiotic|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. | ||
Line 357: | Line 322: | ||
* 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.\ | ||
*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 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=== | ===Surgery=== | ||
* 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 [[Bacteria|bacterial]] sialadenitis may be considered if it does not respond to medical therapy. <ref name="pmid22888457" /> | * 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> | ||
* Surgical resection of involved gland in chronic [[Bacteria|bacterial]] sialadenitis may be considered if it does not respond to medical therapy. <ref name="pmid22888457" /> | |||
===Surgical intervention === | ===Surgical intervention === | ||
For surgical intervention of sialolithiasis please click here. | For surgical intervention of sialolithiasis please [[Sialolithiasis surgery|click here]]. | ||
===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 [[Mouth|oral]] care regimen ( brushing teeth) | **Healthy [[Mouth|oral]] care regimen ( brushing teeth) | ||
**Increased water intake | **Increased water intake | ||
*There are no available [[Vaccine|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><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> | 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 [[Mouth|oral]] care regimen (brushing teeth) | * Healthy [[Mouth|oral]] care regimen (brushing teeth) | ||
Line 388: | Line 352: | ||
{{reflist|2}} | {{reflist|2}} | ||
| |||
| |||
{{WH}} | |||
{{WS}} | |||
[[Category:Gastroenterology]] | |||
[[Category:Medicine]] | |||
[[Category:Radiology]] | |||
[[Category:Up-To-Date]] |
Latest revision as of 00:10, 30 July 2020
https://https://www.youtube.com/watch?v=GzlShSy28uE%7C350}} |
Sialadenitis(Sialoadenitis) | |
![]() | |
---|---|
Micrograph showing chronic sialadenitis. H&E stain. |
WikiDoc Resources for Sialadenitis |
Articles |
---|
Most recent articles on Sialadenitis Most cited articles on Sialadenitis |
Media |
Powerpoint slides on Sialadenitis |
Evidence Based Medicine |
Clinical Trials |
Ongoing Trials on Sialadenitis at Clinical Trials.gov Clinical Trials on Sialadenitis at Google
|
Guidelines / Policies / Govt |
US National Guidelines Clearinghouse on Sialadenitis
|
Books |
News |
Commentary |
Definitions |
Patient Resources / Community |
Patient resources on Sialadenitis Discussion groups on Sialadenitis Patient Handouts on Sialadenitis Directions to Hospitals Treating Sialadenitis Risk calculators and risk factors for Sialadenitis
|
Healthcare Provider Resources |
Causes & Risk Factors for Sialadenitis |
Continuing Medical Education (CME) |
International |
|
Business |
Experimental / Informatics |
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 |
- Submandibular stones can be classified further as anterior, or posterior in relation to the mandibular first molar teeth.
- Stones may be radiopaque, where they can be radiopaque or radiolucent.
- Stones may also be symptomatic or asymptomatic.
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]
- Mumps
- HIV
- Staph aureus
- Streptococci viridans
- Pseudomonas aeruginosa
- Escherichia coli
- Moraxella catarrhalis
- Tuberculosis[9]
Obstruction:
- Stones
- Radiation
- Strictures
- Sarcoidosis
Autoimmune disorders:
Differentiating sialadenitis from Other Diseases
- Sialadenitis must be differentiated from other diseases that cause swelling in salivary glands, such as sialolithiasis, human immunodeficiency virus, radiation, and systemic diseases such as, sarcoidosis, and sjögren's syndrome.[10][11][12][13][14][15][16][17]
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 exact prevalence of submandibular sialadenitis is unclear.
- 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]
- Dehydration
- Diuretics
- Local trauma
- Sjögren's syndrome
- Gout
- Anticholinergic medications
- Smoking
- History of nephrolithiasis
- Chronic periodontal disease
- Head and neck radiotherapy[20]
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
- Common complications of sialadenitis include:[22]
- Recurrence
- Abscess
- Cellulitis
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.
- 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
- Cervical lymphadenitis in cases of infection.
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
- An x-ray is not diagnostic in sialadenitis.
- An x-ray may be helpful in the diagnosis of chronic sialadenitis. Findings on an x-ray suggestive of chronic sialadenitis include:[27]
- Radiopaque stones: 43-60% of the parotid stones and 80-95% of the submandibular stones are radiopaque and can be seen in 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]
- The following results are seen in acute obstruction of the salivary duct due to sialadenitis after administration of contrast:
- 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:
- Preferred regimen (1): 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.\
- 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]
- Prevention of dehydration
- Healthy oral care regimen (brushing teeth)
- Treatment of underlying disease such as Sjögren's syndrome and gout
- Avoid anticholinergic and diuretic medications
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Loury, MC (2006). "Salivary gland disorder". Advanced Otolaryngology.
- ↑ 7.0 7.1 McKenna JP, Bostock DJ, McMenamin PG (1987). "Sialolithiasis". Am Fam Physician. 36 (5): 119–25. PMID 3318353.
- ↑ Maier H, Tisch M (2010). "[Bacterial sialadenitis]". HNO (in German). 58 (3): 229–36. doi:10.1007/s00106-009-2078-x. PMID 20204311.
- ↑ Maier H, Tisch M (2010). "[Bacterial sialadenitis]". HNO (in German). 58 (3): 229–36. doi:10.1007/s00106-009-2078-x. PMID 20204311.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Loury, MC (2006). "Salivary gland disorder". Advanced Otolaryngology.
- ↑ 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.
- ↑ 17.0 17.1 Silvers AR, Som PM (1998). "Salivary glands". Radiol. Clin. North Am. 36 (5): 941–66, vi. PMID 9747195.
- ↑ 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.
- ↑ 19.0 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.
- ↑ Ship JA (2002). "Diagnosing, managing, and preventing salivary gland disorders". Oral Dis. 8 (2): 77–89. PMID 11991308.
- ↑ Briffa NP, Callum KG (1989). "Use of an embolectomy catheter to remove a submandibular duct stone". Br J Surg. 76 (8): 814. PMID 2765834.
- ↑ 22.0 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.
- ↑ 23.0 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.
- ↑ Hupp, James (2008). Contemporary oral and maxillofacial surgery. St. Louis, Mo: Mosby Elsevier. ISBN 9780323049030.
- ↑ Neville, Brad (2002). Oral & maxillofacial pathology. Philadelphia: W.B. Saunders. ISBN 0721690033.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 29.0 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.
- ↑ Wilson KF, Meier JD, Ward PD (2014). "Salivary gland disorders". Am Fam Physician. 89 (11): 882–8. PMID 25077394.
Template:WH Template:WS