Sialadenitis

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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]

WikiDoc Resources for Sialadenitis
Articles
Most recent articles on Sialadenitis Most cited articles on Sialadenitis Review articles on Sialadenitis Articles on Sialadenitis in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Sialadenitis Images of Sialadenitis Photos of Sialadenitis Podcasts & MP3s on Sialadenitis Videos on Sialadenitis
Evidence Based Medicine
Cochrane Collaboration on Sialadenitis Bandolier on Sialadenitis TRIP on Sialadenitis
Clinical Trials
Ongoing Trials on Sialadenitis at Clinical Trials.gov Trial results on Sialadenitis Clinical Trials on Sialadenitis at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Sialadenitis NICE Guidance on Sialadenitis NHS PRODIGY Guidance FDA on Sialadenitis CDC on Sialadenitis
Books
Books on Sialadenitis
News
Sialadenitis in the news Be alerted to news on Sialadenitis News trends on Sialadenitis
Commentary
Blogs on Sialadenitis
Definitions
Definitions of Sialadenitis
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
Symptoms of Sialadenitis Causes & Risk Factors for Sialadenitis Diagnostic studies for Sialadenitis Treatment of Sialadenitis
Continuing Medical Education (CME)
CME Programs on Sialadenitis
International
Sialadenitis en Espanol Sialadenitis en Francais
Business
Sialadenitis in the Marketplace Patents on Sialadenitis
Experimental / Informatics
List of terms related to Sialadenitis

Synonyms and keywords:

Overview

Historical Perspective

The historical perspective of sialadenitis is as follows:

• 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.
• In 2004, Zenk et al. reported the use of semirigid sialendoscope in different types of obstructive salivary disorders.
• In 2006, Nahlieli et al. described sialendoscopy in the management of radioiodine sialadenitis.

Classification

Overview

There is no established system for the classification of sialolithisis, but it may be classified according to location of the stone, radiopaque or radiolucent, symptomatic or asymptomatic.

Classification

• There is no established system for the classification of sialolithiasis, but sialolithiasis may be classified according to location of the stone.

Gland	Percent of stones
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 be visible on radiographs or radiolucent where they will not show up on radiography
• Stones may also be symptomatic or asymptomatic.

Pathophysiology

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

Causes

Common causes of sialadenitis include the following:

Bacterial and viral infections

• Mumps
• HIV
• Staph aureus
• Streptococci
• Pseudomona aeruginosa
• Escherichia coli
• Moraxella catarrhalis
• Tuberculosis

Obstruction

• Stones
• Radiation
• Strictures
• Sarcoidosis

Autoimmune disorders

• Sjogrens

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.

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 ELIZA
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 27.5 per 1,000,000 individuals in United Kingdom.

• Patients of all age groups may develop sialadenitis.

• Sialadenitis commonly affects older, dehydrated patients.

Risk Factors

There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

Screening

There is insufficient evidence to recommend routine screening for sialadenitis.

Natural History, Complications, and Prognosis

Natural History

• If left untreated, patients with sialolithiasis may progress to develop secondary infection and chronic sialadenitis and gland atrophy.

Complications

• Common complications of sialolithiasis include:
  • Infection
  • Recurrence
  • Sialadenitis ( inflammation of salivary gland)
  • Abscess

Prognosis

• Prognosis is generally good but very small number of patients with secondary infection may develop cellulitis, abscess and compromised airway.

References

Prognosis is generally good with fluid management and antimicrobial therapy, but edema in the gland may persist for several weeks. , and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

Acute symptoms resolve within 1 week; however, edema in the area may last for several weeks 

Diagnosis

Diagnostic Criteria

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

History and Symptoms

The majority of patients with [disease name] are asymptomatic.

OR

The hallmark of [disease name] is [finding]. 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.[symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].

Common symptoms of chronic sialadenitis are similar to acute sialadenitis but with less intensity.

Physical Examination

Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of sialadenitis include gland tenderness

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Laboratory Findings

An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

Electrocardiogram

There are no ECG findings associated with sialadenitis.

X-ray

There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with [disease name].

OR

Ultrasound may be helpful in the diagnosis of neoplasm, sialolith and abnormalites of Wharton's duct as causes of siladenitis.

Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

CT scan

There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

MRI

There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Other Imaging Findings

There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

nitial treatment should include rehydration oral antistaphylococcal antibiotic should be started while awaiting culture results. Hygiene and repeated massaging of the gland when tenderness had subsided.

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR   The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

Rehydration and oral antistaphylococcal antibiotic are recommended among all patients who develop acute sialadenitis while awaiting culture results. repeated massaging of the gland when tenderness had subsided. 

Repeated massaging of the involved gland is very useful after tenderness had subsided.

Radiation may be considered for chronic bacterial sialadenitis that dose not respond to medical therapy.

 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

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Surgery

Surgical intervention is not recommended for the management of [disease name].

OR

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.

Surgical resection of involved gland in chronic bacterial sialadenitis mey be considered if it does not respond to medical therapy.

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

Primary Prevention

There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

Secondary Prevention

Effective measures for the secondary prevention of acute sialadenitis include hygiene and repeated massaging of the gland when tenderness had subsided. 

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