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Diseases

Sialadenitis

OVERVIEW

  • Highlights & Basics
  • Images

DIAGNOSIS

  • Diagnostic Approach
  • Risk Factors
  • History & Exam
  • Tests
  • Differential Diagnosis
  • Criteria
  • Screening

TREATMENT

  • Tx Approach
  • Tx Options
  • Emerging Tx
  • Prevention

FOLLOW-UP

  • Overview
  • Complications

REFERENCES

  • Citations
  • Guidelines
  • Credits

PATIENT RESOURCES

  • Patient Instructions

Highlights & Basics

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Key Highlights
  • Sialadenitis is the inflammation and enlargement of one or several major salivary glands. It most commonly affects parotid and submandibular glands.

  • Bacterial infection can occur if salivary flow is diminished by illness or medication, or is obstructed by a sialolith (salivary stone). Most commonly caused by Staphylococcus aureus.

  • Intermittent painless unilateral or bilateral swellings without accompanying signs of infection may be idiopathic or due to an underlying condition, such as ductal stenosis or autoimmune disease.

  • Chronic sclerosing sialadenitis presents as a painless unilateral swelling that can mimic tumors. Biopsy is required for diagnosis.

  • Airway compromise is an important potential consequence of acute glandular swelling.

Acute bacterial sialadenitis of left parotid gland
Acute bacterial sialadenitis of left parotid gland
From the personal collection of Dr A. Aguirre; used with permission

Quick Reference

  • History & Exam

    • Key Factors

      • Other Factors

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      • Diagnostics Tests

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        • Treatment Options

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          Definition

          Epidemiology

          Etiology

          Pathophysiology

          content by BMJ Group
          Last updated

          Images

          • Acute bacterial sialadenitis of left parotid gland

            Acute bacterial sialadenitis of left parotid gland

          • Occlusal radiographic film showing presence of multiple sialoliths in the left Wharton duct

            Occlusal radiographic film showing presence of multiple sialoliths in the left Wharton duct

          • Intraoral view of right parotid gland showing purulent exudate exiting Stensen duct

            Intraoral view of right parotid gland showing purulent exudate exiting Stensen duct

          • Bilateral swelling of parotid glands in Sjogren syndrome

            Bilateral swelling of parotid glands in Sjogren syndrome

          Citations

            Key Articles

            • Fattahi TT, Lyu PE, Van Sickels JE. Management of acute suppurative parotitis. J Oral Maxillofac Surg. 2002;60:446-448.[Abstract]

            • Kraaij S, Karagozoglu KH, Forouzanfar T, et al. Salivary stones: symptoms, aetiology, biochemical composition and treatment. Br Dent J. 2014 Dec 5;217(11):E23.[Abstract][Full Text]

            Referenced Articles

            • 1. Seifert G. Aetiological and histological classification of sialadenitis. Pathologica. 1997;89:7-17.[Abstract]

            • 2. Abdel Razek AAK, Mukherji S. Imaging of sialadenitis. Neuroradiol J. 2017 Jun;30(3):205-15.[Abstract][Full Text]

            • 3. Baer AN, Walitt B. Sjögren syndrome and other causes of sicca in older adults. Clin Geriatr Med. 2017 Feb;33(1):87-103.[Abstract][Full Text]

            • 4. Kassan SS, Moutsopoulos HM. Clinical manifestations and early diagnosis of Sjögren syndrome. Arch Intern Med. 2004 Jun 28;164(12):1275-84.[Abstract][Full Text]

            • 5. Dafni UG, Tzioufas AG, Staikos P, et al. Prevalence of Sjögren's syndrome in a closed rural community. Ann Rheum Dis. 1997 Sep;56(9):521-5.[Abstract][Full Text]

            • 6. Puxeddu I, Capecchi R, Carta F, et al. Salivary Gland Pathology in IgG4-Related Disease: A Comprehensive Review. J Immunol Res. 2018;2018:6936727.[Abstract][Full Text]

            • 7. Geyer JT, Ferry JA, Harris NL, et al. Chronic sclerosing sialadenitis (Küttner tumor) is an IgG4-associated disease. Am J Surg Pathol. 2010 Feb;34(2):202-10.[Abstract]

            • 8. Suresh L, Aguirre A. Subacute necrotizing sialadenitis: a clinicopathological study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Sep;104(3):385-90.[Abstract]

            • 9. Laskawi R, Schaffranietz F, Arglebe C, et al. Inflammatory diseases of the salivary glands in infants and adolescents. Int J Pediatr Otothinolaryngol. 2006;70:129-136.[Abstract]

            • 10. Singh SA, Singhal N. Suppurative submandibular sialadenitis in a preterm infant. Int J Pediatr Otothinolaryngol. 2004;68:593-595.[Abstract]

            • 11. McAdams RM, Mair EA, Rajnik M. Neonatal suppurative submandibular sialadenitis: case report and literature review. Int J Pediatr Otothinolaryngol. 2005;69:993-997.[Abstract]

            • 12. Ismail EA, Seoudi TM, Al-Amir M, et al. Neonatal suppurative parotitis over the last 4 decades: report of three new cases and review. Pediatr Int. 2013 Feb;55(1):60-4.[Abstract]

            • 13. Seifert G. Aetiological and histological classification of sialadenitis. Pathologica. 1997;89:7-17.[Abstract]

            • 14. Fox PC, Ship JA. Salivary gland diseases. In: Greenberg MS, Glick M, Ship JA, ed. Burkket's oral medicine. 11th ed. Hamilton, Ontario: BC Decker. 2008:208-215.

            • 15. Helmick CG, Felson DT, Lawrence RC, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum. 2008;58:15-25.[Abstract][Full Text]

            • 16. Porola P, Laine M, Virkki L, et al. The influence of sex steroids on Sjogren's syndrome. Ann NY Acad Sci. 2007;1108:426-432.[Abstract]

            • 17. Goldberg MH, Bevilacqua RG. Infections of salivary glands. Oral and Maxillofac Surg Clin N Am. 1995;7:423-430.

            • 18. Fattahi TT, Lyu PE, Van Sickels JE. Management of acute suppurative parotitis. J Oral Maxillofac Surg. 2002;60:446-448.[Abstract]

            • 19. Brook I. Acute bacterial suppurative parotitis: microbiology and management. J Craniofac Surg. 2003;14:37-40.[Abstract]

            • 20. Ellies M, Laskawi R. Diseases of the salivary glands in infants and adolescents. Head Face Med. 2010 Feb 15;6:1.[Abstract][Full Text]

            • 21. Krippaehne WW, Hunt TK, Dunphy JE. Acute suppurative parotitis: a study of 161 cases. Ann Surg. 1962;156:251-257.[Abstract][Full Text]

            • 22. Carlson ER. Diagnosis and management of salivary gland infections. Oral Maxillofac Surg Clin North Am. 2009 Aug;21(3):293-312.[Abstract]

            • 23. Salivary gland pathology. In: Neville BW, Damm DD, Allen CM, et al, eds. Oral and maxillofacial pathology. 3rd ed. Philadelphia, PA: Saunders Elsevier; 2008:459.

            • 24. Lombardi T, Samson J, Küffer R. Subacute necrotizing sialadenitis: a form of necrotizing sialometaplasia? Arch Otolaryngol Head Neck Surg. 2003 Sep;129(9):972-5.[Abstract][Full Text]

            • 25. Gallo A, Martellucci S, Fusconi M, et al. Sialendoscopic management of autoimmune sialadenitis: a review of literature. Acta Otorhinolaryngol Ital. 2017 Apr;37(2):148-154.[Abstract][Full Text]

            • 26. Tiemann M, Teymoortash A, Schrader C, et al. Chronic sclerosing sialadenitis of the submandibular gland is mainly due to a T lymphocyte immune reaction. Mod Pathol. 2002 Aug;15(8):845-52.[Abstract][Full Text]

            • 27. Papadaki ME, McCain JP, Kim K, et al. Interventional sialoendoscopy: early clinical results. J Oral Maxillofac Surg. 2008;66;954-962.[Abstract]

            • 28. Kraaij S, Karagozoglu KH, Forouzanfar T, et al. Salivary stones: symptoms, aetiology, biochemical composition and treatment. Br Dent J. 2014 Dec 5;217(11):E23.[Abstract][Full Text]

            • 29. Blanco M, Mesko T, Cura M, et al. Chronic sclerosing sialadenitis (Kuttner's tumor): unusual presentation with bilateral involvement of major and minor salivary glands. Am Diagn Pathol. 2003;7:25-30.[Abstract]

            • 30. Williams HK, Connor R, Edmondson H. Chronic sclerosing sialadenitis of submandibular and parotid glands. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89:720-723.[Abstract]

            • 31. Fowler CB, Brannon RB. Subacute necrotizing sialadenitis: report of 7 cases and a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000 May;89(5):600-9.[Abstract]

            • 32. Spijkervet FK, Haacke E, Kroese FG, et al. Parotid Gland Biopsy, the Alternative Way to Diagnose Sjögren Syndrome. Rheum Dis Clin North Am. 2016 Aug;42(3):485-99.[Abstract]

            • 33. McGuirt WF Jr, Whang C, Moreland W. The role of parotid biopsy in the diagnosis of pediatric Sjögren syndrome. Arch Otolaryngol Head Neck Surg. 2002 Nov;128(11):1279-81.[Abstract][Full Text]

            • 34. Deshpande V, Zen Y, Chan JK, et al. Consensus statement on the pathology of IgG4-related disease. Mod Pathol. 2012 Sep;25(9):1181-92.[Abstract][Full Text]

            • 35. Vogl TJ, Al-Nawas B, Beutner D, et al. Updated S2K AWMF guideline for the diagnosis and follow-up of obstructive sialadenitis--relevance for radiologic imaging. Rofo. 2014;186:843-846.[Abstract][Full Text]

            • 36. Miranda-Rius J, Brunet-Llobet L, Lahor-Soler E, et al. Salivary Secretory Disorders, Inducing Drugs, and Clinical Management. Int J Med Sci. 2015;12(10):811-24.[Abstract][Full Text]

            • 37. Jiao A, Farsad K, McVinnie DW, et al. Characterization of iodide-induced sialadenitis: meta-analysis of the published case reports in the medical literature. Acad Radiol. 2020 Mar;27(3):428-35.[Abstract][Full Text]

            • 38. Chandra SR. Sialoendoscopy: review and nuances of technique. J Maxillofac Oral Surg. 2019 Mar;18(1):1-10.[Abstract][Full Text]

            • 39. Wilson KF, Meier JD, Ward PD. Salivary gland disorders. Am Fam Physician. 2014 Jun 1;89(11):882-8.[Abstract][Full Text]

            • 40. Ko YC, Philipone E, Florin W, et al. Subacute necrotizing sialadenitis: a series of three cases and literature review. Head Neck Pathol. 2016 Dec;10(4):425-8.[Abstract][Full Text]

            • 41. Troeltzsch M, Pache C, Probst FA, et al. Antibiotic concentrations in saliva: a systematic review of the literature, with clinical implications for the treatment of sialadenitis. J Oral Maxillofac Surg. 2014;72:67-75.[Abstract][Full Text]

            • 42. European Medicines Agency. Quinolone and fluoroquinolone-containing medicinal products. November 2018 [internet publication].[Full Text]

            • 43. Medicines and Healthcare products Regulatory Agency. Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects. March 2019 [internet publication].[Full Text]

            • 44. Food and Drug Administration. FDA Drug Safety Communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together. December 2016 [internet publication].[Full Text]

            • 45. Food and Drug Administration. FDA warns about increased risk of ruptures or tears in the aorta blood vessel with fluoroquinolone antibiotics in certain patients. December 2018 [internet publication].[Full Text]

            • 46. Food and Drug Administration. FDA reinforces safety information about serious low blood sugar levels and mental health side effects with fluoroquinolone antibiotics; requires label changes. October 2018 [internet publication].[Full Text]

            • 47. Marchal F, Bradley PJ. Treatment of infections and inflammatory conditions. In: Management of infections of the salivary glands. Berlin, Germany: Springer Berlin Heidelberg. 2007:169-176.

            • 48. National Institute for Health and Care Excellence. Therapeutic sialendoscopy - Interventional procedures guidance [IPG218]. May 2007 [internet publication].[Full Text]

            • 49. Strychowsky JE, Sommer DD, Gupta MK, et al. Sialendoscopy for the management of obstructive salivary gland disease: A systematic review and meta-analysis. Arch Otolaryngol Head Neck Surg. 2012;138:541-547.[Abstract]

            • 50. Su YX, Lao XM, Zheng GS, et al. Sialoendoscopic management of submandibular gland obstruction caused by intraglandular foreign body. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114:e17-e21.[Abstract]

            • 51. Moody AB, Avery CM, Walsh S, et al. Surgical management of chronic parotid disease. Br J Oral Maxillofac Surg. 2000;38:620-622.[Abstract]

            • 52. Moody AB, Avery CM, Taylor J, et al. A comparison of 150 consecutive parotidectomies for tumours and inflammatory disease. Int J Oral Maxillofac Surg. 1999;28:211-215.[Abstract]

            • 53. Amin MA, Bailey BM, Patel SR. Clinical and radiological evidence to support superficial parotidectomy as the treatment of choice for chronic parotid sialadenitis: a retrospective study. Br J Oral Maxillofac Surg. 2001;39:348-352.[Abstract]

            • 54. Patel RS, Low TH, Gao K, et al. Clinical outcome after surgery for 75 patients with parotid sialadenitis. Laryngoscope. 2007;117:644-647.[Abstract]

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