Sialadenitis

Sialadenitis: Definition & Classification - The Gland Stand

• Definition: Inflammation of one or more salivary glands, leading to swelling and pain.
• Classification:
  • By Onset & Duration:
    • Acute: Rapid onset, significant pain, glandular swelling.
    • Chronic: Persistent or recurrent, often less painful, glandular enlargement/fibrosis.
  • By Etiology:
    • Infectious: Bacterial (e.g., Staphylococcus aureus), Viral (e.g., Mumps).
    • Non-infectious: Obstructive (e.g., sialoliths), autoimmune (e.g., Sjögren's syndrome), post-radiation.
• Major Glands: Parotid, Submandibular, Sublingual. Minor glands can also be involved.

⭐ Most common gland affected by sialolithiasis is the submandibular gland.

Sialadenitis: Etiology & Risk Factors - Gland Invaders

Etiological Agents (Invaders):

⭐ Staphylococcus aureus is the most common bacterial cause of acute suppurative sialadenitis.

Key Risk Factors:

• Dehydration, sialolithiasis (ductal obstruction)
• Poor oral hygiene, post-operative state (esp. after major surgery)
• Medications (anticholinergics, diuretics) → xerostomia
• Immunosuppression (e.g., HIV, chemotherapy)
• Sjögren's syndrome, radiation therapy
• Advanced age, debilitation

Sialadenitis: Clinical Features & Diagnosis - Decoding Distress

• Acute Sialadenitis:

  • Sudden onset of pain & swelling in the affected gland (parotid, submandibular).
  • Erythema and tenderness over the gland.
  • Fever, malaise.
  • Trismus (if parotid gland involved, especially with abscess).
  • Pus from duct orifice (Stensen's for parotid, Wharton's for submandibular).
  • Aggravated by meals (salivary stimulation).

• Chronic Sialadenitis:

  • Recurrent, less severe swelling, often postprandial.
  • Gland may be firm, less tender than acute.
  • Reduced salivary flow; dry mouth (xerostomia).
  • Palpable stones (sialolithiasis) in some cases.

• Diagnosis:

  • Clinical examination: gland palpation, duct massage for pus.
  • Ultrasound (USG): initial imaging of choice; shows inflammation, abscess, stones, duct dilation.
  • CT/MRI: for deep infections, suspected tumors, or complex cases.
  • Sialography: less common now; shows ductal anatomy.
  • FNAC/Biopsy: if tumor suspected or diagnosis unclear.

⭐ Purulent discharge from Stensen's or Wharton's duct is highly suggestive of acute bacterial sialadenitis.

Sialadenitis: Management & Complications - Fixing & Foiling

Management Aims: Control infection, pain relief, restore salivary function, prevent recurrence.

• Acute Bacterial Sialadenitis:
  • Supportive: Hydration, analgesia, warm compresses, sialogogues (lemon, Vit C), oral hygiene.
  • Antibiotics: Anti-staphylococcal (clindamycin, amox-clav). IV for severe/immunocompromised.
  • Surgical drainage for abscess.

  ⭐ First-line treatment for acute bacterial sialadenitis includes hydration, sialogogues, and anti-staphylococcal antibiotics.

• Chronic Sialadenitis:
  • Conservative: Gland massage, sialogogues, NSAIDs.
  • Interventional: Sialendoscopy (diagnosis, stone removal, stricture dilation), intraductal steroids.
  • Surgical: Gland excision for refractory disease.
• Viral (Mumps): Symptomatic relief (analgesics, hydration).

Complications:

• Abscess, cellulitis
• Ductal stricture, sialocele, fistula
• Sialolithiasis (stone formation)
• Ludwig's angina (submandibular)
• Chronic sialadenitis, gland atrophy
• Recurrence

High‑Yield Points - ⚡ Biggest Takeaways

• Acute bacterial sialadenitis: Staphylococcus aureus is the prime pathogen; parotid gland most frequently involved.
• Major risk factors: Dehydration, post-operative state, elderly, immunosuppression, and sialolithiasis.
• Key symptoms: Sudden painful gland swelling, erythema, purulent ductal discharge, and fever.
• Sialolithiasis: Most common in submandibular gland (Wharton's duct); a significant predisposing factor.
• Küttner tumor (chronic sclerosing sialadenitis): A specific form affecting the submandibular gland.
• Viral mumps: Caused by paramyxovirus, presents as bilateral parotitis typically.