Diagnosis

Sialadenitis

Etiology

Cause [22d][fvn][ba7][tyc]

• Obstruction:

  • Sialolithiasis (peak between 31 and 55 years of age)

  • Strictures: Surgery, trauma

  • Congenital anomaly of a salivary duct

  • Excretory duct obstruction/foreign body: Fish bone, hair, grass blade

  • External compression of duct: Denture flanges

  • Secretion disorder

  • Benign tumors: Hemangioma, hemangiolymphoma, pleomorphic adenoma, Oncocytoma, Sialolipoma

  • Malignant tumors: Mucoepidermoid carcinoma, adenoid-cystic carcinoma, acinic cell carcinoma, salivary duct carcinoma, adenocarcinoma, clear cell carcinoma, SCC, malignant lymphoma, embryonic rhabdomyosarcomas

• Infection

  • Bacteria: Staphylococcus aureus, Streptococcus viridans, Pseudomonas aeruginosa, E.coli, Moraxella cataralis, Hemophilus influenza, Tuberculosis, Actinomyces

  • Virus: Mumps, parainfluenza, Epstein-Barr virus, HIV

• Inflammation: Postradiation, contrast-induced, radioiodine treatment

• Autoimmune: Sjogrens syndrome, IgG4-related disease

• Drug-induced: Clozapine, I-asparaginase, Phenylbutazone

• Granulomatous sialadenitis: Sarcoidosis, Xanthogranulomatous sialadenitis

• Sialoadenosis is caused by: Bulimia nervosa, vitamin deficiency, diabetes mellitus, hypothyroidism, obesity, cirrhosis, malabsorption, Sjogrens syndrome, Valproic acid, Thiourea

Pathophysiology [tyc]

1. Normal physiology:

   • Parasympathetic stimulation increases saliva secretion,

   • Saliva contain substances that begin food breakdown and maintain the oral cavity’s health, including immunoglobulin A

2. Hyposecretion --> Duct obstruction --> Salivary stasis --> Painful swelling

3. Secondary inflammation

4. Eventually leading to retrograde contamination of salivary ducts from the oral cavity

   • Interstitial neutrophilic infiltration

   • Necrosis with acinar destruction

   • Chronic sialadenitis: Chronic inflammation and fibrosis

5. Sialadenosis is a non-inflammatory benign swelling with atrophy of parenchymal tissue and a compensatory increase in the amount of adipose tissue

Risk factors [tyc]

• Hyposecretion

  • Dehydration

  • Immunocompromised

  • Undernourished

  • Medications: Antihistaminics, diuretics, and beta-blockers

  • After surgery

  • Radiation therapy

  • Sjogren syndrome

• Older age

• Poor oral hygiene

• Gout

• History of nephrolithiasis

• Smoking

Complications [tyc]

• Abscess

• Chronic sialadenitis

• Dental decay due to decreased protection from acid erosion

Epidemiology

Incidence per 100.000 [cok][fvn][a5m]

Approach

• Blood test: Blood cell count, ESR, electrolytes, antinuclear antibody, anti-Ro/SS-A/SS-B/La antibodies

• Blood culture

• Ultrasonography can demonstrate sialolith and abscess cavity

• Sialoendoscopy

• Distal subtraction angiography sialography

• CT/MRI

• PET/CT

• Fine-needle aspiration and biopsy

Treatment

1. Acute sialadenitis: [xut][tyc]

   • NSAIDs

   • Hydration

   • Warm compress

   • Massage if calculi

   • Antibiotics: Dicloxacillin/Cephalexin 500mg x 4 for 7-10 days, Clindamycin

   • Not responding to conservative treatment --> surgery:

     • Duct cannulation with stone removal

     • Drainage of abscess

     • Gland excision in recurrent case

2. Chronic sialadenitis:

   • Hydration

   • Oral hygiene

   • Pain relief

   • Sialogogues

   • Infection --> broad-spectrum antibiotics

   • Sialolithiasis --> salivary gland stone removal

     • Interventional sialendoscopy

     • Extracorporeal shock wave lithotripsy

     • Excision of the salivary gland if recurrent sialadenitis (>3 episodes/year) or in chronic sclerosing sialadenitis

3. Sialadenosis: Expectant management and treatment of the underlying cause

Differential diagnoses

Actinomycosis, Benign tumors of salivary glands, Cat scratch disease, Cellulitis, Cirrhosis, Diabetes mellitus, HIV, Hypothyroidism, Lymphoma, Malignant tumors of salivary glands, Sarcoidosis, Sialolithiasis, Sjogren syndrome, Systemic lupus erythematosus, Tuberculosis, Tularemia, Vitamin deficiency