What is the diagnosis of sialadenitis (inflammation of the salivary glands)?

From the Guidelines

Diagnosis of sialadenitis requires a combination of clinical evaluation and appropriate diagnostic tests, with CT scanning being particularly useful in detecting calculus disease resulting in sialadenitis, as stated in the study by 1. The diagnosis begins with a thorough history and physical examination, looking for symptoms such as pain, swelling, and tenderness in the affected salivary gland, often accompanied by fever, dry mouth, and foul-tasting discharge.

• Bimanual palpation of the gland is essential to assess for firmness, tenderness, and possible stone presence.
• Laboratory tests including complete blood count and inflammatory markers (ESR, CRP) help evaluate for infection. Imaging studies are crucial, with ultrasound being the first-line option due to its accessibility and ability to detect stones, ductal dilation, and parenchymal changes without radiation exposure.
• CT scanning provides excellent visualization of gland inflammation and calcifications, while MRI offers superior soft tissue contrast for evaluating tumors or deep tissue involvement, as noted in the study by 1.
• Sialography, which involves injecting contrast into the salivary duct, can identify strictures and stones but is contraindicated during acute infection.
• Sialendoscopy allows direct visualization of the ductal system and can be both diagnostic and therapeutic. In cases where malignancy is suspected, fine needle aspiration or biopsy may be necessary.
• Bacterial culture of purulent discharge guides antibiotic therapy in infectious cases, typically requiring coverage for oral flora including Staphylococcus aureus and anaerobes, as mentioned in the study by 1.

From the Research

Diagnosis of Sialadenitis

• Sialadenitis is an inflammation or infection of the salivary glands that may affect the parotid, submandibular, and small salivary glands 2
• Imaging findings vary among unilateral or bilateral salivary gland enlargement, atrophy, abscess, ductal dilation, cysts, stones, and calcification 2
• Imaging can detect abscess in acute bacterial suppurative sialadenitis, ductal changes with cysts in chronic adult and juvenile recurrent parotitis 2

Imaging Techniques

• Ultrasonography, sialendoscopy, and MR-sialography are technical achievements that have increased the possibilities for diagnosis and treatment of patients with obstructive sialadenitis 3
• Diagnostic ultrasound and resonance methods are focused on because they can investigate almost all inflammatory diseases of the large salivary glands with accurate results, without exposing the patient to radiation 4
• Ultrasound will stay the procedure of first choice for imaging of salivary gland diseases in Germany, and in combination with fine-needle aspiration cytology, high sensitivity and specificity for the assessment of salivary gland tumors can be achieved 5

Sialoendoscopy

• Sialoendoscopy is a new technology being used for the diagnosis and management of obstructive sialadenitis, with superior diagnostic potential and decreased morbidity compared to traditional techniques 6
• Sialoendoscopy can successfully endoscopically canalize the duct, remove stones, and identify other abnormal findings such as strictures, scars, and mucoid debris 6
• The use of laser lithotripsy for fragmentation of larger stones is being trialed at some institutions 6

Guideline and Recommendations

• A new S2k AWMF guideline for the treatment of obstructive sialadenitis has been published, describing all relevant steps to diagnose an obstructive sialadenitis and valuing all diagnostic tools critically 3
• The guideline recommends various modern treatment options, such as sialendoscopy, extracorporeal shock-waves lithotripsy, and salivary duct incision, to preserve the affected gland in most patients, especially in cases of sialolithiasis 3