From the Guidelines
Management of salivary gland infections in elderly patients should prioritize a multidisciplinary approach, with a focus on symptomatic relief using topical therapies, as recommended by the European League Against Rheumatism (EULAR) 1.
Key Considerations
- The first therapeutic approach for dryness should be symptomatic relief using topical therapies, as more than 95% of patients present with sicca symptoms, which have a significant impact on health-related quality of life (HRQoL) 1.
- Baseline evaluation of salivary gland function is recommended before starting treatment for oral dryness, and the preferred first therapeutic approach for oral dryness may be non-pharmacological stimulation for mild dysfunction, pharmacological stimulation for moderate dysfunction, or saliva substitution for severe dysfunction 1.
- Concomitant diseases should be evaluated in patients presenting with fatigue/pain, and treatment of systemic disease should be tailored to organ-specific severity using the ESSDAI definitions 1.
Treatment Recommendations
- For acute bacterial sialadenitis, empiric antibiotic therapy should be initiated with amoxicillin-clavulanate or clindamycin, and adequate hydration is essential to promote salivary flow.
- Warm compresses and gentle massage of the gland may help reduce pain and inflammation, and pain management with acetaminophen is preferred in elderly patients to avoid NSAIDs.
- Sialogogues like sugar-free lemon candies can stimulate saliva production, and daily oral hygiene with chlorhexidine mouthwash and regular dental check-ups are important preventive measures.
Important Considerations
- Elderly patients often have reduced salivary flow due to medications, systemic diseases, or prior radiation therapy, making them more susceptible to infections.
- If symptoms worsen despite treatment, purulent drainage is present, or the patient develops fever above 101°F, immediate medical reevaluation is necessary as surgical drainage or hospitalization for intravenous antibiotics may be required.
- A multidisciplinary approach involving various health professionals is essential, with a central role for specialists in autoimmune diseases, who should act as the coordinator of diagnostic and therapeutic healthcare processes, based on a shared-decision policy between the patient and the specialist 1.
From the Research
Managing Salivary Gland Infection in Elderly
- Salivary gland infections can be treated with a diverse array of modalities ranging from conservative medical therapy to removal of the affected salivary gland 2.
- The goal of management of such infections is to preserve the gland, and minimally invasive techniques employing diagnostic and interventional sialoendoscopy can be used 2.
- Acute and chronic inflammatory diseases of the major and minor salivary glands constitute the most common clinical syndrome of salivary glands, and the use of antibiotics along with fluid hydration and electrolyte management has almost eliminated the development of fulminating acute suppurative parotitis in hospital surgical patients 3.
- Intraductal instillation of penicillin or saline is a simple and surprisingly successful technique for the treatment of chronic sialadenitis, with high success rates in patients with submandibular sialadenitis and parotitis 4.
- Updated guidelines recommend the use of sialendoscopy and other emerging minimally invasive techniques for the therapy of sialolithiasis and other obstructive salivary gland diseases, and emphasize the importance of conservative therapeutic measures 5.
- A practical evidence-based approach to the management of patients with sialadenitis involves history and physical examination, imaging, and prompt recognition and treatment of the condition to prevent the development of complications, with family physicians playing an important role in diagnosis and management 6.
Treatment Options
- Conservative medical therapy
- Minimally invasive techniques employing diagnostic and interventional sialoendoscopy
- Intraductal instillation of penicillin or saline
- Removal of the affected salivary gland
- Antibiotics along with fluid hydration and electrolyte management
Important Considerations
- Preserving the gland is a key goal of management
- Prompt recognition and treatment can prevent complications
- Family physicians can play an important role in diagnosis and management
- Red flags such as suspected abscess formation, signs of respiratory obstruction, facial paresis, and fixation of a mass to underlying tissue should prompt urgent referral to head and neck surgery or a visit to the emergency department 6