From the Research
Bacterial sialadenitis is distinguished through a combination of clinical presentation, physical examination, and diagnostic tests, with the most recent and highest quality study 1 emphasizing the importance of imaging findings in detecting abscess, ductal changes, and salivary stones. Patients typically present with sudden onset of pain, swelling, and tenderness in the affected salivary gland, most commonly the parotid or submandibular gland. On examination, you may observe:
- Erythema over the gland
- Purulent discharge from the duct opening when the gland is massaged
- Possibly fever Laboratory findings often show:
- Leukocytosis with neutrophil predominance
- Elevated inflammatory markers Imaging studies such as ultrasound may reveal:
- Gland enlargement
- Ductal dilation
- Abscess formation CT or MRI can provide more detailed information in complex cases, as noted in 2. Microbiological confirmation can be obtained by culturing the purulent discharge, with Staphylococcus aureus and Streptococcus species being common pathogens, as reported in 3 and 4. Bacterial sialadenitis differs from viral causes by its more acute presentation, presence of purulence, and response to antibiotics. Treatment typically includes:
- Empiric antibiotics such as amoxicillin-clavulanate 875/125 mg twice daily for 7-10 days
- Adequate hydration
- Warm compresses
- Gland massage
- Sialogogues like lemon drops to stimulate saliva flow, as discussed in 5. Severe cases may require hospitalization for IV antibiotics and possible surgical drainage if an abscess develops.