What is sialadenitis and how is it treated?

Sialadenitis: Definition and Treatment Approach

Sialadenitis is an inflammation or infection of the salivary glands that requires prompt treatment with hydration, massage, antibiotics, and sometimes steroids to prevent complications such as airway compromise. 1

What is Sialadenitis?

• Sialadenitis is inflammation or infection affecting the salivary glands, which may involve the parotid, submandibular, or minor salivary glands 2
• It can present as acute, recurrent, or chronic inflammation with symptoms of pain and localized swelling 3
• Common causes include:
  • Obstructive causes (sialolithiasis/stones) - most common cause in submandibular gland (40%) 4
  • Bacterial infections leading to suppurative sialadenitis 1
  • Mechanical compression of salivary ducts, particularly Wharton's duct 5
  • Viral infections (mumps, HIV) 1
  • Autoimmune conditions 3

Clinical Presentation

• Rapid-onset pain and swelling of the affected salivary gland in acute cases 1
• Recurrent episodes of swelling and pain in chronic or recurrent cases 1
• Possible fever and purulent discharge from the salivary duct in bacterial cases 1
• In severe cases, particularly post-surgical sialadenitis, potential complications include:
  • Airway compromise requiring reintubation or tracheostomy 6
  • Neurological complications including brachial plexopathy, facial nerve palsy, and Horner syndrome due to inflammatory compression 5

Diagnosis

• Clinical examination revealing tender, swollen salivary gland 1
• Imaging studies may show:
  • Unilateral or bilateral salivary gland enlargement 2
  • Ductal dilation, cysts, stones, or calcification 2
  • Abscess formation in acute bacterial cases 2
• Imaging modalities include:
  • Ultrasonography - first-line imaging for suspected sialadenitis 3
  • CT or MRI for more detailed evaluation when complications are suspected 2

Treatment Algorithm

1. Acute Suppurative Sialadenitis

• First-line treatment:

  • Antibiotics (typically covering Staphylococcus aureus and oral anaerobes) 7
  • Aggressive hydration to promote salivary flow 6
  • Salivary gland massage to promote drainage 6
  • Sialagogues (lemon drops or vitamin C lozenges) to stimulate salivary flow 6, 1
  • Warm compresses to the affected area 6

• For severe cases with significant swelling:

  • Monitor airway closely - maintain low threshold for reintubation if airway compromise is suspected 6
  • Consider corticosteroids to reduce inflammation and swelling 6

2. Obstructive Sialadenitis (Sialolithiasis)

• Conservative management as above for mild cases 1
• For persistent obstruction:
  • Stone removal may be required via:
    • Minimally invasive techniques (sialendoscopy) for accessible stones 1
    • Surgical excision of the affected gland for recurrent cases or inaccessible stones 7

3. Chronic/Recurrent Sialadenitis

• Address underlying cause if identified 1
• For recurrent episodes without identifiable cause:
  • Maintain good hydration 7
  • Regular salivary gland massage 6
  • Consider surgical excision of the affected gland for cases unresponsive to conservative management 7, 4

Special Considerations

• Post-surgical sialadenitis (particularly after skull base surgery):

  • Prevention through careful intraoperative positioning to avoid extreme head/neck flexion or rotation 8
  • Prompt recognition of submandibular swelling, typically occurring within 4 hours following surgical closure 6
  • Aggressive airway management with low threshold for reintubation 6

• Pediatric sialadenitis:

  • Relatively rare in children and adolescents 4
  • Surgical intervention may be necessary for cases unresponsive to conservative treatment 4

Treatment Outcomes

• Most patients with sialadenitis achieve complete recovery with appropriate treatment 6
• Surgical excision of the affected gland is typically curative for recurrent cases 7, 4
• Post-surgical sialadenitis cases generally have favorable outcomes when airway compromise is effectively managed 8

Common Pitfalls to Avoid

• Delaying treatment of acute sialadenitis, which can lead to abscess formation or airway compromise 6
• Failing to recognize potential airway compromise in severe cases, particularly post-surgical sialadenitis 6
• Inadequate hydration, which is essential for promoting salivary flow and preventing stasis 6
• Missing underlying causes such as stones or strictures that may require specific interventions 1