What is the treatment for sialadenitis?

Treatment of Sialadenitis

The management of sialadenitis should focus on identifying and treating the underlying cause, with conservative measures as first-line therapy including warm compresses, hydration, massage, and sialagogues to stimulate salivary flow. 1

Initial Management

• Apply warm compresses to the affected area to promote salivary flow and reduce inflammation 1, 2
• Ensure aggressive hydration (oral or intravenous) to dilute saliva and reduce viscosity 1, 2
• Perform gentle massage of the salivary gland to encourage drainage (use with caution in elderly patients or those with suspected carotid stenosis) 1, 3
• Administer sialagogues (saliva stimulants) to increase flow and reduce stasis 1, 4
• Prescribe non-steroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation 1

Antibiotic Therapy

• Antibiotics should be prescribed if bacterial infection is suspected 1, 5
• Cephalosporins and fluoroquinolones are preferred due to superior pharmacokinetics in saliva and coverage of bacteria implicated in sialadenitis 6
• These antibiotics achieve concentrations in saliva that exceed the minimal inhibitory concentrations of relevant bacteria (Staphylococcus aureus, Viridans streptococci, gram-negative strains, and anaerobes) 6
• Phenoxymethylpenicillin and tetracyclines should be avoided as they do not reach bactericidal levels in saliva 6

Management of Obstructive Causes

• For sialolithiasis (salivary stones), treatment options include:
  • Conservative management with hydration and sialagogues for small stones 7
  • Surgical interventions such as salivary lithotripsy, basket retrieval, or sialendoscopy for larger stones 7
• For strictures or other mechanical obstructions, addressing the underlying cause is essential 8

Advanced Interventions

• For recurrent or chronic sialadenitis unresponsive to conservative measures, consider:
  • Sialendoscopy for direct visualization and treatment of ductal pathology 4
  • Total excision of the salivary gland and its duct may be necessary in cases of recurrent infection 5

Special Considerations for Post-Surgical Sialadenitis

• Maintain a very low threshold for airway management (including reintubation) if acute sialadenitis with significant swelling develops 3
• Monitor for neurologic complications including brachial plexopathy, facial nerve palsy, and Horner syndrome 3
• Corticosteroids may be considered for significant airway swelling 2

Imaging

• Ultrasound is the preferred initial imaging modality for salivary gland assessment 1, 9
• MRI may be indicated for suspected tumors or complex cases 1
• Imaging can detect abscesses, ductal changes, cysts, stones, and strictures 9

Monitoring and Follow-up

• Monitor for signs of airway compromise, which may require prompt intervention 3
• Watch for potential complications including bacterial superinfection 2
• Most patients with properly managed sialadenitis achieve complete or near-complete recovery 3