From the Guidelines
Parotid sialoadenitis should be evaluated with a CT face and/or neck with IV contrast to assess for acute inflammation and other underlying causes, as recommended by the American College of Radiology 1.
Diagnosis and Evaluation
The diagnosis of parotid sialoadenitis involves a combination of clinical evaluation and imaging studies.
- CT face and/or neck with IV contrast is the preferred imaging modality for evaluating palpable parotid region abnormalities, including suspected parotid acute inflammation 1.
- CT without IV contrast may be helpful in a small number of cases, but it is not the primary choice for evaluating parotid sialoadenitis.
- The use of dual-phase CT (without and with IV contrast) is not usually necessary, as most sialoliths are not obscured by contrast 1.
Treatment and Management
The treatment of parotid sialoadenitis depends on the underlying cause and severity of the condition.
- For acute bacterial parotid sialoadenitis, empiric antibiotic therapy should be initiated with amoxicillin-clavulanate or clindamycin, and adequate hydration is essential.
- Salivary stimulation using sugar-free lemon candies or chewing gum, and warm compresses applied to the affected area, can help reduce pain and inflammation.
- In severe cases with abscess formation, surgical drainage may be necessary.
- Chronic recurrent parotid sialoadenitis may require sialendoscopy to remove stones or strictures, or in refractory cases, parotidectomy might be considered. Note that the management of salivary gland malignancy, as discussed in the ASCO guideline 1, is not directly relevant to the evaluation and treatment of parotid sialoadenitis.
From the Research
Definition and Causes of Parotid Sialoadenitis
- Parotid sialoadenitis refers to inflammation or infection of the parotid gland, which can be caused by a broad range of processes including infectious, obstructive, and autoimmune factors 2.
- Nonneoplastic disorders of the salivary glands, such as parotid sialoadenitis, involve inflammatory processes and can be managed conservatively with antibiotics, warm compresses, massage, sialogogues, and adequate hydration 3.
Diagnosis and Management
- History and physical examination play important roles in directing management, while imaging is often useful to establish a diagnosis 2.
- Sialendoscopy has emerged as a leading diagnostic technique and intervention for parotid sialoadenitis, offering a minimally invasive option for the diagnosis and management of chronic inflammatory disorders of the salivary glands 3, 4.
- 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 2.
Treatment Options
- Conservative management with antibiotics, warm compresses, massage, sialogogues, and adequate hydration is often the first line of treatment, but up to 40% of patients may have an inadequate response or persistent symptoms 3.
- Sialendoscopy offers a safe and effective gland-preserving treatment option for parotid sialoadenitis, particularly in pediatric patients 4.
- Investigational studies are needed to address the impact of steroid instillation, postoperative stenting, and long-term outcomes of sialendoscopy in the treatment of parotid sialoadenitis 4.