Submandibular Salivary Gland Infection: Medical Terminology and Management
Medical Terminology
The medical term for submandibular salivary gland infection is "submandibular sialadenitis." 1, 2, 3
Immediate Assessment Priorities
Evaluate airway patency immediately in any patient presenting with acute submandibular sialadenitis, as rapid facial and neck swelling can cause life-threatening airway compromise within 4 hours of onset, particularly in post-surgical cases where 84% required emergent airway intervention. 1
- Monitor specifically for worsening dysphagia or new-onset drooling, which signal heightened risk of airway compromise. 1
- Maintain an extremely low threshold for reintubation or tracheostomy if acute swelling develops. 1
Conservative Medical Management (First-Line Treatment)
Most cases of submandibular sialadenitis respond to conservative measures without requiring antibiotics. 1, 4
Mechanical and Physical Interventions
- Apply warm compresses to the affected submandibular gland to promote salivary excretion. 1, 4
- Perform gentle gland massage to facilitate drainage (use caution in elderly patients or those with suspected carotid stenosis). 1, 4
Pharmacologic Stimulation
- Administer sialogogues (pilocarpine or cevimeline) to stimulate salivary flow and reduce stasis. 1
- Alternatively, use gustatory stimulants such as lemon drops or vitamin C lozenges. 4
Hydration and Supportive Care
- Provide aggressive intravenous hydration, particularly critical for patients unable to maintain oral intake. 1, 4
- Encourage oral hydration and limit caffeine intake. 1
- Maintain oral hygiene to prevent bacterial superinfection. 3, 4
Antibiotic Therapy (Selective Use Only)
Antibiotics are NOT routinely necessary for submandibular sialadenitis unless specific criteria are met. 1
Indications for Antibiotic Use
- Temperature >38.5°C or heart rate >110 beats/minute. 1
- Erythema extending >5 cm beyond the affected area. 1
- Suspected bacterial superinfection with purulent drainage. 1, 3
Antibiotic Selection
Cephalosporins are the preferred antibiotic choice, achieving the highest concentrations in saliva and covering the spectrum of bacteria implicated in sialadenitis (Staphylococcus aureus, Viridans streptococci, gram-negative strains, and anaerobes). 1, 5
- Fluoroquinolones are an alternative option with favorable salivary pharmacokinetics. 5
- Avoid phenoxymethylpenicillin and tetracyclines, as they do not achieve bactericidal levels in saliva. 5
Duration of Therapy
- Typical duration is 24-48 hours for mild cases with systemic signs. 1
- Longer courses may be needed for severe bacterial infections with abscess formation. 1
Corticosteroid Therapy
Consider systemic corticosteroids (e.g., prednisone) for moderate to severe cases with significant airway swelling, used in 47.4% of post-surgical cases. 1, 6
- Corticosteroids are particularly indicated when conservative measures fail and inflammatory swelling threatens the airway. 1
Monitoring for Complications
Neurologic Sequelae
- Watch for brachial plexopathy (~10.5% of cases), facial nerve palsy, and Horner syndrome from inflammatory compression of adjacent structures. 1
- These neurologic complications occur in approximately 15.8% of severe acute sialadenitis cases. 1
Chronic Complications
- Monitor for dental caries and tooth loss in chronic cases with persistent xerostomia, requiring dental referral. 1
Expected Outcomes
Most patients (78.9%) achieve complete recovery with appropriate conservative management. 1
- Recovery typically occurs within days to weeks, though severe cases may take months. 1
- Hospitalization duration varies from 6 days up to 2 months depending on severity and complications. 1
Common Pitfalls to Avoid
- Do not routinely prescribe antibiotics for uncomplicated submandibular sialadenitis, as most cases are inflammatory or obstructive rather than infectious. 1
- Do not delay airway assessment in patients with rapid submandibular swelling, as airway compromise can develop within hours. 1
- Do not perform aggressive massage in elderly patients or those with suspected carotid stenosis due to risk of vascular complications. 1