From the Guidelines
Sialadenitis should be managed with a multidisciplinary approach, focusing on symptomatic relief using topical therapies, and considering the underlying cause of the inflammation, such as bacterial or viral infections, autoimmune conditions, or radiation therapy 1.
Causes and Risk Factors
Sialadenitis can occur due to various factors, including:
- Reduced or blocked salivary flow, allowing bacteria to ascend from the mouth into the gland
- Viral infections
- Autoimmune conditions, such as Sjögren's syndrome
- Radiation therapy
Treatment Approach
The treatment approach for sialadenitis depends on the underlying cause, but typically includes:
- Hydration
- Warm compresses
- Salivary massage
- Sialogogues (substances that stimulate saliva production) like lemon drops or sugar-free candies
- Antibiotics, such as amoxicillin-clavulanate, for bacterial sialadenitis
- Analgesics, like acetaminophen or NSAIDs, to manage pain
Management of Specific Cases
For chronic or recurrent cases, sialendoscopy (endoscopic examination of salivary ducts) or removal of the affected gland might be considered 1. In cases of malignant tumors, the basic treatment is complete surgical excision, with or without postoperative irradiation, according to the clinical stage and the histological grade 1.
Key Considerations
- Prompt treatment is important to prevent complications like abscess formation or chronic inflammation
- Patients should maintain good oral hygiene and increase fluid intake to 2-3 liters daily to promote saliva flow
- A multidisciplinary approach, involving various health professionals, is essential for the management of sialadenitis, especially in cases of underlying autoimmune conditions or malignant tumors 1.
From the Research
Definition and Causes of Sialadenitis
- Sialadenitis refers to inflammation or infection of the salivary glands, which can be caused by a broad range of processes including infectious, obstructive, and autoimmune factors 2.
- The condition can be acute, recurrent, or chronic, and its presentation can vary depending on the underlying cause 3.
Symptoms and Diagnosis
- Acute suppurative sialadenitis presents as rapid-onset pain and swelling, while chronic sialadenitis may cause recurrent or persistent pain and swelling 3.
- Diagnosis is often made through history and physical examination, and imaging studies such as ultrasonography, computed tomography, or magnetic resonance imaging may be used to establish a diagnosis 3, 2.
- 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 and Management
- Treatment for sialadenitis depends on the underlying cause, and may include antibiotics, salivary massage, hydration, and sialagogues such as lemon drops or vitamin C lozenges for acute suppurative sialadenitis 3.
- For chronic sialadenitis, management is directed at relieving the obstruction, and may include surgical intervention such as salivary lithotripsy, basket retrieval, and sialendoscopy 4.
- Family physicians can play an important role in the diagnosis and management of sialadenitis, and prompt recognition and treatment of the condition can prevent the development of complications 2.
Related Conditions
- Sialolithiasis, or the formation of salivary stones, is a common cause of sialadenitis, and may range from tiny particles to several centimeters in length 4.
- Chronic inflammatory diseases of the salivary glands, including sialectasia and sialolithiasis, can also contribute to the development of sialadenitis 5.