Inflammation of the salivary glands is known as Sialadenitis. This condition can be caused by several factors including obstructions or infections.
Types of Sialadenitis
The two main types of sialadenitis are:
- Acute (short term) condition
- Chronic (long term) condition
Sometimes it can also be further classified by the exact salivary gland that is affected such as parotid or submandibular.
Acute Sialadenitis
This is usually caused by a bacterial infection and it is known to mostly affect the submandibular gland (under the chin) or the parotid gland (located in front of the ear).
Causes & Symptoms of Sialadenitis
A dry mouth or dehydration are the major risk factors that lead to sialadenitis. Hence, this condition is more common in individuals who are on medications that cause dry mouth or who are already ill. In addition, there are several medical conditions that can put you at a higher risk of developing acute sialadenitis, such as:
- Diabetes mellitus
- Hypothyroidism
- Sjogren’s syndrome
- Recent surgery
- History of radiation treatment of the oral cavity or mouth
Symptoms of acute sialadenitis include:
- Severe pain and swelling that comes on suddenly on the affected gland
- If the gland is rubbed or massaged, pus may come out of it
- Redness of the skin over the affected gland
- Chills and fever
- The gland may be tender to touch and may feel like a hard lump
Diagnosis of Acute Sialadenitis
A diagnosis of acute sialadenitis is based off the patient’s symptoms and medical history plus a doctor’s examination. If a sample of the pus can be obtained from the affected gland, it is sent to the laboratory to determine what might be causing the infection. This will help in deciding the best course of treatment. The most common type of bacteria that causes acute sialadenitis are the staphylococcus aureus and other different strains of streptococcus.
Acute sialadenitis can also in rare cases be caused by viruses such as the herpes virus, mumps virus, HIV and haemophilus influenza. Viral infections cannot be treated with antibiotics, but rather the symptoms are treated while waiting for the body to fight off the virus on its own. However, in severe cases, antiviral medications may be used. These types of medications are not routinely prescribed because of their severe side effects.
Treatment Options of Acute Sialadenitis
Acute sialadenitis is typically treated with an appropriate course of antibiotics. This can be best achieved if a culture is obtained. Antibiotics should always be taken exactly as prescribed by your physician and the entire dose finished.
Restoring proper flow of saliva is also very important in the treatment of acute sialadenitis. This is best achieved by eating, drinking, or sucking on things that stimulate the flow of saliva such as cough drops as well as drinking plenty of fluids. If you are on medications that cause dry mouth, you should talk to your doctor about switching to a different medication or other ways to manage this side effects.
In rare and extreme cases, acute sialadenitis can lead to formation of an abscess. If this happens, the abscess may have to be drained surgically.
Chronic Sialadenitis
Unlike acute sialadenitis, chronic sialadenitis is likely to be caused by an obstruction than an infection.
Causes & Symptoms of Chronic Sialadenitis
The obstruction can be caused by scar tissue, stones (salivary calculi) or in rare cases tumours. Regardless of what’s causing it, the obstruction leads to decreased flow of saliva and chronic inflammation. Chronic sialadenitis mostly affects the parotid gland.
Symptoms of chronic sialadenitis include:
- Tenderness and mild swelling over the affected gland
- The gland may initially be enlarged then decrease in size
- Pain in the area of the gland while eating
Diagnosis of Chronic Sialadenitis
Chronic sialadenitis is diagnosed in as similar manner as acute sialadenitis but the difference is that emphasis is placed on identifying and treating its underlying cause. Imaging with ultrasound or a CT scan is usually helpful with the diagnosis. Also, during examination by a doctor, if the affected gland is massaged, it will usually not produce any saliva.
Treatment Options for Chronic Sialadenitis
When the underlying cause of chronic sialadenitis is diagnosed, treatment is usually focused on reversing the underlying cause of the condition. In the case of an obstruction, surgery may be performed to remove it. If no obstruction is found, treatment consists of massage, hydration and sometimes medications to reduce inflammation. Sucking on cough drops or lozenges may also help to restore the flow of saliva. In rare and severe cases, the entire salivary gland may need to be surgically removed.
Other Similar Conditions
There are other conditions which are associated with or may cause similar symptoms as sialadenitis. Your doctor will usually need to rule these out before making a sialadenitis diagnosis and recommending treatment.
Some these conditions include:
Recurrent Parotitis of Childhood
One condition which typically occurs in children is the recurrent parotitis of childhood. Although the exact cause of this condition is not known, it usually occurs only in children and they grow out of it by the time they reach puberty. Recurrent parotitis of childhood is characterized by repeated episodes of swelling of the parotid gland (usually on one side). The welling is accompanied by other symptoms such as malaise and fever.
Treatment for recurrent parotitis of childhood is similar to that of sialadenitis, and might include:
- Massaging warm compresses over the gland to stimulate saliva flow
- Proper hydration
- Sucking on vitamin C drops or cough drops
- Antibiotics can occasionally be prescribed.
The episodes of recurrent parotitis of childhood can occur every few months and last a few days to a couple of weeks.
Salivary Duct stones or Sialolithiasis
Another related condition is the salivary duct stones or sialolithiasis. This condition can occur by itself or can lead to sialadenitis. Stones in the salivary ducts are formed by the minerals found in saliva such as proteins, salts and calcium carbonate.
The salivary duct stones can be palpated (felt by the doctor on examination), but they are usually diagnosed through an ultrasound or CT scan. The stones usually need to be surgically removed.
Next Step
At King’s College Hospital Dubai, we focus on offering an exemplary service, from initial consultation through to final diagnosis and treatment and beyond. Our team of expert doctors and nurses are here to offer tailored management and treatment of your condition, and to answer any questions that you might have throughout your time with us. Whatever you need us for, we’re only a phone-call away.
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