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Key Features

  • Acute bacterial sialadenitis most commonly affects either the parotid or submandibular gland

  • Often occurs in the setting of dehydration or in association with chronic illness

  • Underlying Sjögren syndrome may contribute

Clinical Findings

  • Presents with acute swelling of the gland, increased pain and swelling with meals, and tenderness and erythema of the duct opening

  • Pus often can be massaged from the duct

  • Ductal obstruction, often by an inspissated mucous plug, is followed by salivary stasis and secondary infection

Diagnosis

  • The most common organism recovered from purulent draining saliva is Staphylococcus aureus

  • Ultrasound or CT scan may be helpful in establishing the diagnosis

Treatment

  • Intravenous antibiotics such as nafcillin (1 g intravenously every 4–6 hours) and measures to increase salivary flow, including hydration, warm compresses, sialagogues (eg, lemon drops), and massage of the gland

  • Then, can switch to an oral agent based on clinical improvement and microbiologic results to complete a 10-day treatment course

  • Less severe cases can often be treated with oral antibiotics with similar spectrum

  • Failure of the process to improve and ultimately resolve on this regimen suggests

    • Abscess formation

    • Ductal stricture

    • Stone

    • Tumor causing obstruction

  • Suppurative sialadenitis

    • May develop in acute illness

    • A potentially life-threatening form of sialadenitis

    • Causative organism is usually S aureus

    • However, often no pus will drain from Stensen papilla

    • Patients often do not respond to rehydration and intravenous antibiotics

    • Operative incision and drainage to resolve the infection may be required

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