Sialadenitis

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

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

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

Ultrasound or CT scan may be helpful in establishing the diagnosis

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