Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 8-24: Acute Inflammatory Salivary Gland Disorders + Key Features Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ The most common organism recovered from purulent draining saliva is Staphylococcus aureus Ultrasound or CT scan may be helpful in establishing the diagnosis + Treatment Download Section PDF Listen +++ ++ 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