Sialadenitis

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