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Essential Features

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  • • Paired major salivary glands include parotid, submandibular, and sublingual glands

    • Minor salivary glands are distributed in the mucosa of the lips, cheeks, hard and soft palate, uvula, floor of mouth, tongue, and peritonsillar region

    • Few salivary glands in the nasopharynx, paranasal sinuses, larynx, trachea, bronchi, and lacrimal glands

    • Infectious and inflammatory diseases of the salivary glands are common, and frequently involve the major salivary glands, especially the parotids

    • Tend to occur in those patients whose overall health is compromised (by poor nutrition, dehydration, altered fluid and electrolyte balance, or immunocompromise)

    • Etiologies include:

    • –Actinomycosis

      –Acute bacterial sialoadenitis

      –Cat scratch disease

      –Mumps

      –TB

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Epidemiology

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  • S aureus is the most common bacteria in acute bacterial sialoadenitis

    • Mumps is the most common viral etiology of sialoadenitis; other etiologies include coxsackievirus A and echovirus

    • Mumps primarily affects children and young adults

    • Fungal sialoadenitis (usually with actinomycosis) usually follows dental manipulations

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Clinical Findings

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Symptoms and Signs

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  • • Parapharyngeal edema

    • Pain

    • Fever

    • Indurated, enlarged, tender gland

    • External pressure on the gland release purulent material from gland opening

    • Fluctuance

    • Bilateral swelling and clear salivary secretions suggest viral etiology

    • Trismus

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Laboratory Findings

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  • • Leukocytosis

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Imaging Findings

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  • • X-ray for sialolith

    • CT scan if suspect abscess

    • Sialogram

    • Radionuclide scanning

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Diagnostic Considerations

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  • • Abscess and fluctuance easily palpated in submandibular glands; septations in parotid gland lead to formation of multiple, small, nonpalpable abscesses

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Rule Out

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  • • Salivary gland tumor

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Work-up

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  • • History and physical exam

    • Cultures of salivary secretions; possibly blood cultures (depending on degree of systemic illness)

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Treatment and Management

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  • • Antibiotic therapy and fluid management is the mainstay of treatment of acute bacterial sialoadenitis

    • No specific treatment for viral sialoadenitis

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Surgery

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Indications
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  • • Lack of clinical improvement with antibiotics alone; aim of surgical intervention is abscess drainage

    • Gland excision for chronic/recurrent sialoadenitis or sialolithiasis

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Medications

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  • • Antibiotics, antifungals, antituberculous chemotherapy

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Complications

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  • • Chronic sialoadentis

    • Altered salivary flow

    • Sialolithiasis

    • Tooth damage due to reduced salivary flow

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Resources

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References

Baldwin AJ, Foster ME. Tuberculous parotitis. Br J Oral Maxillofacial Surg. 2002;40:444.  [PubMed: 12379196]
Brook I. Acute bacterial suppurative parotitis: microbiology and management. J Craniofacial Surg. 2003;14:37.  [PubMed: 12544218]
Steyer TE. Peritonsillar abscess: diagnosis and treatment. Am Fam Physician. 2002;65:93.  [PubMed: 11804446]

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Essential Features

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  • • Paired major ...

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