Salivary Gland Infections

• • 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

Epidemiology

• • 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

Symptoms and Signs

• • 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

Laboratory Findings

• • Leukocytosis

Imaging Findings

• • X-ray for sialolith

  • CT scan if suspect abscess

  • Sialogram

  • Radionuclide scanning

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

Rule Out

• • Salivary gland tumor

• • History and physical exam

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

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

  • No specific treatment for viral sialoadenitis

Surgery

Indications

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

  • Gland excision for chronic/recurrent sialoadenitis or sialolithiasis

Medications

• • Antibiotics, antifungals, antituberculous chemotherapy

Complications

• • Chronic sialoadentis

  • Altered salivary flow

  • Sialolithiasis

  • Tooth damage due to reduced salivary flow

References