Sialadenitis

Section: Head and neck Curriculum: Curriculum, page 42

Definition

Sialadenitis - inflammation of unilateral or bilateral glands Sialadenosis - chronic, bilateral, diffuse non inflammatory, non neoplastic swelling

Differential diagnosis

Acute Unifocal Swelling

• Obstruction
  • Sialolithiasis
    • See dedicated note
  • Ductal stricture
    • Many causes including RTX, trauma and prior instrumentation
    • Investigations
      • Sialography
    • Management
      • First conservative - sialogogues, hydration, massage
      • Abx if infection
      • Recurrent/persistent → ENT
      • Steroid infusion
      • Botox
      • Sialoendoscopic dilation
      • Sialadenectomy (rare)
  • Ductal FB
    • Retrograde entrance into duct e.g. fish bone, hair, toothbrush bristle
    • Nidus for stone formation
    • Management
      • Sialoendoscopy ID and removal
  • Pneumoparotitis
    • Occurs in positive pressure ventilation or woodwind instrument use
    • Usually self limiting as air resorbs with cessation of cause
  • External compression of duct
    • Denture flange
    • Enlarged mandible
    • Hypertrophy of masseter kinking the parotid duct
• Infection
  • Bacterial
    • Bugs
      • Staph aureus
      • Strep pneumoniae, strep viridans
      • Anaerobes - bacteroides
      • GN - enterobacter
    • Presentation
      • Sudden pain, swelling, sx/signs infection
      • Pus at orifice
    • Other
  • Actinomycosis
  • TB
• Inflammatory
  • Post-radiation
    • Damages gland parenchyma

Acute Multifocal Swelling

• Viral
  • Mumps
    • Fever, headache, malaise, myalgia, parotitis
  • Other - EBV
• Inflammatory
  • Radioiodine - acute sialadenitis
    • Tx with simple measures
  • Contrast induced - acute sialadenitis
    • Tx with simple measures
  • Juvenile recurrent parotiditis
    • Recurrent acute parotitis
    • Young boys up to 15 y/o
    • Unknown cause
• Drug induced sialadenitis
  • E.g. clozapine
  • Cause unknown - ?SM spasm, SNS vasoconstriction, anticholinergic effect
• Bulimia

Chronic Unifocal Swelling

• Tumour
  • Primary including lymphoma
• Secondary - cutaneous cancer mets
• Polycystic parotid disease

Chronic Multifocal Swelling

• Metabolic disease
  • Diabetes
  • EtOH
  • Bulimia
  • Malnutrition
  • Liver disease
• Autoimmune
  • Sjogren’s disease
    • Lymphocytic infiltration of exocrine glands
    • Dry eyes dry mouth
    • IgG4
    • Kussmaul
      • Allergic process causing mucous plugs of salivary ducts
• Granulomatous disease
  • Sarcoidosis
  • ANCA vasculitides
  • Xanthogranulomatous
• HIV
• Infiltrative
  • Amyloidosis
• Idiopathic

Summary of DDX for sialoadenitis

• Acute
  • Unilateral
    • Stones
    • Strictures - RTX, trauma, surgery
    • FB
    • Dentures
    • Bacterial infection - strep/staph
  • Bilateral
    • Viral infection - mumps, EBV
    • Inflammatory - radioiodine, contrast
    • Drugs - Clozapine
• Chronic
  • Unilateral
    • Tumour
    • Primary - lymphoma
    • Secondary - melanoma or SCC met
  • Bilateral
    • Autoimmune - Sjogrens, IgG4
    • Sarcoid
    • HIV

Clinical

• Assess affected salivary glands
• Episodic/chronicity
• Unilateral vs bilateral
• Diffuse vs focal
• Distal duct involved
• Signs of infection

Complications

• Recurrent acute infection or obstruction can lead to scarring and gland atrophy
• Chronic episodes also lead to gland atrophy

Management

• Invx and Mx Options are same as above
• Treat underlying cause
• Conservative
• Medical
• Endoscopic
• Radiological
• Surgical
• ENT involvement