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Sialadenitis (Salivary gland infection)

Sialadenitis

The salivary glands are exocrine glands (with ducts) responsible for the production of saliva and amylase (enzymes responsible for breaking down of starch to maltose).  There are three major salivary glands namely parotid glands (largest and found below the ears), submandibular glands (underneath the lower jaw and produces 70% of saliva) and the sublingual glands (below the tongue and produces 5% of saliva entering the mouth). There are more than six hundred minor glands located at the submucosal layer of the oral cavity responsible for coating the mouth with saliva.

The salivary glands can be principally mixed, mucus (thick, clear) or serous (opalescent and made up of protein and water) in secretion. Saliva moistens the oral cavity and food, acts as a buffer, digests carbohydrates (through the presence of amylase), has antibacterial properties (IgA, lysozymes), assists in mineralization and acts as a protective pellicle. The amount of saliva excreted each day would equal 1 to 1.5 liters (1cc/min).

Salivary Gland Infection

Sialadenitis or salivary glands infection, which commonly affects the parotid glands and the submandibular glands, is due to hyposecretion or obstruction of the ducts but may also develop without any obvious cause. Most of the times, it is caused by a bacteria or virus (mumps). Individuals in their 50’s to 60’s, with Sjögren’s syndrome, chronically ill individuals having xerostomia, teenagers, those with anorexia, poor oral hygiene and those who have undergone radiation of the mouth are the ones commonly affected.

Bacterial sialadenitis is usually brought on by Staphylococcus aureus but may also be caused by other microorganisms including coliforms, streptococci or several anaerobic bacteria. There are chronic and acute forms. Acute sialadenitis is uncommon and usually affects the parotid glands.

Chronic Sialadenitis

Chronic sialadenitis is a recurrent salivary glands inflammation. Reduction of the salivary flow involving stasis is the key factor to this type of sialadenitis. The obstruction of the ducts is most often caused by salivary calculi (salivary duct stone). The condition may also occur following a previous episode of acute sialadenitis especially if it had suppurative inflammation that lead to glandular destruction.

Recurrent parotitis may also be another possible causative factor for this condition. The chronic inflammatory process causes the alteration of the saliva’s chemistry which leads to sialectasis, acinar atrophy and ductal ectasia with lymphocyte infiltrates.

Submandibular Sialadenitis

Submandibular sialadenitis (submandibular gland swelling) is the inflammation of the glands that produces saliva located underneath the mouth’s floor. It comes in acute and chronic forms. Acute infection is mostly due to bacterial infection while chronic forms are related to formation of calculi and diminished saliva related to several causes. To assess this gland, the doctor’s primary diagnostic tool is the ultrasound since it is safe, economical and accurate.

Parotid Gland Infection

This condition is also known as parotid sialadenitis and is usually manifested with intermittent yet painful swelling of the parotids. Acute conditions are usually caused by an infiltration of the Staphylococcus aureus. They may also be due to microorganisms that cause tuberculosis and would lead to suppurative parotitis.

Sometimes other medical conditions may also cause swelling of the partotids (parotitis) and these would include diabetes, eating disorders such as bulimia and anorexia, AIDS and alcoholism. Chronic parotid gland infection may be due to Sjogren’s syndrome, an autoimmune disease, characterized by parchedness of mouth, dry eyes, nose and face.

Sialadenitis Symptoms

Common manifestations of this disease condition include chills, fever, unilateral inflammation and pain (below the ear or jaw). Affected gland is diffusely tender and firm and erythematic; its overlying skin may exhibit edema. Focal enlargement may be a sign of abscess and pus should be squeezed out from the salivary duct and cultured to determine causative organism. Other not so common symptoms would include inflammation of the oral cavity, difficulty in swallowing, neck and mouth pain, nausea, vomiting and dental pain.

 

Sialadenitis Treatment

Initial treatment would be the use of antibiotics against the causative microorganism. If the inflammation is caused by Staphyloccoccu aureus, diclocacillin 250mg (first generation cephalosporin) four times a day or clindamycin may be taken but this can be modified based on the results of the culture and sensitivity test results. However, with an increasing incident of Staph meticillin-resistant bacteria especially with the elderly in nursing homes, the need for vancomycin may be necessary.

Local measures such as hydration, warm compress, sialagogues (substances that generate production and flow of saliva like lemon juice and hard candy), gland massage and the maintenance of good oral hygiene should be done also. If abscesses are present, then it is important to drain them. Relaspsing and chronic sialadenitis may need superficial removal of the parotid glands or excision of the submandibular gland.

 

References:

http://emedicine.medscape.com/article/882358-overview

http://www.merckmanuals.com/professional/sec08/ch090/ch090b.html



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