II. Pathophysiology

  1. Mechanism
    1. Bacterial Infection with seeding via retrograde infection from the oral cavity
    2. Stasis due to volume depletion or Xerostomia allows for Salivary GlandBacterial parenchymal infection
  2. Most common in age >50 years
    1. Contrast with Viral Sialoadenitis
  3. Parotid Gland is most commonly affected Salivary Gland
    1. Less bacteriostatic secretions than submandibular

III. Causes: Bacterial

IV. Risk Factors

  1. Advanced age
  2. Volume depletion
  3. Diabetes Mellitus
  4. Hypothyroidism
  5. Renal Failure
  6. Sjogren Syndrome
  7. Debilitated or recently post-operative or post-hospitalization
  8. Anticholinergic Medications causing Xerostomia
  9. Secondary to Salivary Gland Calculus
    1. Known as Obstructive Sialadenitis

V. Symptoms

  1. Acute pain and swelling localized over affected Salivary Gland
  2. High fever with chills often present

VI. Signs

  1. Ill appearing patient
  2. Exquisitely tender, swollen Salivary Gland (usually Parotid Gland)
  3. Regional Lymphadenopathy
  4. Pus at affected Salivary duct orifice
    1. Affected gland may be massaged to express pus for culture
    2. Parotid duct (Stensen's Duct) at upper second molar
    3. Submandibular duct (Wharton's Duct) at frenulum

VII. Labs

  1. Gram Stain and culture of Salivary duct discharge

VIII. Radiology

  1. CT Scan if not improving within 3-4 days
  2. Avoid sialography in acute Bacterial Sialoadenitis

X. Management

  1. Precautions
    1. Acute Parotitis and other severe Sialadenitis may require initial inpatient parenteral antibiotics (e.g. Nafcillin and metronizadole)
    2. MRSA coverage should be considered in cases failing to improve or immunocompromised patients (e.g. Vancomycin)
  2. Start antibiotic coverage for Staphylococcus aureus and other Gram Positive organisms (as well as Anaerobes)
    1. Augmentin
    2. Dicloxacillin
    3. Clindamycin
  3. Increase Saliva production
    1. Increase fluid intake
    2. Lemon drops to increase Saliva secretion
    3. Stop Anticholinergics and other Xerostomia causes
  4. Symptomatic therapy
    1. Analgesics
    2. Warm compresses over affected Salivary Gland
    3. Attempt to milk gland of discharge
  5. Otolaryngology Consultation
    1. Surgical drainage may be required
    2. Consider early intervention or if no improvement in 3-4 days

XI. Complications

  1. Salivary Gland abscess (rare)

XII. References

  1. Fedok in Noble (2001) Primary Care Medicine, p. 1770-1
  2. Chow in Mandell (2000) Infectious Disease, p. 699-700
  3. Walner in Cummings (1998) Otolaryngology, p. 5-121
  4. Wilson (2014) Am Fam Physician 89(11): 882-8 [PubMed]

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Ontology: Obstructive sialadenitis (C0149773)

Concepts Anatomical Abnormality (T190)
SnomedCT 235127000
English glands obstructions salivary, salivary gland obstruction, Obstructive sialadenitis, Salivary gland obstruction, Obstructive sialadenitis (disorder)
Spanish obstrucción de glándula salival, sialoadenitis obstructiva (trastorno), sialoadenitis obstructiva

Ontology: Acute bacterial sialadenitis (C0341049)

Concepts Disease or Syndrome (T047)
SnomedCT 235124007
English Acute bacterial sialadenitis, Suppurative sialadenitis, Acute bacterial sialadenitis (disorder)
Spanish sialoadenitis bacteriana aguda (trastorno), sialoadenitis bacteriana aguda, sialoadenitis supurativa