Sialadenitis represents inflammation mainly
involving the acinoparenchyma of the gland.
Acute infection more
often affects the
major glands than
the minor glands
1. Retrograde contamination of the salivary ducts
and parenchymal tissues by bacteria inhabiting
the oral cavity.
2. Stasis of salivary flow through the ducts and
parenchyma promotes acute suppurative
More common in parotid gland.
The etiologic factor most associated with this
entity is the retrograde infection from the
Predilection for Parotid
The composition of parotid secretions
differs from those in other major glands.
Parotid is primarily serous, the others have a
greater proportion of mucinous material.
Mucoid saliva contains elements that protect against
bacterial infection including lysozymes & IgA
antibodies (therefore, parotid has bacteriostatic activity)
Mucins contain sialic acid which agglutinates bacteria
and prevents its adherence to host tissue.
Specific glycoproteins in mucins bind epithelial cells
competitively inhibiting bacterial attachment to these
Stensen’s duct lies adjacent to the maxillary
molars and Wharton’s near the tongue.
It is thought that the mobility of the tongue may
prevent salivary stasis in the area of Wharton's that
may reduce the rate of infections in SMG.
Risk Factors continued…
Neoplasms (pressure occlusion of duct)
Sialectasis (salivary duct dilation) increases the risk for
retrograde contamination. Is associated with cystic
fibrosis and pneumoparotitis
Extremes of age
Poor oral hygiene
Acute Suppurative Parotitis
Sudden onset of erythematous swelling of the
pre/post auricular areas extend into the angle
of the mandible.
Is bilateral in 20%.
Purulent saliva should be sent for culture.
Staphylococcus aureus is most common
Streptococcus pnemoniae and S.pyogenes
Haemophilus Influenzae also common
Treatment of Acute Sialadenitis
Reverse the medical condition that may have
contributed to formation
Warm compresses, give sialogogues (lemon
External salivary gland massage if tolerated
Treatment of Acute
70% of organisms produce B-lactamase or
Need B-lactamase inhibitor like Augmentin or
Unasyn or second generation cephalosporin
Can also consider adding metronidazole or
clindamycin to broaden coverage
Surgery for Acute Parotitis
When a discrete abscess is identified, surgical
drainage is undertaken
Approach is anteriorly based facial flap with
multiple superficial radial incisions created in the
parotid fascia parallel to the facial nerve
Close over a drain
Complications of Acute Parotitis
Abscess ruptures into external auditory canal and
TMJ have been reported
Thrombophlebitis of the retromandibular or
facial veins are rare complications
Extension of an abscess into the parapharyngeal space
may result in airway obstruction, mediastinitis, internal
jugular thrombosis and carotid artery erosion
Dysfunction of one or more branches of the facial
nerve is rare.
Causative event is thought to be a lowered
secretion rate with subsequent salivary stasis.
More common in parotid gland.
Damage from bouts of acute sialadenitis over
time leads to progressive acinar destruction
combined with a lymphocyte infiltrate.
The clinician should look for a treatable
predisposing factor such as a calculus or a
No treatable cause found:
Initial management should be conservative and
includes the use of sialogogues, massage and
antibiotics for acute exacerbations.
Should conservative measures fail, consider
removing the gland.
Acute viral infection (AVI)
Mumps classically designates a viral parotitis
caused by the paramyxovirus
However, a broad range of viral pathogens have
been identified as causes of AVI of the salivary
Mumps is a non-suppurative acute sialadenitis
Is endemic in the community and spread by
Enters through upper respiratory tract
2-3 week incubation after exposure (the virus
multiplies in the upper respiratory tract or
Then localizes to biologically active tissues like
salivary glands, germinal tissues and the CNS.
Caused by paramyxovirus, an RNA virus
Others can cause acute viral parotitis:
Coxsackie A & B virus, cytomegalovirus and
HIV involvement of parotid glands is a rare
cause of acute viral parotitis
30% experience prodromal symptoms prior to
development of parotitis
Headache, anorexia, malaise
Onset of salivary gland involvement is
preceeded by earache, gland pain, dysphagia and
Glandular swelling (tense, firm) Parotid gland
involved frequently, SMG & SLG can also be
May displace pinna
75% cases involve bilateral parotids, may not
begin bilaterally (within 1-5 days may become
Low grade fever
Orchitis, testicular atrophy and sterility in
approximately 20% of young men
Oophoritis in 5% females
Aseptic meningitis in 10%
Pancreatitis in 5%
Hearing loss <5%
80% cases are unilateral
Most common immunologic disorder
associated with salivary gland disease.
Characterized by a lymphocyte-mediated
destruction of the exocrine glands leading to
xerostomia and keratoconjunctivitis sicca
90% cases occur in women
Average age of onset is 50y
Published in 1933 by Sjögren, a Swedish
Primary: involves the exocrine glands only
Secondary: associated with a definable
autoimmune disease, usually rheumatoid
80% of primary and 30-40% of secondary involves
unilateral or bilateral salivary glands swelling
Salivary gland swelling may be permanent or
Rule out lymphoma
Keratoconjuntivitis sicca: diminished tear production
caused by lymphocytic cell replacement of the lacrimal
Evaluate with Schirmer test. Two 5 x 35mm strips of
red litmus paper placed in inferior fornix, left for 5
minutes. A positive finiding is lacrimation of 5mm or
less. Approximately 85% specific & sensitive
Sjögren’s Lip Biopsy
Biopsy of SG mainly used to aid in the diagnosis
Sjögren’s Lip Biopsy
Single 1.5 to 2cm horizantal incision labial mucosa.
Not in midline, fewer glands there.
Include 5+ glands for identification
Glands assessed quantitatively to determine the
number of foci of lymphocytes per 4mm2/gland
Non-specific term used to describe a noninflammatory non-neoplastic enlargement of a
salivary gland, usually the parotid.
May be called sialosis
The enlargement is generally asymptomatic
Mechanism is unknown in many cases.
Metabolic “endocrine sialendosis”
Nutritional “nutritional mumps”
Obesity: secondary to fatty hypertrophy
Malnutrition: acinar hypertrhophy
Any condition that interferes with the absorption
of nutrients (uremia, chronic pancreatitis)
Alcoholic cirrhosis: likely based on protein
deficiency & resultant acinar hypertrophy
Drug induced: iodine mumps
Low dose radiation to a salivary gland causes an
acute tender and painful swelling within 24hrs.
Serous cells are especially sensitive and exhibit
marked degranulation and disruption.
Continued irradiation leads to complete
destruction of the serous acini and subsequent
atrophy of the gland.
Similar to the thyroid, salivary neoplasm are
increased in incidence after radiation exposure.
Primary Tuberculosis of the salivary glands:
Uncommon, usually unilateral, parotid most
Believed to arise from spread of a focus of infection
Secondary TB may also involve the salivary
glands but tends to involve the SMG and is
associated with active pulmonary TB.
Sarcoidosis: a systemic disease characterized by
noncaseating granulomas in multiple organ systems
Clinically, SG involvement in 6% cases
True cysts of the parotid account for 2-5% of
all parotid lesions
May be acquired or congenital
Branchial arch cysts are a duplication anomaly
of the membranous external auditory canal
Salivary Gland Neoplasms
2% of head and neck neoplasms
Parotid: 80% overall; 80% benign
Submandibular: 15% overall; 50% benign
Sublingual/Minor: 5% overall; 40% benign
Most common of all salivary gland neoplasms
70% of parotid tumors
50% of submandibular tumors
45% of minor salivary gland tumors
6% of sublingual tumors
F:M = 3-4:1
Slow-growing, painless mass
Parotid: 90% in superficial lobe, most in tail of
Minor salivary gland: lateral palate
Basal cell is most common: 1.8% of benign
epithelial salivary gland neoplasms
M:F = approximately 1:1
Caucasian > African American
Most common in parotid
Basal Cell Adenoma
Solid nests of tumor
Influenced by site, stage, grade
Stage I & II
Wide local excision
Stage III & IV
+/- neck dissection
+/- postoperative radiation therapy
Adenoid Cystic Carcinoma
Overall 2nd most common malignancy
Most common in submandibular, sublingual
and minor salivary glands
Asymptomatic enlarging mass
Pain, paresthesias, facial weakness/paralysis