Salivary gland infections
Different Types of infections – Bacterial, Viral
Pathogenesis – etiology
Signs and Symptoms
• There are 3 paired salivary glands in humans
1. Parotid - largest of the major salivary glands
Two Lobes divided by facial nerve
2. Submandibular deep to mylohyoid, superficial
3. Sublingual - Smallest of the salivary glands
• Common surgical disease; infection/calculi
Acute bacterial parotitis
- Retrograde infection in reduced salivary flow
- Local abnormalities in gland architecture
• Microbiology - Staph aureus,
- Streptococci (alpha hemolytic)
- Haemophylus species
are the common ones isolated.
• Exact causative organism is difficult to isolate as
sample collection is difficult.
• Redness (erythma) over the side of the face or
the upper neck
• Swelling in pre and post auricular areas
extending to angle of mandible
• Breathing or swallowing difficulty (these may
be emergency symptoms).
• Extreme mouth or facial pain especially when
Thick purulent discharge (pus) on milking.
Dry mouth, Fever with chills,.
Abnormal tastes, foul tastes
Decreased ability to open the mouth
Swelling of the face (particularly in front of the ears,
below the jaw, or on the floor of the mouth)
• WBC COUNT - Leucocytosis
• Milk the exact pus from gland and do culture
and sensitivity, Gram stain.
• X- ray or CT scan or ultrasound may be done if
there is an abscess.
• Warm salt water rinses (1/2 teaspoon of salt in 1 cup
of water) may be soothing and keep the mouth
• Massaging the gland with heat may help.
• Hydration- Drink lot of water and use sugar-free
lemon drops to increase the flow of saliva and
• If there is an abscess, surgery to drain it or aspiration
may be done.
• Appropriate antibiotic therapy (Flucloxacillin,
• Severe cases - Antibiotics +surgical intervention
• Treat the cause – Sialography (imaging) stones or
strictures, any abnormalities.
• Sialography is contraindicated in acute
• Abscess of salivary gland
• Infection returns
• Spread of infection (cellulitis, Ludwig's angina)
Chronic bacterial parotitis
Recurrent episodes of parotitis
Damaged glands (Sjogren’s syndrome)
Clinical course - intermittent exacerbations
• Destroys the gland
• Parotidectomy for long term infection and
Recurrent parotitis of childhood
• Repeated acute episodes of painful
enlargement of one or both parotid glands.
• Etiology - Unclear,
• Suggested congenital abnormalities of ductal
system( mumps, foreign bodies, trauma from
• Most will resolve by puberty, Remove
identified predisposing factor, Antibiotics.
• Good oral hygiene may prevent some cases of
• Drink plenty of water, keep mouth wet.
• Tuberculosis secondary to pulmonary
• M. tuberculosis and Atypical mycobacteria
• Rarely seen
• Parotids are commonly affected
• C/F - Firm non tender swelling, rarely facial
• Management – Skin tests, ATT.
• A.israeli is implicated.
• Salivary glands may be infected in upto 10% of
• MANAGEMENT – diagnose and treat.
• Family-paramyxoviridae , genus - Rubulavirus
• Mumps is acute contagious non suppurative
inflammation on one or both salivary glands
• Mild childhood disease with serious
complications in adults
• Humans are only the natural hosts
• 1/3 of infections are asymptomatic
• Acquired via repiratory route by saliva and
• Replicate in respiratory epithelium
• Viremia spread virus to salivary gland
• Virus is present in saliva 2 days before and 9
days after salivary gland swelling
• Infect kidney, viruria may persist 2 wks
1/3 are asymptomatic
Painful swelling of parotid
glands (50% of cases) unior bilateral
Aseptic meningitis (15%)