The document discusses several inflammatory disorders of the salivary glands including Mumps, Acute Suppurative Sialadenitis, Parotid Abscess, Neonatal Suppurative Parotitis, Recurrent Parotitis of Childhood, Chronic Sialadenitis, and Sjogren's Syndrome. It describes the etiology, clinical features, investigations, complications, and treatment of each condition.

1. INFLAMMATORY DISORDERS OF
SALIVARY GLAND
Anurag E K

2. Salivary Glands
Parotid glands: Pair of glands with serous secretion that account for 20-25% of total
secretion. Drains through Stenson’s duct at the buccal mucosa.
Submandibular glands: Major contributor to the normal secretion of saliva- 70%. Drains by
Wharton’s duct.
Sublingual and minor salivary glands: Present beneath the sublingual folds and drain
through multiple ducts.
Functions:
• Helps keep oral mucosa lubricated.
• During mastication, helps form bolus of food.
• Enzymes, mainly amylase, for carbohydrate digestion.
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3. DISORDERS OF SALIVARY GLAND
 Congenital
 Inflammatory
 Obstructive
 Traumatic
 Neoplasms
 Degenerative Conditions

4. Mumps
Etiology: Acute viral parotitis – Paramyxovirus
• m/c/c of acute non-suppurative sialadenitis
• Mostly affects children(<15 yrs.)
• Transmission through airborne droplets from salivary and nasal
secretions.
• Enters through URT and localizes in glandular tissue.
• IP: 2-3 weeks
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5. Mumps
Clinical features:
• Viral prodrome – low grade fever, headache, myalgia, anorexia,
arthralgia and malaise.
• Localized pain, exacerbated by chewing.
• Gland swelling is tense and firm (b/l parotid swelling in 75% cases).
• Otalgia, Trismus and Dysphagia
Complications: Orchitis, Aseptic meningitis, Pancreatitis, Nephritis and
SNHL.
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6. Mumps
Investigations:
• Serology: Complement fixing soluble Ab against viral core.
• Leukopenia
• Elevated serum salivary amylase.
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7. Mumps
Treatment:
• Supportive measures – Bed rest, oral hygiene, Hydration, Dietary
modifications to minimize secretions.
• Paracetamol or Ibuprofen for fever and pain.
Prevention:
• SC vaccine ( live attenuated Jerry-Lynn strain) given as MMR at 12-15
months and 2nd dose at 4-6 years.
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8. Acute Suppurative Sialadenitis
-m/c involved: parotid gland
Risk Factors:
• Age ( 50-60 yrs.)
• Debilitating conditions- Malignant lesions and pre-existing infections.
• Post-operative period
• Local factors- stenosis and sialolithiasis
• Systemic diseases- DM, hypothyroidism, Renal failure, Sjogren's syndrome
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9. Acute Suppurative Sialadenitis
Etiology:
• Community acquired
• S. pyogenes
• S. pneumoniae and
• H. influenzae
• Penicillin-resistant S. aureus in hospitalized patients.
• Anaerobic
• Peptostreptococcus
• Bacteroides sp.
• Fusobacterium
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10. Acute Suppurative Sialadenitis
Clinical Features:
• Rapid onset of pain and swelling, fever, chills and malaise.
• Dehydration with dry mucosa.
• Suppurative discharge on bimanual palpation.
D/D:
• Lymphoma, Bezold’s abscess, Cervical adenitis, Dental abscesses.
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12. Acute Suppurative Sialadenitis
Investigations:
• Leucocytosis with neutrophilia
• Cultures – purulent discharge, percutaneous needle aspiration.
• CT or USG indicated to look for abscess, if patient does not respond to
medical treatment.
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13. Acute Suppurative Sialadenitis
Treatment:
• Oral hygiene
• Fluid & Electrolyte replacement
• Reversal of salivary stasis
• Sialagogues such as lemon drops, orange juice
• Analgesics and local heat application
• Antimicrobial therapy
o Augmented penicillin
o 1st gen Cephalosporin
o Vancomycin
o Metronidazole
• Surgical drainage of loculated abscess.
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14. Parotid Abscess
- Advanced cases of suppurative parotitis.
Complications:
• Suppuration of potential spaces of face, neck and mediastinum.
• Rupture through the floor of EAC or spontaneous drainage through the
cheek.
• Rarely, Osteomyelitis, Thrombophlebitis of Jugular vein, Septicaemia,
Respiratory obstruction and death.
- Treated by Incision and Drainage.
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16. Neonatal Suppurative Parotitis
- Common in preterm and male neonates.
- m/c S. aureus, others – E. coli, Pseudomonas, GBS
- Fever, Anorexia, Irritability and Failure to gain weight.
- b/l swelling, which is tender, firm or fluctuant.
- I&D if no improvement with parenteral antibiotics.
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17. Recurrent Parotitis of Childhood
- Periodic episodes of u/l acute or subacute inflammation.
- second m/c infl. Salivary gland disease of childhood.
- characterized by swelling, pain, fever and malaise.
Proposed etiologies:
• Congenital ectasia of portions of secondary ductal systems predisposed
to S. aureus and S. viridians colonization.
• Autosomal inheritance
• IgG3 and IgA deficiencies
• Juvenile onset primary Sjogren’s syndrome
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18. Recurrent Parotitis of Childhood
Treatment:
• Adequate hydration
• Gland massage
• Local heat application
• Sialagogues
• Appropriate antibiotics for penicillin-resistant staphylococcus
- Most cases resolve spontaneously in late adolescence.
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19. Chronic Sialadenitis
- Salivary stasis predisposes to episodes of infection and inflammation.
Inciting factors:
• Sialolithiasis
• Stricture of duct
• External compression by tumors.
• Stenosis secondary to scar.
• Congenital dilatation
• Foreign bodies
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20. Chronic sialadenitis
Clinical Features:
• Recurrent swelling and tenderness of the affected gland a/w eating.
• Minimal saliva can be milked from the salivary orifice.
• Usually the condition is preceded by an attack of acute suppurative
sialadenitis.
Treatment:
- Surgical removal of gland when conservative management fail.
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21. Chronic sialadenitis
Complications:
• Benign lymphoepithelial lesions
• Kutner's tumour – middle aged adults present with painless mass at the
submandibular gland.
• Ductal carcinoma
• Mikulicz’s disease – BLL a/w Sjogren’s syndrome.
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22. Sjogren's syndrome
- Chronic autoimmune disorder of exocrine glands.
- Salivary and Lacrimal glands are primarily affected.
- Lymphocytic infiltration results in glandular hypofunction.
- 4th–5th decade of life, >90% are women.
Types:
• Primary – confined to exocrine glands
• Secondary – characteristic signs and symptoms of primary disorder a/w
features of other autoimmune diseases, usually Rheumatoid arthritis.
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23. Sjogren’s syndrome
Clinical features:
• Oral findings
o Xerostomia causes difficulty in chewing, swallowing and phonation,
multiple dental caries
o Intolerance to acidic and spicy foods
o Tongue is typically smooth with fissures and atrophy of filiform
papillae.
o Oral thrush
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24. • Eye findings
o m/c foreign body sensation
o Keratoconjunctivitis sicca
• Systemic findings
o Fever, malaise
o Myalgia and arthralgia
o Vasculitis
o Peripheral sensory and motor polyneuropathies.
Sjogren’s syndrome
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25. Lab Investigations:
• ESR
• +ve Rheumatoid factor and ANA
• Sialography – sialectasis in 90% patients
• ELISA to detect anti-SSA/Ro & anti-La/SSB antibodies
• Biopsy – lymphocytic infiltrate
Sjogren’s syndrome
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26. Treatment:
• Saliva substitutes
• Systemic sialagogues – Pilocarpine 5mg TD or QD
• Systemic corticosteroids
• Eradicating fungal overgrowth
• Eye lubricants and patching if corneal ulcers have developed.
Sjogren’s syndrome
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