This document discusses various non-neoplastic diseases of the salivary glands. It covers common and uncommon infectious diseases like viral and bacterial sialadenitis. It also discusses specific infections like mumps which causes parotid gland swelling. Other conditions covered include Sjögren's syndrome, sialolithiasis (salivary stones), drug-induced salivary gland disorders, sialosis (non-inflammatory swelling) and bulimia nervosa related salivary gland enlargement. The document provides details on clinical features, investigations, diagnosis and treatment of these salivary gland conditions.

1. Non-neoplastic salivary gland diseases
Infections of the salivary gland
Viral & bacterial infection are the the most common infectious disorders of the salivary glands,
although very rarely other infectious agents can be involved. In addition, the salivary glands may be
the site of asymptomatic viral infection- particularly some of the herpes group( human herpes 6,
CMV & human herpes 8,while saliva can be a vehicle for a wide range of infectious agents including
hepatitis B virus, hepatitis C, Humane herpes virus-8, & HIV.
Infections of the salivary glands.
Common Uncommon
Acute suppurative sialadenititis
Mumps
Human immunodeficiency virus associated
salivary gland disease;
Hepatitis C virus-associated sialoadenitis
Human T-lymphocytic virus 1(HTLV-1)
Epstein-Barr virus
CMV
Mycobacteria tuberculosis
Non-tuberculous mycobacteria
Haemophilus infleuenzae
E.coli
Treponema pallidum
Actionmycosis
Salmonella
Histoplasma
Candidia sp.
Cysticercosis
Mumps (epidemic parotitis)
Mumps is an acute generalized paramyxovirus infection of children & young adults. Mumps typically
affects the major salivary glands, although involvement of the other structures can occur including
the pancrease, testes , ovaries, brain, breast, liver, joints, &heart.
Mumps is transmitted via the droplet route & has an incubation time of approximately 14-18 days.

2. Clinical features
Patient with initial pyrexia, chills 7 facial pain. The parotid is typically bilateral enlarged, although
this may be unilateral. There is often swelling of the submandibular glands together with
lymphadenopathy, giving rise to profound facial & neck swelling.
Orchitis may develop approximately four to five days ofter the onset of parotitis, typically one testis
but both testis can be involved. Orchitis tends to arise in post-pubertal boys.
Mumps can give rise to a viral meningitis(lymphocytic). Other neurological manifestation include
retrobulbar neuritis& encephalitis. Likewise cardiac hepatic & joint can occur.
Diagnosis of mumps is typically based on clinical picture; it may be confirmed by detection of viral
IgG &IgA
Treatment:
Analgesic & appropriate fluid intake is tha main stay of treatment.
Corticosteroids may be effective for severe parotitis & other organ involvement like orchitis.
Mumps can be prevented with vaccination (Mumps/measles/rubella(MMR)).
HIV salivary gland disease
HIV salivary gland disease is a distinct disorder characterized by recurrent or persistent major
salivary gland enlargement & xerostomia, tends to arise late in HIV infection, although can be first
manifestation. A variety of lesions can underlie the salivary gland disease of HIV infection includes
bacterial sialadenitis, intraparotid lymphadenopathy, primary or metastatic non-Hodgkin’s
lymphoma or Kaposi’s sarcoma.
Salivary gland disease in HIV infection.
Disease Clinical features
HIV salivary gland disease
Kaposi’s sarcoma
No-Hodgkin lymphoma
Lymphadenopathy
Acute suppurative sialadenitis
Xerostomia
Salivary gland enlargement
HIV salivary gland disease more generalized termed diffuse infiltrated lymphocytosis syndrome
characterized by CD8 T cell infiltration of the lungs ,salivary glands, & lacrimal glands.
Clinical picture mimics that of Sjogren’s syndrome however, there are distinct histopathological &
serological differences between two disorders. Patient with HIV do not have anti-Ro & anti-La
antibodies but do have hypergammaglobulinaemia.

3. Histologically ; perivascular, periacinar & periductal lymphocytic infiltration. Majority CD8 T cells.
Multicystic lymphoepithelial lesions may also occur due to intraductal obstruction by
hyperplastic/infiltrating lymphoid tissue.
Diagnosis
FNAC to exclude malignancy;
Similar to Sjogren’s syndrome.
Treatment
Antiretroviral therapy may cause at least some short-term resolution of the swelling.
Others therapies are repeared aspiration, tetracycline sclerosis or surgical removal of an enlarged
gland.
External beam radiation (8-10 Gy) can cause transient improvement, although higher dose (24Gy)
can cause resolution of the disease for at least for 24 months- without causing severe xerostomia.
Hepatitis c virus infection
Unlike other hepatotropic hepatitis viruses, hepatitis C virus (HCV) gives rise to a wide spectrum of
extrahepatic manifestation that include salivary gland. Hepatitis C virus-associated salivary gland
disease arises as many as 80% of the infected patients.
Xerostomia is the predominant symptom of HCV-associated salivary gland disease.
The histopathological features of HCV-associated sialoadenitis not identical to Sjogren’s syndrome.
In HCV-associated sialoadenitis, there is a pericapillary lymphocytic infiltration within salivary gland.
Occasionally HCV infection give rise to non-Hodgkin’s lymphoma but not Sjogren’s syndrome.
Suppurative sialadenitis (suppurative parotitis)
Acute suppurative sialadenitis is an uncommon disorder, usually of childhood, characterized by
recurrent or persistent enlargement of one major salivary gland. The parotid are more commonly
affected than the submadibular glands. Patient can have episodes of disease akin to acute
suppurative sialoadenitis. Affected patients are generally well & have no disease likely to cause
sialoadenitis, although they may have a history of recurrent parotitis of childhood or previous
sialolithiasis.
In most instances, chronic non-specific sialoadenitis reflects abnormalities of the ductal system- the
recurrent infection having caused or worsen any ductal strictures. Primary cause of this disorder are
small stone sialoliths, less commonly denture induced ductal defect, congenital ductal edfects,
radiotherapy-induced salivary gand damage.
Investigations
Sialography & ultrasonogrphy are the principal investigation.

4. Sialography will reveal stricture & distortion of the major ducts. There can be variable sialectasis.
Clinical feature of the chronic non-specific sialoadenitis is highly varied, about 50% of the patients
have eventual spontaneous resulotion of symptoms after upto 5years & 40 % needs surgical
intervention.
Treatment
-management of acute infection with chronic non-specific sialoadenitis follows that of acute
suppurative disease.(hydration & appropriate antibiotics).
-in addition, sialagogues such as chewing gum, duct& glandular massage, improved oral
hygiene,& therapeutic sialography have been suggested to be useful.
- unless the cause is likely to be a sialolith, subtotal or total surgical removal of the affected
gland may be the only useful treatment.( chronic , non-infected state unless calculi can be
identified.)
Recurrent parotitis of childhood(juvenile recurrent parotitis)
Recurrent parotitis of childhood is characterized by recurrent parotid inflammation usually
associated with non-obstructive sialectasis of the parotid gland.
Recurrent parotitis can occur at any age but usually occur at 3 to 6 years of age. Childhood onset
usually in male but adult onset in female.
The disease is characterized by localized pain & swelling that may last upto 14days. Fever &
overlying erythema are common. Occasionally white mucopus can express from the duct. Usually
unilateral but may be bilateral. The number of attack vary from one to five episodes per year but
may be upto 20 episodes.
The frequency of recurrence tends to peak between 5 to 7 years of age & about 90% of the patients
have resolution of the disease by puberty.
Sialography & ultrasonography reveal sialectasis( this feature can be observed in the non-affected
gland of the opposite side.
Treatment
Analgesic is the mainstay of therapy. Antibiotic do not shorten attacks. In general , disease tends to
resolve and there is no need for surgical intervention.
Sialolithiasis

5. Clinical features
Sialolithiasis is a common disorder characterized by the formation of a calculus usually within the
ductal system of a gland. Sialoliths can arise in both the major & minor salivary glands.
Sialolith are more common in the submandular glands 83%, parotid 10%, sublingual 7%. More
common in female,& much more likely in adult than children.
Sialolithiasis presents as pain & swelling, typically in the submandibular gland with gestation or
eating. The swelling is diffuse, develops rapidly & is often associated with a burning-like local pain.
The swelling is nontender & gradually resolves over a few hours.
Long-standing sialolithiasis may give rise to acute suppurative sialolithiasis or chronic non-specific
sialolithiasis.
The cause of sialolithiasis ; defect migration of autophaogsomes through the ductal system or the
calcification of the mucous plugs. Sialolithiasis may be associated with DM,HTN,& chronic liver
disease & possibly nephrolithiasis but not to water hardness.
Investigations
Plain x-ray may reveal a sialolith- provided it is large & radiopague.
Ultrasonography can detect both radiopaque & radiolucent sialoliths while sialography may also be
helpful. Panoral tomograms are not helpful.
Treatment
When small & accessible, it may be possible to express a sialolith from the submandibular duct by
manual palpation. Or surgically, this carry a risk of stricture formation.
Surgical removal of an affected gland may often be only effective treatment for calculi in the
posterior aspect of the duct or within the gland.
Lithotripsy is most effective for calculi less than 7mm in diameter.
Drug-associated salivary gland disease
A wide range of drug-related salivary disorders can arise, these predominantly comprise salivary
gland swelling, xerostomia, salivary gland pain.
1.Salivary gland swelling
Painless, usually bilateral, salivary gland enlargement may be an occasional side effect
phenylbutazone, chlorhexidine, iodine, radioactive iodine usage. Mild acute sialoadenitis( iodine
mumps) can arise in response to iodine based contrast media for angioplasty. Insulin & interferon &
sulphonamides also causes salivary gland enlargement.
2.Xerostomia
Over 500 drugs can cause dry mouth, common complaints of many elderly people.

6. Principal mechanism of action to cause xerostomia is anticholinergic & sympathomimetic. Therefore,
tricylic , benzodiapines, atropine, betablockers & antihstamin are the most common culprits.
3.Salivary gland pain
Salivary gland enlargement due to sialosis may be associated with DM, hypothyroidism,
malnutrition, hepatic cirrhosis puberty, menopause& antihypertensive drugs.
Treatment of often difficult with endocrine & hepatic causes if sialosis being particularly resistant
even if the underlying disorder is addressed.
Sialosis
Sialosis is an uncommon nonneoplastic & non-inflammatory disorder giving rise to bilateral non-painful
enlargement of the major salivary glands. Sialosis tends to arise in middle to late life with
peak incidence in the fifth & sixth decades. There is a slight female predominace. The parotid glands
are typically affected, indeed often the enlargement is profound. The enlargement develops slowly
& there may be some decrease in salivary flow.
Aetiology is unknown, but may be neuropathy. There is association with DM,
hypothyroidism,malnutrition, alcoholic, & hepatic cirrohsis. Puberty , menopause, reaction to anti
hypertensive drugs.
Sialosis is histopathologically chacterized by acinar cel hypertrophy, atrophy of striated ducts with
oedema of the interstitial connective tissue. Ultimately , widespread fatty replacement of acini.
Treatment
Treatment of the underlying cause.
Rarely surgical reduction of the parotids glands may be necessary.
Pilocarpine successfully resolving sialosis associated with bulimia nervosa.
Bulimia nervosa
Salivary gland enlargement can occur with bulimia nervosa. Functional hypertrophy of the salivary
glands.(autonomic neuropathy, endocrine disease or past alcohol) with high level of serum amylase.
Treatment local application of heat, salivary substitutes & use of pilocarpine may result in reduction
in the size of the parotid gland. Superficial parotidectomy may rarely required.

7. Principal mechanism of action to cause xerostomia is anticholinergic & sympathomimetic. Therefore,
tricylic , benzodiapines, atropine, betablockers & antihstamin are the most common culprits.
3.Salivary gland pain
Salivary gland enlargement due to sialosis may be associated with DM, hypothyroidism,
malnutrition, hepatic cirrhosis puberty, menopause& antihypertensive drugs.
Treatment of often difficult with endocrine & hepatic causes if sialosis being particularly resistant
even if the underlying disorder is addressed.
Sialosis
Sialosis is an uncommon nonneoplastic & non-inflammatory disorder giving rise to bilateral non-painful
enlargement of the major salivary glands. Sialosis tends to arise in middle to late life with
peak incidence in the fifth & sixth decades. There is a slight female predominace. The parotid glands
are typically affected, indeed often the enlargement is profound. The enlargement develops slowly
& there may be some decrease in salivary flow.
Aetiology is unknown, but may be neuropathy. There is association with DM,
hypothyroidism,malnutrition, alcoholic, & hepatic cirrohsis. Puberty , menopause, reaction to anti
hypertensive drugs.
Sialosis is histopathologically chacterized by acinar cel hypertrophy, atrophy of striated ducts with
oedema of the interstitial connective tissue. Ultimately , widespread fatty replacement of acini.
Treatment
Treatment of the underlying cause.
Rarely surgical reduction of the parotids glands may be necessary.
Pilocarpine successfully resolving sialosis associated with bulimia nervosa.
Bulimia nervosa
Salivary gland enlargement can occur with bulimia nervosa. Functional hypertrophy of the salivary
glands.(autonomic neuropathy, endocrine disease or past alcohol) with high level of serum amylase.
Treatment local application of heat, salivary substitutes & use of pilocarpine may result in reduction
in the size of the parotid gland. Superficial parotidectomy may rarely required.