Sialadenitis
Inflammation of salivary glands, acute or chronic.
Sialadenitis, also known as sialoadenitis, refers to inflammation of the salivary glands, most often affecting the major ones—primarily the parotid, followed by the submandibular and sublingual glands. This condition is distinct from sialadenosis (or sialosis), which involves non-inflammatory enlargement of the major salivary glands. Sialadenitis is categorized as either acute or chronic, and its causes span bacterial infections (most frequently *Staphylococcus aureus*), viral infections, and autoimmune disorders.
Acute sialadenitis typically presents as a red, tender, and painful swelling. Predisposing factors include salivary stones (sialolithiasis), reduced saliva flow due to dehydration, postoperative states, or medications, poor oral hygiene, and flare-ups of low-grade chronic sialadenitis. Clinical features may include edema of the cheek, periorbital area, and neck, low-grade fever, malaise, elevated inflammatory markers (ESR, CRP, leukocytosis), and purulent discharge from the duct opening.
Chronic sialadenitis is generally less painful but involves recurrent swellings, often after meals, without redness. It is usually unilateral, with mild pain or swelling, a reddened duct orifice, and decreased saliva flow. A visible or palpable stone may or may not be present. In the parotid gland, it causes recurrent painful swellings; in the submandibular gland, it is often secondary to stones or strictures.
Signs and symptoms vary by type. Acute sialadenitis from obstruction (e.g., stones) leads to increasingly painful swelling over 24–72 hours, purulent discharge, and systemic symptoms. Chronic sialadenitis causes intermittent, recurring tender swellings. Chronic sclerosing sialadenitis is typically unilateral and can mimic a tumor. Autoimmune sialadenitis, such as in Sjögren’s syndrome, produces unilateral or bilateral painless swellings unless a secondary infection occurs.
The most common viral salivary gland infection is mumps, characterized by bilateral parotid swelling, though other major glands are affected in about 10% of cases. Swelling lasts about a week, accompanied by low-grade fever and malaise. Recurrent parotitis of childhood involves periodic pain and swelling in the parotid gland with fever.
- Types
- Acute, chronic, autoimmune, infective
- Common cause
- Bacterial (Staphylococcus aureus), viral (mumps), autoimmune
- Most affected gland
- Parotid gland
- Acute symptoms
- Red, painful swelling, tender to touch, purulent exudate
- Chronic symptoms
- Recurrent swellings after meals, mild pain, no redness
- Common viral cause
- Mumps (bilateral parotid swelling)
Lore & Background
Sialadenitis presents as acute or chronic inflammation of the major salivary glands. Acute sialadenitis often involves red, painful swelling with systemic manifestations such as fever and malaise, while chronic sialadenitis causes intermittent, tender swellings, typically after meals. Predisposing factors for acute cases include sialolithiasis, decreased salivary flow, poor oral hygiene, and exacerbation of low-grade chronic sialadenitis. Bacterial pathogens, especially *Staphylococcus aureus*, are the most common cause overall, particularly in adults and hospitalized patients, though viral causes like mumps are also significant. Autoimmune conditions like Sjögren's syndrome and sarcoidosis are common causes of chronic sialadenitis.
Reader's Guide
Sialadenitis is significant as a common clinical condition affecting the major salivary glands, with acute and chronic forms requiring different management. Acute sialadenitis often presents with painful swelling and systemic signs, while chronic sialadenitis may mimic tumors and is frequently linked to autoimmune diseases or sialolithiasis. The condition's causes span infections, autoimmune disorders, and obstructions, with mumps being the most common viral cause. Histologically, acute cases show neutrophil infiltration and acinar necrosis, while chronic cases feature lymphocytic infiltrate, fibrosis, and acinar atrophy. Understanding sialadenitis helps differentiate it from sialadenosis and guides treatment, which may range from conservative measures to surgical removal of affected glands, especially when calculi are present.
Did You Know?
- The most common salivary gland infection is mumps, characterized by bilateral swelling of the parotid glands.
- Acute sialadenitis secondary to obstruction presents with painful swelling of 24–72 hours, purulent discharge, and systemic manifestations.
- Chronic sclerosing sialadenitis is commonly unilateral and can mimic a tumor.
- One study found that 82% of submandibular glands removed in an ENT department in Stockholm had salivary calculi, all but one with chronic sialadenitis.
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