Sialadenitis is the inflammation of a salivary gland. When a gland becomes inflamed, its normal function is disrupted, leading to noticeable symptoms. This condition can affect people of any age, though it occurs more frequently in the elderly or chronically ill.
The Salivary Glands
The human body contains three major pairs of salivary glands that produce the majority of saliva. The largest are the parotid glands, situated on either side of the face, just in front of the ears. The submandibular glands are located beneath the jaw, and the smallest, the sublingual glands, lie under the tongue on the floor of the mouth.
These glands work constantly to produce up to 1.5 liters of saliva daily, a fluid that aids in swallowing, begins the digestion of starches, and helps protect the mouth from bacteria. Sialadenitis occurs when one or more of these glands swells and becomes inflamed, often due to an infection or an obstruction within the duct system. Inflammation causes pain and swelling, which interferes with the smooth flow of saliva into the mouth.
Primary Causes and Contributing Factors
Sialadenitis typically begins when saliva flow is reduced or blocked, allowing oral bacteria to travel backward into the gland and multiply. The most common bacterial cause of this infection is Staphylococcus aureus, though other bacteria like streptococci can also be responsible.
Viral infections are another frequent cause. Mumps is the most well-known virus affecting the parotid glands, but other viruses, including influenza and coxsackie, have also been linked to glandular inflammation. Unlike bacterial infections, viral sialadenitis may affect multiple glands at once.
A common physical cause of obstruction is the formation of salivary stones (sialolithiasis). These calcified masses form in the ducts of the salivary glands, most frequently in the submandibular glands. The stones physically block the exit of saliva, causing stasis that encourages bacterial growth and inflammation.
Several factors can contribute to reduced salivary flow and increase the risk of developing sialadenitis:
- Dehydration
- Recent illness or poor oral hygiene
- Certain medications, such as diuretics, antihistamines, and some beta-blockers, which have a drying effect
Identifying the Key Symptoms
Symptoms include rapid-onset pain and swelling in the area of the affected gland. If the parotid gland is involved, swelling is located in the cheek area just in front of the ear. Submandibular gland involvement causes swelling beneath the jaw.
The pain often worsens during meals because eating stimulates the gland to produce more saliva, which then cannot escape due to the obstruction or inflammation. Along with localized tenderness and swelling, a bacterial infection can cause systemic signs like fever and chills. In more severe cases of infection, pus may be seen draining from the duct opening into the mouth.
Diagnosis and Management Options
Diagnosis begins with a physical examination, where a healthcare provider checks the affected area for swelling, firmness, and tenderness. They may gently massage the gland to see if pus or cloudy fluid can be expressed from the duct, which confirms an active infection. If pus is present, a sample is often collected for culture to identify the specific bacteria and determine the most effective antibiotic.
Imaging tests are frequently used to identify the underlying cause, especially if a salivary stone or abscess is suspected. An ultrasound or a computed tomography (CT) scan can help visualize obstructions or collections of pus within the gland.
Management for acute sialadenitis involves conservative measures aimed at promoting saliva flow and treating any infection. Patients are advised to maintain hydration and use warm compresses on the swollen area to help reduce discomfort. Sialogogues, substances that stimulate saliva production (such as lemon drops or hard candy), are used to flush the duct. If a bacterial infection is confirmed, antibiotics effective against Staphylococcus aureus are typically prescribed, and analgesics help manage the pain. When conservative methods fail, or if a large abscess or persistent salivary stone is present, surgical intervention may be necessary, ranging from minimally invasive sialendoscopy to surgical drainage of an abscess.