Sialadenitis (sialoadenitis) – causes, symptoms, diagnosis, treatment, pathology

“Sial” refers to saliva, “aden” refers
to a gland, and “itis” is inflammation – so acute sialadenitis is the sudden inflammation
of any of the salivary glands, the major ones being the parotid, submandibular and sublingual
gland. Sialadenitis usually affects a single parotid
gland rather than both, and is most common among individuals in their 50s and 60s but
can occur at any age, even in a newborn. Acute sialadenitis is most often caused by
the bacteria Staphylococcus aureus, but may also be caused by Streptococcus viridans,
or in Haemophilus influenzae, as well as viruses like mumps and HIV. When it’s a bacterial infection, it often
starts up after a salivary duct is plugged up by a salivary stone. Salivary glands secrete saliva through tiny
ducts in the mouth, to help lubricate the inside of the mouth, and also moisten and
soften food. The antibacterial properties of saliva and
the quick flow through the salivary duct both help to prevent infections from developing. But there are various factors that reduce
the rate of salivary flow, such as dehydration, illness, and certain medications. These factors can allow deposits to settle
in the walls of the salivary duct, physically blocking the path and further slowing down
the flow of saliva. This can allow tiny areas of stagnation where
more deposits of calcium, phosphorous, and other electrolytes can precipitate out, ultimately
forming small concretions called microsialoliths – or tiny salivary stones. Over time, these can grow into sialoliths
which are larger salivary stones. Salivary stones block up the duct, allowing
bacteria to move from the mouth up and around the blockage and into the salivary duct. And this results in inflammation and tissue
swelling which can further compresses the salivary duct, and worsen the problem. Acute sialadenitis causes pain and swelling
as well as redness of the skin overlying the affected gland. Because the salivary gland is affected, it
also means that less saliva is being made which dries out the mouth, and can cause a
bad taste in the mouth from pus leaking out of the affected duct. Severe sialadenitis can also make it painful
to open the mouth, which can make eating and drinking tough as well. Like any severe infection, it can cause fever
and chills and also develop into an abscess. Chronic sialadenitis, in contrast, is less
painful and causes the gland to enlarge following meals, typically without the overlying redness
of the skin. The chronic form of the disease is associated
with conditions linked to chronic decreased salivary flow, rather than dehydration. One mechanism for this would be when an acute
episode of inflammation leads to salivary duct fibrosis which alters the glandular tissue
and the composition of saliva itself, making it more viscous and slow-moving. In other cases of chronic sialadenitis, there
may be an autoimmune disease such as Sjogren’s syndrome, which causes chronic inflammation
and salivary duct fibrosis. Diagnosis of sialadenitis is generally based
on a swollen salivary gland, and laboratory culture of pus which can be collected by gentle
compression, or “milking” of the gland. Imaging can also be helpful to check for an
abscess, salivary stone, or tumor. With regard to treatment, hydration and glandular
massage are both helpful in stimulating salivary flow, and antibiotics can help to treat an
infection. Medications that stimulate saliva production
can help clear the salivary duct, but individuals with recurrent disease may need partial or
complete surgical removal of the affected gland. So, as a quick recap, sialadenitis is inflammation
and swelling of the salivary gland. Acute sialadenitis is typically caused by
a bacterial infection like Staphylococcus aureus, which can get established when a salivary
duct is plugged up by a salivary stone. Chronic sialadenitis is generally associated
with decreased salivary flow, which may be caused by salivary duct fibrosis after an
acute infection, or an autoimmune process. Both of which can lead to recurrent infections. Thanks for watching, you can help support
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