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Sialadenitis causes, symptoms and treatment

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Sialadenitis is an infection of the salivary glands. It is usually caused by a virus or bacteria. The parotid (in front of the ear) and submandibular (under the chin) glands are most commonly affected. Sialadenitis may be associated with pain, tenderness, redness, and gradual, localized swelling of the affected area. .

Sialadenitis often occurs in the setting of dehydration or in association with chronic illness. Underlying Sjögren syndrome and chronic periodontitis may contribute. Ductal obstruction, often by an inspissated mucous plug, is followed by salivary stasis and secondary infection. The most common organism recovered from purulent draining saliva is S aureus.


Sialadenitis usually occurs after decreased flow of saliva (hyposecretion) or duct obstruction, but may develop without an obvious cause. Saliva flow can be reduced in people who are sick or recovering from surgery, or people who are dehydrated, malnourished, or immunosuppressed. A stone or a kink in the salivary duct can also diminish saliva flow, as can certain medications (such as antihistamines, diuretics, psychiatric medications, beta-blockers, or barbiturates). It often occurs in chronically ill people with dry mouth (xerostomia), people with Sjogren syndrome, and in those who have had radiation therapy to the oral cavity.

Sialadenitis is most commonly due to bacterial infections caused by Staphylococcus aureus. Other bacteria which can cause the infections include include streptococci, coliforms, and various anaerobic bacteria. Although less common than bacteria, several viruses have also been implicated in sialadenitis. These include the mumps virus, HIV, coxsackievirus, parainfluenza types I and II, influenza A, and herpes.



Signs and symptoms of sialadenitis may include fever, chills, and unilateral pain and swelling in the affected area. The affected gland may be firm and tender, with redness of the overlying skin. Pus may drain through the gland into the mouth.


Treatment consists of intravenous antibiotics, such as nafcillin (1 g intravenously every 4–6 hours), measures to increase salivary flow, including hydration, warm compresses, sialagogues (eg, lemon drops), and massage of the gland. Treatment can usually then be switched to an oral agent based on clinical improvement and microbiologic results to complete a 10-day treatment course.

Less severe cases can often be treated with oral antibiotics with similar spectrum. Complete resolution of parotid swelling and pain can take 2–3 weeks. Failure of the process to improve and ultimately resolve on this regimen suggests abscess formation, ductal stricture, stone, or tumor causing obstruction.

Ultrasound or CT scan may be helpful in establishing the diagnosis. In the setting of acute illness, a severe and potentially life-threatening form of sialadenitis, sometimes called suppurative sialadenitis, may develop. The causative organism is usually S aureus, but often no pus will drain from Stensen papilla. These patients often do not respond to rehydration and intravenous antibiotics and thus may require operative incision and drainage to resolve the infection.

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