Sialoadenitis

00:01 This leads us into Sialoadenitis.

00:04 So sialo, salivary gland, adenitis means inflammation of that salivary gland.

00:10 It's going to be often associated with stones but not always.

00:13 So Sialoadenitis is inflammation or infection of a salivary gland.

00:18 What's the epidemiology of this? Well, it's hard to know because the exact incidence is unknown.

00:26 In many cases, it kind of, you have a little bit of pain, discomfort, and then, it goes away.

00:32 So we don't really have a true knowledge about what the incidence is.

00:38 There doesn't appear however to be any particular predilection for ethnicity or gender.

00:43 I will say that it tends to occur in older, chronically ill, and debilitated or dehydrated patients.

00:51 The risk factors that we do recognize, so geriatric individuals, people who are older than 50 years, so, me.

00:57 They may not have normal salivary gland or saliva production, so called xerostomia.

01:05 They may be dehydrated, so they're not producing more saliva because they are dry.

01:12 That will go along clearly with anorexia or bulimia.

01:16 Sjogren Syndrome because it is associated with inflammation of the salivary gland.

01:23 And/or duct is a common precursor risk factor for developing Sialoadenitis.

01:29 And clearly, last but not least, if you have a stone that sits within the draining duct, Sialolithiasis that puts you at risk for developing inflammation more upstream in the salivary gland.

01:42 The pathophysiology of this is not that hard to think about.

01:46 So you can have primary inflammation due to an infection.

01:49 So viruses such as mumps or Epstein Barr virus or parainfluenza, frequently cause inflammation of the salivary glands.

01:58 You can have an autoimmune Sialoadenitis.

02:02 And it will typically be one of the manifestations of Sjogren's disease.

02:06 Other infections include staphylococcus aureus and strep viridans, oral flora, and radiation treatment, clearly, by causing inflammation and/or stenosis of the salivary ducts.

02:19 We're looking here at our three main salivary glands, the parotid, the sublingual, the submandibular for reasons that I don't completely understand, the vast majority of the Sialoadenitis is actually going to occur in the parotid gland up here at the angle of the jaw.

02:38 And we're showing here a stone that's in the primary duct that causes then obstruction.

02:45 And there may be bacteria behind that because, again, there's bacteria throughout the salivary gland and/or salivary duct.

02:53 And if you are not moving fluid through that, they may grow and then, a combination of the obstruction And the infection leads to an inflamed parotid gland in this case.

03:06 The clinical presentation, it's usually unilateral with salivary gland swelling on that side.

03:13 So you see this poor kid who has a really severe parotid gland Sialoadenitis.

03:19 The pain and swelling typically is worse with meals.

03:22 Again, when you eat or drink and you are trying to make saliva and it can't get out of the salivary gland, that's going to increase the pain and swelling.

03:33 Usually, it's very red, firm, and diffusely tender, all the cardinal features of inflammation.

03:39 If there is necrosis or a lot of bacterial infection, we will get purulent exudate will actually form an abscess.

03:48 And with systemic manifestations of a bacterial - a secondary bacterial infection, you'll get fevers and chills or rigors.

03:56 How do we diagnose this? Well, it's mainly clinical.

03:59 You have swelling, you've got pain, and it's unilateral and it seems to be involving a gland.

04:04 That's not that hard to make that diagnosis.

04:07 But we do want to specifically identify what are the bugs that are in there.

04:11 So you want to do a gram staining culture of any exudate that's coming from the gland if that's possible.

04:16 You may also want to evaluate for mumps or other viral causes of this.

04:23 So you can do PCR serology. Mumps is going to be the most common but there are others that will be associated with it.

04:30 When it is important to kind of sort this out from, say, a tumor of the salivary gland, then you may need to do some imaging. CT, ultrasonography, magnetic residence imaging.

04:43 You'll want to visualize whether or not there are stones in the duct because you can treat a Sialoadenitis but if you don't get rid of the obstruction, it's going to come back.

04:51 And if there's an abscess, we're going to have to identify that and drain it.

04:55 Okay. So what are we going to do about this? Most of this is going to be treating the symptoms.

05:01 But we can do some more definitive things to make sure it doesn't come back.

05:05 So we'll use compresses and heat.

05:08 Basically, applying heat will cause dilation of the salivary duct and improved flow.

05:14 And if there's an obstruction, you may resolve that.

05:17 If there's secondary infection, possibility of infection, antibiotics are due - usually indicated.

05:23 We'll want to treat the pain obviously, but we want to give anti-inflammatories to reduce swelling.

05:28 And that will also open up the duct.

05:31 And then, we can also use Sialogogues, things that will increase salivation.

05:36 So if you're a dog, we'll ring a bell. No, we won't do that.

05:39 But we can get things like peppermint oil which will increase salivation, to Sialogogues.

05:44 And with that, we have concluded our discussion of Sialolithiasis and Sialoadenitis.