Acute suppurative parotitis in an old female patient
Note hot, red and board-like swelling with distended temporal veins
Sialoadenitis means inflammation of the salivary glands. It occurs much more common on the parotid gland than in the submandibular gland. Non specific
forms of sialoadenitis occurs due to mixed infection that ascend to the gland via the duct, while specific forms (e.g. Mumps) are mostly blood-borne. Diagnosis is usually not a problem basing on the clinical picture and laboratory findings (Table 6-4). Generally
the condition is a disease of elderly, dehydrated, malnourished patient, as well as, chronically ill patients. Table 6-5 shows a list for the treatment modalities for acute sialoadenitis. However, once sialoadenitis has occurred it tends to reoccur frequently
in the subacute or chronic forms. This is especially true in elderly and compromised patients.
Chronic sialoadenitis is similar to that of acute form
of the disease but symptoms are less sever. Usually there is no erythema and tenderness of the skin overlying the gland.
In the submandibular gland the condition is almost exclusively a complication of ductal obstruction which cause ductal dilatation
and salivary stasis. This is followed by glandular atrophy and fibrosis. Retrograde invasion of bacteria via the duct result in abscesses formations. In the parotid gland, on the other hand, the route of infection is less understood. However, low secretion
rate of parotid may be a predisposing factor.
Diagnosis is based on the presence of paste history of acute sialoadenitis or glandular pain and/or swelling. Sialogram may show "Pruned tree" appearance due to lack of aciner filling. Long standing cases
show "Punctate-dilatation" appearance of the peripheral ductules. Treatment of the chronic sialoadenitis is listed in table 6.
Chronic recurrent parotitis in children
condition occurs mostly in children at the age of 3-6 years. It is characterized by its unilateral occurrence and spontaneous healing. Sialograms show normal ductal architecture. Treatment is symptomatic. The condition must be differentiated from mumps. Differentiation
can be done by the following criteria:
- The condition occurs unilaterally while mumps is always bilaterally.
- Purulent material could be expressed from the gland in chronic recurrent parotitis.
- In mumps virus can be detected in the saliva by complement fixation test.
The symptoms of this condition is similar to those of chronic
recurrent sialoadenitis. However, there is some disagreement about the nature of the disease. It has been stated that the condition is not a disease but rather a sign for an inflammatory reaction in the gland.
Mumps (Epidemic Parotitis)
Mumps is a nonsuppurative, acute sialoadenitis of viral origin. It is a highly infectious disease that is presented clinically as a painful enlargement of one or more of the salivary glands.
It usually affects children between 6-8 years of age. The most common affected salivary gland is the parotid and in 10% of cases the submandibular gland become affected as well. The virus may affect other organs as pancreas, testis and ovaries. Clinical signs
and symptoms of viral mumps are listed in table 6-7 and its complications are listed in table 8.
Mumps usually resolves spontaneously within 5-10 days. Accordingly, treatment include symptomatic relief of pain and fever and prevention of dehydration.
Persistent or recurrent cases are indicative for development of chronic bacterial sialoadenitis secondary to viral mumps.
Post Irradiation Sialoadenitis
radiation for malignancies in the head and neck usually develop an acute inflammatory reaction within the salivary glands. There may be xerostomia, and swelling of the parotid and submandibular gland which increase for 12-24 hours then rapidly subside without
treatment. Over the period of the irradiation therapy degenerative changes occur that may lead to atrophy of the gland.
Post Surgical Parotitis
This condition develop 4-6
days after surgery and the symptoms are very similar to those of acute sialoadenitis. Predisposing factor is diminished salivary flow after surgery which is probably due to dehydration and fever and trauma to the gland by prolonged pressure from an anesthetic
mask. Treatment include fluid intake, stimulation of salivary flow, antibiotics and analgesics.
Salivary Gland Inclusion Disease
The condition also called "Cytomegalic
Inclusion Disease" and it results from infection by cytomegalovirus. The majority of cases occur in infants below 2 years of age. The disease may be acquired inutero or at any time postnatally. The organs most often affected are salivary glands, kidneys, pancreas,
liver, lungs and thyroid gland.
Cellular changes which occur in the affected gland include the appearance of large intranuclear bodies with less distinct cytoplasmic inclusion bodies. The parotid gland is most often affected in infants and children
while the submandibular gland is more frequently involved in adult cases.
Most cases of inclusion disease in the salivary glands are subclinical. However, in newborn and infants a serious disease may result that is characterized by prematurity, intracranial
calcifications and hepatosplenomegaly. Diagnosis depends on the identification of the virus in the saliva, urine, blood or tissues of the patient.
This condition affects mostly the minor salivary glands of the hard palate. It occurs more commonly in men than women. Clinically the lesion may be mistaken for mucoepidermoid carcinoma or squamous cell carcinoma. The lesion appears clinically as ulceration
on the mucous membrane that vary in size from 1-3 cm. Swelling and a feeling of fullness may precede the appearance of some lesions. Pain is not a common symptom. (Fig 5)
The most likely etiology of the disease is local ischemia of the minor salivary
gland that result in squamous metaplasia of the ductal epithelium. The cause of this local ischemia is unknown. The use of alcohol, tobacco and drugs, as well as diabetes and wearing ill fitted dentures have all been suggested as a predisposing factors.
The condition is self-limiting and heals by secondary intention over a period of 6-8 weeks. Lesion debridement and the use of saline mouth wash may aid in the healing process. Recurrence is quite uncommon.