II. Pathophysiology

  1. Repeated episodes of Salivary Gland (typically Parotid Gland) pain and inflammation
    1. Secondary to Sialolithiasis (due to stone, stricture, scarring or external compression)
    2. Salivary Gland stasis and acini replaced with cysts
  2. Chronic, low-grade Salivary gland Bacterial Infection
    1. Staphylococcus aureus
    2. Mixed Bacterial Infection
  3. Ultimately results in Salivary Gland destruction
    1. Progressive Salivary acini destruction and fibrosis
    2. Sialectasis

III. Symptoms

  1. Recurrent Parotitis
  2. Mild Salivary Gland swelling and tenderness provoked with eating

IV. Signs

  1. Salivary Gland prominent and firm initially and later small and atrophic
  2. Unlike acute Sialoadenitis, the region is not warm, and tenderness is minimal to mild
  3. No Saliva typically expressed on Salivary Gland massage

VI. Imaging

  1. Evaluate for Sialolithiasis (intraductal stone or stenosis, or external compression)
  2. Modalities
    1. Sialogram
    2. Computed Tomography (CT)
    3. Sialendoscopy

VII. Management

  1. Exclude obstruction (see imaging above)
    1. Treat Sialolithiasis if present
  2. Conservative therapy for non-obstructive cases
    1. Hydration
    2. Lemon drops and other sialagogues
    3. Salivary Gland massage
    4. NSAIDs
  3. Antibiotics
    1. Consider if suspected Bacterial Sialoadenitis (e.g. Augmentin, Clindamycin)
  4. Salivary Gland resection (e.g. Parotidectomy)
    1. Indicated in refractory cases
    2. O'Brien (1993) Head Neck 15(5): 445-9 [PubMed]

VIII. References

  1. Chow in Mandell (2000) Infectious Disease, p. 699-700
  2. Walner in Cummings (1998) Otolaryngology, p. 5-121
  3. Wilson (2014) Am Fam Physician 89(11): 882-8 [PubMed]

Images: Related links to external sites (from Bing)

Related Studies