Chronic Sialoadenitis

Aka: Chronic Sialoadenitis, Chronic Sialadenitis, Recurrent Parotitis, Chronic Bacterial Sialadenitis, Chronic Bacterial Parotitis, Chronic Suppurative Sialadenitis

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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

V. Differential Diagnosis

  1. General
    1. Lymphadenopathy of the Head and Neck
    2. Sialolithiasis
  2. Parotid Gland
    1. Recurrent Parotitis of Childhood
    2. Sjogren Syndrome
    3. Sarcoidosis
    4. Fungal infections
    5. Mycobacterium species
    6. Diabetes Mellitus
    7. Cirrhosis
    8. Salivary Gland Neoplasm
    9. Medications (rare)
      1. L-aspariginase
      2. Clozapine
      3. Phenylbutazone
      4. Brooks (2012) Ann Pharmacother 46(12): 1688-99 [PubMed]

VI. Imaging

  1. Evaluate for Sialolithiasis (intraductal stone or stenosis, or external compression)
  2. Modalities
    1. MRI 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. Gentle Salivary Gland massage
    3. NSAIDs
    4. Sialologues induce Salivation (help clear stone)
      1. Lemon drops
      2. Vitamin C lozenges
      3. Citric acid or malic acid (lemons, limes, apples, grapes)
  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. Kim (2024) Am Fam Physician 109(6): 550-9 [PubMed]
  4. Wilson (2014) Am Fam Physician 89(11): 882-8 [PubMed]

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