Otolaryngology Book


Acute Suppurative Sialoadenitis

Aka: Acute Suppurative Sialoadenitis, Acute Suppurative Sialadenitis, Obstructive Sialadenitis, Bacterial Sialoadenitis, Suppurative Parotitis, Acute Parotitis, Parotitis
  1. See Also
    1. Sialadenitis
    2. Recurrent Parotitis of Childhood
    3. Acute Nonsuppurative Sialoadenitis (Viral)
    4. Chronic Sialoadenitis
    5. Sialolithiasis
    6. Salivary Gland Tumor
  2. Pathophysiology
    1. Mechanism
      1. Bacterial Infection with seeding via retrograde infection from the oral cavity
      2. Stasis due to volume depletion or Xerostomia allows for Salivary GlandBacterial parenchymal infection
    2. Most common in age >50 years
      1. Contrast with Viral Sialoadenitis
    3. Parotid Gland is most commonly affected Salivary Gland
      1. Less bacteriostatic secretions than submandibular
  3. Causes: Bacterial
    1. See Viral Sialoadenitis
    2. Staphylococcus aureus (most common, cultured in >50% of cases)
    3. Streptococcus species (esp. Streptococcus Pyogenes)
    4. HaemophilusInfluenzae
    5. Gram Negative Bacteria
    6. Anaerobic Bacteria
  4. Risk Factors
    1. Advanced age
    2. Volume depletion
    3. Diabetes Mellitus
    4. Hypothyroidism
    5. Renal Failure
    6. Sjogren Syndrome
    7. Debilitated or recently post-operative or post-hospitalization
    8. Anticholinergic Medications causing Xerostomia
    9. Secondary to Salivary Gland Calculus
      1. Known as Obstructive Sialadenitis
  5. Symptoms
    1. Acute pain and swelling localized over affected Salivary Gland
    2. High fever with chills often present
  6. Signs
    1. Ill appearing patient
    2. Exquisitely tender, warm, swollen Salivary Gland (usually Parotid Gland)
    3. Regional Lymphadenopathy
    4. Pus at affected Salivary duct orifice
      1. Affected gland may be massaged to express pus for culture
      2. Parotid duct (Stensen's Duct) at upper second molar
      3. Submandibular duct (Wharton's Duct) at frenulum
  7. Labs
    1. Gram Stain and culture of Salivary duct discharge
  8. Imaging
    1. CT Scan if not improving within 3-4 days
    2. Avoid sialography in acute Bacterial Sialoadenitis
  9. Differential Diagnosis
    1. See Lymphadenopathy of the Head and Neck
    2. Sialolithiasis
    3. Viral Sialoadenitis
    4. Chronic Sialoadenitis
  10. Management
    1. Precautions
      1. Acute Parotitis and other severe Sialadenitis may require initial inpatient parenteral antibiotics (e.g. Nafcillin and metronizadole)
      2. MRSA coverage should be considered in cases failing to improve or Immunocompromised patients (e.g. Vancomycin)
    2. Start antibiotic coverage for Staphylococcus aureus and other Gram Positive organisms (as well as Anaerobes)
      1. Total treatment course: 10-14 days
      2. Oral agents (non-toxic patient)
        1. Augmentin
        2. Dicloxacillin
        3. Clindamycin
      3. Parenteral agents
        1. Use broad spectrum coverage instead for immunosuppressed patients (e.g. Zosyn and Vancomycin)
        2. Clindamycin 600 mg IV every 6-8 hours OR
        3. Nafcillin 2 g IV every 4 hours AND Metronidazole 500 mg IV every 6 to 8 hours
    3. Increase Saliva production
      1. Increase fluid intake
      2. Lemon drops to increase Saliva secretion
      3. Stop Anticholinergics and other Xerostomia causes
    4. Symptomatic therapy
      1. Analgesics
      2. Warm compresses over affected Salivary Gland
      3. Attempt to milk gland of discharge
    5. Otolaryngology Consultation
      1. Surgical drainage may be required
      2. Consider early intervention or if no improvement in 3-4 days
  11. Complications
    1. Salivary Gland abscess (rare)
  12. References
    1. (2018) Sanford Guide, accessed on IOS 12/24/2019
    2. Fedok in Noble (2001) Primary Care Medicine, p. 1770-1
    3. Chow in Mandell (2000) Infectious Disease, p. 699-700
    4. Walner in Cummings (1998) Otolaryngology, p. 5-121
    5. Wilson (2014) Am Fam Physician 89(11): 882-8 [PubMed]

Obstructive sialadenitis (C0149773)

Concepts Anatomical Abnormality (T190)
SnomedCT 235127000
English glands obstructions salivary, salivary gland obstruction, Obstructive sialadenitis, Salivary gland obstruction, Obstructive sialadenitis (disorder)
Spanish obstrucción de glándula salival, sialoadenitis obstructiva (trastorno), sialoadenitis obstructiva
Derived from the NIH UMLS (Unified Medical Language System)

Acute bacterial sialadenitis (C0341049)

Concepts Disease or Syndrome (T047)
SnomedCT 235124007
English Acute bacterial sialadenitis, Suppurative sialadenitis, Acute bacterial sialadenitis (disorder)
Spanish sialoadenitis bacteriana aguda (trastorno), sialoadenitis bacteriana aguda, sialoadenitis supurativa
Derived from the NIH UMLS (Unified Medical Language System)

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