History

Fact Explanation
Pain over the gland Parotid and the submandibular glands are the commonly involved salivary glands. Patients complain of pain over the affected gland. When the patient eats the swelling becomes more prominent and the pain also exacerbates. [2]
Swelling of the gland Affected salivary glands are swollen due to inflammatory edema. [2]
Fever Although not common some patients can have fever. [2]
Inability to open the mouth This is a rare complain. Patients complain of inability to open the mouth because of the pain. [2]
Unpleasant taste Discharged pus from the infected glands gives the unpleasant taste. [2,4]
Poor oral hygiene Poor oral hygiene is a predisposing factor for the development of infectious sialadenitis. Common organisms include Streptococcus aureus, Streptococcus viridans, Pseudomonas aeruginosa, Escherichia coli and Moraxella catarrhalis. [1,2,4]
Use of radio-contrast material Patients can develop "iodide mumps", iodine induced sialadenitis as a side effect of contrast use. Patients who have underwent procedures which use the radiocontrast materials recently are at risk of developing sialadenitis. [3]
History of radiotherapy Radiation sialadenitis can occur as a consequence of fibrosis of the gland secondary to radiotherapy to head and neck area.
Risk factors A history of recent dental work should be looked for in the history as this can lead to development of sialadenitis. Presence of autoimmune diseases like Sjogren's syndrome, rheumatoid arthritis, ankylosing spondylitis also increases the risk of sialadenitis. Elderly patients are at high risk because of poor fluid intake and starvation. [5]
References
  1. ORLANDI MA, PISTORIO V, GUERRA PA. Ultrasound in sialadenitis J Ultrasound [online] , 16(1):3-9 [viewed 30 July 2014] Available from: doi:10.1007/s40477-013-0002-4
  2. CHANDAK RAKHI, DEGWEKAR SHIRISH, CHANDAK MANOJ, RAWLANI SHIVLAL. Acute Submandibular Sialadenitis—A Case Report. Case Reports in Dentistry [online] 2012 December, 2012:1-3 [viewed 30 July 2014] Available from: doi:10.1155/2012/615375
  3. SHACHAM Y, HAVAKUK O, ROTH A. A rare case of acute contrast-induced sialadenitis after percutaneous coronary intervention. Isr Med Assoc J [online] 2013 Oct, 15(10):652-3 [viewed 30 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/24266096
  4. CHANDAK RAKHI, DEGWEKAR SHIRISH, CHANDAK MANOJ, RAWLANI SHIVLAL. Acute Submandibular Sialadenitis—A Case Report. Case Reports in Dentistry [online] 2012 December, 2012:1-3 [viewed 30 July 2014] Available from: doi:10.1155/2012/615375
  5. HELENIUS L M J. Focal sialadenitis in patients with ankylosing spondylitis and spondyloarthropathy: a comparison with patients with rheumatoid arthritis or mixed connective tissue disease. [online] 2001 August, 60(8):744-749 [viewed 30 July 2014] Available from: doi:10.1136/ard.60.8.744

Examination

Fact Explanation
Febrile Some affected patients are febrile. [1]
Swelling of the gland Affected gland is swollen, and the overlying skin is erythematous. In parotitis the parotid gland swelling is visible over the angle of the mandible. Swelling of the deep lobe of the parotid gland can be palpated as a diffuse firm swelling over the soft palate and tonsils. Sialadenitis of the submandibular gland causes swelling over the floor of the mouth. Diffuse firm swelling can be palpated bimanually. [1]
Tenderness of the gland Salivary glands are tender to palpation in sialadenitis. Superficial lobe of the parotid gland is tender to palpation over the angle of the jaw. Intraoral examination will reveal tenderness over the soft palate if the deep lobe of the parotid gland is involved. Submandibular gland is tender on bimanual palpation. [1]
Discharge Purulent discharge can be seen at the site of opening of the ducts, especially the Wharton’s duct of the salivary gland. The opening of the Wharton's duct lies on the anterior floor of the mouth at the sublingual papilla. [1]
Signs suggestive of autoimmune diseases Patients with Sjogren's syndrome have dry eyes and dry mucous membranes. Rheumatoid nodules, joint deformities like swan neck deformity, symmetrical swelling of the small joints of the hand and "Z thumb" deformity are suggestive of rheumatoid arthritis.
References
  1. CHANDAK RAKHI, DEGWEKAR SHIRISH, CHANDAK MANOJ, RAWLANI SHIVLAL. Acute Submandibular Sialadenitis—A Case Report. Case Reports in Dentistry [online] 2012 December, 2012:1-3 [viewed 30 July 2014] Available from: doi:10.1155/2012/615375

Differential Diagnoses

Fact Explanation
Salivary gland tumors When compared to sialadenitis salivary gland tumors present with painless enlargement of the gland. Clinical assessment alone cannot differentiate benign from malignant lesions. Fine needle aspiration cytology and MRI scan are useful in differentiating the two. [1]
Ranula Ranula are common in the submandibular salivary gland. When the duct of the gland is blocked either by trauma or by calculi, secreted saliva gets accumulated and it appears as a lump. [2]
Submandibular lymph node Enlarged submandibular lymph node can also present as a submandibular swelling. The submandibular salivary gland is bimanually palpable (the small deep lobe of the submandibular gland lies deep to the mylohyoid muscle) whereas lymphnode is not.
References
  1. TO VICTOR SHING HOWE, CHAN JIMMY YU WAI, TSANG RAYMOND K. Y., WEI WILLIAM I.. Review of Salivary Gland Neoplasms. ISRN Otolaryngology [online] 2012 December, 2012:1-6 [viewed 30 July 2014] Available from: doi:10.5402/2012/872982
  2. GUPTA A, KARJODKAR FR. Plunging Ranula: A Case Report ISRN Dent [online] 2011:806928 [viewed 30 July 2014] Available from: doi:10.5402/2011/806928

Investigations - for Diagnosis

Fact Explanation
Ultrasound scan Since the salivary glands lie superficially ultrasound scan is considered a sensitive investigation to diagnose sialadenitis. When compared to CT scan ultrasound scan is non-invasive and does not carry the risk of radiation exposure. Color Doppler ultrasound scan is useful in detecting increased vasculature of the gland in sialadenitis. Ultrasound scan can also detect the presence of calculi. Anatomical abnormalities of the ducts can also be detected by the ultrasound scan. [1,2]
CT scan In some instances the ultrasound scan is inconclusive. CT is useful in those patients. CT scan is considered the gold standard in diagnosing inflammatory conditions of the salivary glands. [1]
Fine needle aspiration cytology Focal lymphocytic sialadenitis is the characteristic histological pattern of Sjogren's syndrome. [3]
X-ray sialography X-ray sialography is contraindicated in suspected sialadenitis because it may aggravate the inflammation. [1]
References
  1. ORLANDI MA, PISTORIO V, GUERRA PA. Ultrasound in sialadenitis J Ultrasound [online] , 16(1):3-9 [viewed 30 July 2014] Available from: doi:10.1007/s40477-013-0002-4
  2. CHANDAK RAKHI, DEGWEKAR SHIRISH, CHANDAK MANOJ, RAWLANI SHIVLAL. Acute Submandibular Sialadenitis—A Case Report. Case Reports in Dentistry [online] 2012 December, 2012:1-3 [viewed 30 July 2014] Available from: doi:10.1155/2012/615375
  3. HADDAD J., TRINCHET J-C., PATERON D., MAL F., BEAUGRAND M., MUNZ-GOTHEIL C., CALLARD P., AMBROSINI J-C.. Lymphocytic sialadenitis of Sjögren's syndrome associated with chronic hepatitis C virus liver disease. The Lancet [online] 1992 February, 339(8789):321-323 [viewed 30 July 2014] Available from: doi:10.1016/0140-6736(92)91645-O

Management - General Measures

Fact Explanation
Health education If poor oral hygiene is considered the possible etiological factor for the development of sialadenitis, patients should be advised to maintain good oral hygiene to prevent further episodes.
Rehydration Elderly patients are sometimes dehydrated due to poor oral intake. If the patient is unable to take oral fluids administration of intravenous fluid is necessary. [1]
References
  1. CHANDAK RAKHI, DEGWEKAR SHIRISH, CHANDAK MANOJ, RAWLANI SHIVLAL. Acute Submandibular Sialadenitis—A Case Report. Case Reports in Dentistry [online] 2012 December, 2012:1-3 [viewed 30 July 2014] Available from: doi:10.1155/2012/615375

Management - Specific Treatments

Fact Explanation
Conservative managment Patients with acute viral diadadenitis and most of the patients with suppurative sialadenitis recover uneventfully. [1]
Antibiotics Antibiotics are recommended for the treatment of suppurative sialadenitis. Antistreptococcal antibiotics (penicillin, erythromycin, amoxicillin, cephalexin) can be administered empirically as Streptococcus is one of the commonest causative bacteria. [1]
Sialadenectomy For patients with failed conservative and medical management surgical removal of the gland is practiced. [1]
Surgical drainage If suppurative sialadenitis has developed in to an abscess, surgical drainage is necessary. Abscess is drained via a large bore needle under general anesthesia. [1]
Management of autoimmune diseases Possible precipitating autoimmune causes should be treated. Management of Sjgron's syndrome is mainly conservative. If symptomatic patients with autoimmune diseases should be given corticosteroids or prednisolone.
References
  1. CHANDAK RAKHI, DEGWEKAR SHIRISH, CHANDAK MANOJ, RAWLANI SHIVLAL. Acute Submandibular Sialadenitis—A Case Report. Case Reports in Dentistry [online] 2012 December, 2012:1-3 [viewed 30 July 2014] Available from: doi:10.1155/2012/615375
  2. HUANG YI-FAN, CHENG QIAN, JIANG CHUN-MIAO, AN SHU, XIAO LAN, GOU YONG-CHAO, YU WEN-JING, LEI LEI, CHEN QIAN-MING, WANG YATING, WANG JUN. The Immune Factors Involved in the Pathogenesis, Diagnosis, and Treatment of Sjogren's Syndrome. Clinical and Developmental Immunology [online] 2013 December, 2013:1-6 [viewed 30 July 2014] Available from: doi:10.1155/2013/160491