Causes of non-neoplastic salivary gland enlargement
- Acute sialadenitis - viral (mumps, CMV), bacterial
- Recurrent acute sialadenitis
- Chronic sialadenitis - tuberculosis, actinomycosis
- Calculi
- Cysts - mucous retention, ranula
- Systemic disease - pancreatitis, diabetes, acromegaly
- Sjogren's syndrome
- Sarcoidosis
- Mickulicz's syndrome
- Drug induced - phenothiazines
- Allergic
Acute sialadenitis
Mumps
- Commonest cause of acute painful swelling of the parotid gland in children
- Due to paromyxovirus infection
- Flu-like illness is followed by acute bilateral painful parotid swelling
- Resolves spontaneously over 5 -10 days
- Occasionally parotid swelling may be unilateral
- Occasionally may affect submandibular glands
- Similar clinical picture may occur with Coxsackie A or B or parainfluenza virus infection
Bacterial sialadenitis
- Acute ascending bacterial sialadenitis usually affects the parotid glands
- Due to staphylococcus aureus or streptococcus viridans infection
- Incidence of this condition is decreasing
- Used to be seen in dehydrated post-operative patients with poor oral hygiene
- Presents with painful tender swelling of the parotid gland
- Pus can often be expressed from the parotid duct
- Sialogram is contraindicated
- Treatment is with parenteral broad-spectrum antibiotics
- Late presentation can cause a parotid abscess to develop
Sialolithiasis
- Of all salivary stones:
- 80% occur in the submandibular gland
- 10% occur in the parotid gland
- 7% occur in the sublingual gland
Picture provided by Jamshed Shabbir, Glasgow, Scotland
- 80% of submandibular stones are radio opaque
- Most parotid stones are radiolucent
- The classic presentation of a submandibular stone is pain and swelling prior to or during meal
- This does however requires almost complete obstruction of the submandibular duct
- If partial obstruction occurs swelling may be mild with chronic painful enlargement of the gland
- If diagnostic doubt then stone can be demonstrated by sialogram
- Treatment is by either removal of stone from duct or excision of the gland
- The stone should be removed if palpable with no evidence of chronic infection
- The gland should be excised if the stone posterior or gland is chronically inflamed
- The role of extracorporeal lithotripsy is currently under investigation
Sjogren's syndrome
- First described by Henrich Sjogren in 1933
- Autoimmune condition affecting the salivary and lacrimal glands
- Female : male is approximately 10:1
- Patients present with:
- Dry eyes - keratoconjunctivitis sicca
- Dry mouth - xerostomia
- Bilateral parotid enlargement
- Often associated with connective tissue disorders
- Primary Sjogren's Syndrome - No connective tissue disorder
- Secondary Sjogren's Syndrome - associated with connective tissue disorders
- 15% patients with rheumatoid arthritis and 30% patients with SLE develop Sjogren's Syndrome
- Associated with increased risk of B-cell lymphoma
- Sialogram shows a characteristic sialectasis and parenchymal destruction
- Diagnosis can be confirmed by labial gland biopsy
- Treatment is symptomatic
- No treatment will reverse the keratoconjunctivitis and xerostomia
Bibliography
Bradley P J. Benign salivary gland disease. Hosp Med 2001; 62: 392-395
Bull P D. Salivary gland stones: diagnosis and treatment. Hosp Med 2001;
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Escudier M P, Brown J E, Drage N A, McGurk M. Extracorporeal shockwave lithotripsy in
the management of salivary calculi. Br J Surg 2003; 90: 482-485.
Fox R I. Sjogren's syndrome. Lancet 2005:
366: 321-331
Goh Y H, Sethi D S. Submandibular gland excision: a five-year review. J Laryngol
Otol 1998; 112: 269-273.
Sood S, Anthony R, Pease C T. Sjogren's syndrome. Clin Otolaryngol 2000; 25: 350-357. |