Salivary Gland Inflammation (Sialadenitis)

In sialadenitis (thesaurus synonyms: Sialoadenitis; salivary gland inflammation; inflammation of a salivary gland; abscess of the sublingual glands; abscess of the submandibular glands; abscess of the salivary gland duct; adenitis of the salivary glands; adenitis of the salivary gland duct; acute parotitis; acute sialadenitis; chronic parotitis; chronic sialadenitis; suppuration of the salivary gland duct; purulent adenitis of sublingual gland; purulent adenitis of submandibular gland; purulent adenitis of parotid gland; purulent inflammation of Wharton’s duct; purulent parotitis; purulent sialadenitis; inflammation of submandibular gland; inflammation of submandibular duct; inflammation of salivary gland excretory duct; Hyposecretion of salivary gland; hyposialia; infection of salivary gland; infection of salivary gland duct; deficiency of salivary gland secretion; nonepidemic parotitis; obstructive sialadenitis; parotitis; parotid abscess; parotitis infection; parotitis; parotitis not due to mumps; purulent parotitis; septic parotitis; sialadenitis; sialitis; sialoadenitis; sialodochitis; sialodochitis fibrinosa; salivary gland abscess; salivary gland suppuration; salivary gland duct stone; salivary gland secretion disorder; salivary gland stone; salivary gland deficiency; salivary secretion disorder; salivary congestion CD-10 K11. 2 -: Sialadenitis; ICD-10 K11.3 -: Salivary gland abscess; Greek σίαλον, síalon, “saliva,” ἀδεν, áden, “gland,” and -ίτις, -ítis, “inflammation”; ICD-10 K11.7 -: Disorders of salivary secretion) involves inflammation of one or more salivary glands of the head. The following glands may be affected:

  • Glandula parotis (synonym: glandula parotidea, parotid gland; parotid gland) – Excretory duct: stenon duct.
  • Glandula submandibularis (submandibular gland).
  • Glandula sublingualis (sublingual gland) – common excretory duct with glandula submandibularis: Wharton’s duct.
  • Small salivary glands in the mucous membranes of the lips and mouth.

Forms of the disease

Sialadenitis can be acute or chronic, with an acute course usually triggered by a viral or bacterial infection. Chronic-recurrent (chronic-recurring) courses, on the other hand, is usually based on a secretion disorder – often by obstruction (drainage disorder) – or an immunological disease. In addition, radiogenic (radiation-induced) sialadenitis plays a role. Rarely, chronic sialadenitis may also be caused by an infectious granulomatous disease (e.g., tuberculosis). Viral sialadenitis

  • Parotitis epidemica (mumps).
  • Cytomegalovirus sialadenitis

Viral concomitant sialadenitis may be present in:

  • Coxsackie viral disease
  • ECHO virus infection
  • Infection with Epstein-Barr virus
  • Infection with parainfluenza viruses
  • HI virus infection

Acute bacterial sialadenitis

Acute bacterial sialadenitis is usually favored by hyposialia (reduced salivation) and triggered by hemolytic streptococci (group A) and staphylococci (S. aureus).

Chronic sialadenitis

Obstruction (blockage, obstruction of drainage) often underlies a chronic course of inflammation. Obstructive sialadenitis represents the most common form of inflammation of the salivary glands. The obstruction is often sialoliths (salivary stones, concretions). Sialadenitis caused by sialoliths is called sialolithiasis (salivary stone disease). Sialolithiasis represents the most common form of inflammation of the submandibular gland, while sialoliths are rarely found in the parotid gland. The decreased salivary flow favors ascending bacterial infections. For more on “sialadenitis,” see the disease of the same name. For other forms of sialadenitis, see “Pathogenesis (disease development) – Etiology (causes)”. Obstructive electrolyte sialadenitis.

A qualitative disturbance of saliva production in the form of disturbed electrolyte balance leads to altered viscosity. Tougher saliva leads to mucus obstruction (outflow obstruction) and consecutive formation of sialoliths (stone formation). Inorganic and organic material accumulates on an inorganic core and leads to an increase in the volume of the stone. Sex ratio: 55.5% of obstructive sialadenitis is male, 44.5% is female.Men are two to three times more frequently affected by salivary stones than women. Frequency peak: In obstructive sialadenitis there is an accumulation in the 6th and 7th decade of life:

Chronic recurrent sialadenitis of the submandibular gland (synonyms: Küttner tumor; chronic sclerosing sialadenitis; atrophic sialadenitis; English : sclerosing sialadenitis).

Küttner tumor is the most common form of chronic inflammatory sialadenitis (34%), mostly associated with sialolithiasis (50%). Sex ratio: Küttner tumor (chronic sialadenitis of the submandibular gland) preferentially affects males. Frequency peak: The age peak of Küttner tumor is in the 5th to 6th decade of life. Course and prognosis: Secretory disturbance and obstructive electrolyte sialadenitis are followed by periductal fibrosis, secretory thickening, and proliferation. Extensive immunologic destruction of the ductal epithelium and glandular parenchyma (immune responses: IgA, IgG, lactoferrin, lysozyme) occurs, resulting in ascending infections. In the final stage, there is a tumor-like swelling due to sclerosis (hardening of tissue) of the atrophied glandular parenchyma. Chronic recurrent parotitis

Unilateral or bilateral recurrent bacterial infections of the parotid gland with frequency in childhood. Congenital ductal dilation is suspected as a predisposing factor. An immunologic genesis is also discussed due to massive lymphoplasmacytic infiltration. Course and prognosis: The chronic disease always exacerbates acutely. In children, symptoms resolve during puberty in over 50% of cases. In adults, protracted courses are seen, leading to scarring obliteration (“plugging”) of the glandular parenchyma and eventual cessation of saliva production. Chronic myoepithelial sialadenitis

This autoimmune disease is characterized by mostly symmetrical inflammation of the salivary glands, especially the parotid (parotid gland), and also the lacrimal glands. Chronic myoepithelial sialadenitis is part of the symptomatology of the so-called Sjögren’s syndrome, for which inconsistent definitions exist. Mason and Chisholm define a purely oral-ocular (mouth-eye related) symptomatology as Sicca syndrome. The symptoms are often associated with a rheumatic disease, especially chronic polyarthritis. If two of the three symptoms xerostomia / keratoconjunctivitis sicca / rheumatic disease are present, Mason and Chisholm define a Sjögren’s syndrome. However, the term primary Sjögren’s syndrome is also commonly used for oral-ocular symptoms (possibly involving other exocrine glands) and the term sicca syndrome as a secondary form in association with rheumatoid disease. Sex ratio: In Sjögren’s syndrome / Sicca syndrome, the ratio of males to females is 1:9-10. Frequency peak: Sjögren’s syndrome mainly affects postmenopausal women in the 5th to 7th decade of life. Course and prognosis: In one third of cases, the parotid gland is chronically enlarged. Gradual drying up of the glands results in xerostomia (dry mouth) and keratoconjunctivitis sicca (“dry eyes“). Chronic epithelioid cell parotitis

The so-called Heerfordt syndrome (febris uveo-parotidea subchronica; ICD-10: D86.8) is the extrapulmonary (“outside the lungs”) manifestation (“becoming visible”) of sarcoidosis (Boeck’s disease) in the parotid gland, which has a medium-dense, constant swelling on one rather than both sides. Smaller salivary glands may also be involved. Radiation sialadenitis

Radiogenic (radiation-induced) sialadenitis.

Course and Prognosis: Radiogenic (radiation-induced) damage to the serous acini and inflammation of the ductal epithelium is followed by irreversible fibrosis of the glandular parenchyma. This results in sialopenia (saliva deficiency) and consequent xerostomia (dry mouth).

Sialadenitis in hyposialia

In quantitative disorders of salivary secretion in the form of hyposialia (decreased salivary flow), sialadenitis may develop without primary underlying obstruction. The parotid gland is typically affected:

Infectious-granulomatous sialadenitis

  • Tuberculosis – very rare; 75% involves the parotid gland, 25% the submandibular gland. More common is tuberculosis of the intraglandular lymph nodes.
  • Atypical mycobacterioses
  • Actinomycosis (radiation mycosis).
  • Syphilis (lues; venereal disease) – very rare, but must be excluded in granulomatous sialadenitis. Again, three out of four cases involve the parotid gland, and a quarter involve the submandibular gland.

Prevalence (disease incidence):

The most common chronic inflammation of the salivary glands is Küttner’s tumor (34%) of the submandibular gland. This is followed by sialolithiasis (22 %), which in turn affects the submandibular gland in four out of five cases, while only 10 to 20 % of stone tumors are found in the parotid gland. The submandibular gland accounts for less than 10%. Salivary stones occur with a frequency of 1.2% in the population of Germany, but only about 10% of stones cause symptoms. The prevalence of Sjögren’s syndrome is 0.1-4 % of the population. It is second only to rheumatoid arthritis (chronic polyarthritis, CP; chronic inflammatory multisystem disease that usually manifests as synovitis (inflammation of the synovial membrane)) in the frequency of so-called collagen diseases.