The paired salivary glands, especially the three large ones on both sides of the ears, under the tongue and on the lower jaw, fulfil numerous tasks in our everyday life. They moisturize the mouth and play a major role in food intake, speaking and cleaning, as well as protecting the oral mucosa from bacteria and viruses. Like any other organ, the salivary glands can also become inflamed.
In technical terms, this disease is called sialadenitis. “Sial” is the Greek translation for saliva, “Aden” for gland and the ending -itis describes the inflammation. The large salivary glands are most frequently affected by inflammation, and of these, the parotid glands (glandula parotis) are the ones most likely to be affected.
An inflammation of the parotid gland in particular is known as parotitis, based on its technical name. As a rule, only one of the paired salivary glands becomes inflamed. In about 20% of those affected, inflammation of both glands can be observed.
Epidemiology
The most frequent cases of salivary gland inflammation occur between the ages of 20 and 50. However, there are two exceptions that stand out from the age spectrum. One is mumps, colloquially known as mumps, probably the best known viral salivary gland inflammation, which occurs mainly in childhood, and the other is a purulent, bacterial inflammation of the parotid glands, which usually affects people over 50 years of age.
A distinction is made between infectious and non-infectious causes of salivary gland inflammation. Infectious inflammation is caused by bacteria or viruses, although bacterial inflammation caused by staphylococci or streptococci, which can also occur in the mouth and throat area of healthy people, is more common. Non-infectious causes of salivary gland inflammation include autoimmune diseases, such as Sjögren’s syndrome, an inflammation resulting from irradiation of the head and neck area (radiation adenitis) or as a result of radioiodine therapy for thyroid adenomas.
Radiation or radioiodine therapy damages the mucous membrane, resulting in dry mouth with the consequences described above. Furthermore, acute forms are still distinguished from chronic forms. The acute forms appear within days or even suddenly and heal relatively quickly, especially under treatment.
It is mainly caused by bacteria and viruses. Thus, mumps, which is caused by the mumps virus and usually affects both parotid glands, is also included. Mumps is the most common viral-induced salivary gland inflammation and occurs mainly in childhood.
Other viruses as a cause are possible, but very rare. One speaks of a chronic form when salivary gland inflammation occurs repeatedly, often in relapses. This is usually observed in immunocompromised people or those who suffer from an autoimmune disease such as the Sjögren’s syndrome mentioned above.
In Sjögren’s syndrome, which mainly affects women over the age of 40, the body mistakenly produces antibodies that attack the salivary and lacrimal glands. As a result, those affected suffer from dry eyes and mouth, pain and inflammation of the saliva. In this case, the parotid glands are particularly affected by the latter.
This disease usually occurs in combination with other rheumatic complaints. One of the most significant risk factors for the development of salivary gland inflammation is the decrease in oral moisture due to reduced saliva production. As already mentioned, saliva cleans the oral mucosa and thus protects it from bacterial colonization.
If the mouth remains dry for a long time, bacteria and viruses can multiply and infect the salivary gland tissue via the glandular ducts that end in the oral cavity. This leads to salivary gland inflammation. Elderly people in particular suffer from xerostomia (dry mouth), as the feeling of hunger and thirst decreases with age.
Less fluid is consumed and subsequently less saliva is produced. In addition, there are numerous drugs, such as water tablets (diuretics), those for heart complaints (beta blockers, calcium antagonists) and antidepressants, which are prescribed mainly for older people and promote a dry mouth by inhibiting the production of saliva. Also stimulants, especially the excessive consumption of alcoholic beverages, lead to a decrease in saliva production.
Another important risk factor for the development of salivary gland inflammation is salivary stones.They develop particularly in the glandular ducts of the salivary glands in the lower jaw (Glandula submandibularis; Glandula = gland). The salivary stones are able to constrict or even block the duct through which saliva passes from the glandular tissue into the oral cavity. On the one hand, the resulting dryness of the mouth favors the colonization of germs in the oral cavity; on the other hand, the saliva accumulated behind the salivary gland stone forms an ideal breeding ground for the multiplication of these germs, which can subsequently result in inflammation of the salivary gland.
The main components of salivary stones, known as sialolites, are calcium phosphate and calcium carbonate. Both are found in teeth and bones. The formation of sialoliths is promoted by a changed salivary composition in the context of metabolic diseases or after inflammation and/or a narrowed glandular duct, among other things after mumps disease in childhood or in the context of cystic fibrosis.
However, it is important to know that not every salivary stone directly causes salivary gland inflammation. As already mentioned, almost all stones develop in the area of the mandibular salivary glands. However, this area is hardly affected by inflammation, in contrast to the parotid glands, in whose glandular ducts only about 2 of 10 stones are formed.
Nevertheless, a known stone should be observed in order to avoid worse consequences or to be able to contain them in time. In each case, poor oral hygiene accelerates the inflammatory process, since the bacteria and/or viruses do not have to colonize the oral cavity first. In Heerfordt’s syndrome, which is mainly observed in young women and, like Sjögren’s syndrome, is an autoimmune disease, there is also antibody induced destruction of glandular tissue of the lacrimal and parotid glands.
The symptoms are similar to those of Sjögren’s syndrome. Women with Heerfordt syndrome often suffer additionally from sarcoidosis. Recurrent salivary gland inflammation can also occur in the context of tumors in the area of the salivary glands and glandular ducts that constrict or completely close the excretory ducts.
Mumps is the most common viral-induced salivary gland inflammation, more precisely that of the parotid glands in children and adolescents, and is caused by the so-called paramyxo virus. Colloquially, the disease is also known as mumps because the swelling of the inflamed parotid glands causes the ears to protrude forward during the disease. The infection is caused by germs in the air.
A sick person excretes tiny droplets, called aerosols, for example when speaking, sneezing and coughing. These aerosols contain the virus, which can eventually infect other children through inhalation. For this reason, sick children should stay at home; on the one hand to take it easy on themselves, on the other hand not to infect other children with mumps.
The dangerous thing about the mumps virus is that not only children who already have symptoms are contagious, but also children who have already had symptoms, because the affected child excretes the virus approximately one week before symptoms occur and one week after they have subsided. The virus usually attacks and infects both parotid glands. Once the virus has entered a previously healthy body, it takes some time to multiply and settle.
This time is called the incubation period. With the mumps virus it is two to four weeks. In the beginning, the children appear tired and weak, as with other viral infections.
They also have no appetite. In the course of the disease, the parotid glands swell in most children and are enlarged and painfully palpable. In the course of the disease, a slight increase in temperature may occur in the sick child.
However, there are also a smaller number of children who are also infected with mumps and do not show any symptoms or feeling of illness. Since mumps is caused by a virus, the only sensible therapy is one that alleviates the child’s symptoms and the symptoms of the disease. Unfortunately, there is no therapy that specifically attacks and destroys the virus.
Symptomatic therapy includes cold compresses wrapped around the head along the inflamed parotid glands. Fever and pain can be reduced with the help of medication. However, it is still advisable to consult a doctor for a detailed clarification of the further therapy.
The disease heals without consequences within seven to fourteen days. Once an infection has been passed through, there is lifelong immunity, which also explains why the peak age of the disease is in childhood and adolescence.Acute and chronic forms of salivary gland inflammation also differ in some symptoms. Those affected by acute sialadenitis often complain of sudden, unilateral swelling of the salivary glands, often with pressure pain.
The infected gland feels rough to hard when touched. The overlying skin may be overheated due to the inflammation and appear red. There is often a marked swelling of the face.
If the acute salivary gland inflammation is bacterial in origin, pus may be discharged into the oral cavity. In the case of viral salivary gland inflammation, both sides are often affected; in the case of bacterial inflammation, one side is usually affected. In contrast to bacterial inflammation, not a purulent but a watery secretion is produced.
When eating and chewing, the pain can increase because the salivary glands work more during food intake and produce more saliva to moisten and utilize the food and transport it into the oral cavity. As the inflamed tissue swells and hinders the outflow of saliva, this exerts additional pressure on the already sensitive salivary gland, which subsequently causes it to swell even more and cause even more pain. Some sufferers suffer from such severe pain that they find it difficult to open their mouth or swallow.
The corresponding muscles are located in the immediate vicinity of the glands and irritate the inflamed salivary gland tissue when they move. The body reacts to the inflammation with fever. Surrounding lymph nodes can also swell as a result of the salivary gland inflammation and can be confused with it on palpation.
By preparing a blood count and evaluating inflammation parameters, such as the number of white blood cells, the treating physician can find indications of the presence of an inflammation. A chronic inflammation of the salivary glands can last for several weeks. In contrast to the acute form, the onset is not sudden, but is characterized by a gradual worsening of the symptoms over weeks.
In addition, a relapsing occurrence of salivary gland inflammation is typical of a chronic form. Once the chronic inflammation has reached its peak, the affected salivary gland is also painful and hardened palpably. It occasionally secretes milky, granular secretions, which may also contain pus.
The chronic inflammation of the salivary glands usually occurs on one side, but can change sides from relapse to relapse. If a salivary stone is the cause of the disease, it can occasionally be felt in the glandular duct as a hardening, depending on its size. If a swollen, enlarged salivary gland is palpated, it is important to consult a physician and discuss the further procedure with him.
If you wait too long and the cause of the salivary gland inflammation is not properly counteracted, a serious complication can be an abscess, i.e. a purulent accumulation caused by the colonized bacteria. The danger of the abscess is that it can break into blood vessels and in the worst case scenario the bacteria can subsequently cause life-threatening blood poisoning. The doctor can usually make the diagnosis based on the clinical symptoms and in discussion with the person affected, or at least a suspicion about it.
Indicative of the presence of an inflammation of the glandular tissue of the salivary organs is a swelling and pressure pain in this area and an increase in discomfort when eating. Earlier irradiation of the head and neck area and the intake of certain medications, combined with the corresponding symptoms, can be an indication of the presence of an inflammation of the salivary glands. If the inflammation occurs repeatedly and the person affected also suffers from rheumatic diseases, this indicates a chronic form of inflammation to the doctor.
When inspecting the oral cavity, inflammatory changes can be seen in some patients, especially those with bacterial and viral salivary gland inflammation. If bacterial inflammation is suspected, the doctor will try to massage the pus out of the glandular tissue and duct system to confirm his suspicion. A smear test can be useful in the case of bacterial salivary gland inflammation in order to find out to which antibiotic the triggering pathogen responds so that a targeted therapy can be started.
If salivary stones are involved as triggers, they can be gently detected in an ultrasound examination. Tumors or possible abscesses can also be seen with the help of this diagnostic method.Rarely is imaging by means of MRI, CT or endoscopic examination of the salivary gland ducts using a small camera considered as a diagnostic tool. Indications for an endoscopic examination are the suspicion of an autoimmune disease as the triggering cause, since sample material can be obtained during the procedure and examined for this purpose. In addition, the glandular duct can be rinsed and freed from stones during the examination. The disadvantage of the examination is that it must be performed under local anesthesia.
