Salivary Gland Inflammation (Sialadenitis): Symptoms, Complaints, Signs

The following symptoms and complaints may indicate sialadenitis (salivary gland inflammation):

Viral sialadenitis

Parotitis epidemica (mumps).

  • Mumps affects both parotids (parotid glands) in the form of glandular swelling in about two-thirds of all cases.
  • The maximum swelling is reached between the second and third day. After one to two weeks, the swelling gradually subsides.
  • Low-grade painful swelling in the parotid region with lockjaw suggest parotitis epidemica.
  • In 10 to 15% of cases, the glandulae submandibulares (submandibular gland) and sublinguales (sublingual gland) are also involved.
  • Half of the diseases asymptomatic or subclinical.
  • Associated symptoms: Fever, headache, sore throat and edema of the eyelids and ear canal.

Cytomegalovirus sialadenitis

  • In prenatal (before birth) infection sialadenal fetopathy (disease of the fetus), swelling of the major salivary glands accompanied by Morbus haemolyticus neonatorum.
  • In postnatal (after birth) infection salivary gland swelling in more than 10% of cases.
  • Adult cytomegaly often develops in poor immune response; lymphadenopathy (lymph node enlargement), fever episodes and thrombocytopenia as leukopenia (abnormal decrease in platelets/platelets and lymphocytes/white blood cells) are possible.

Coxsackie A virus disease

  • Triad: parotitis (parotid gland inflammation), gingivitis (gum inflammation), herpangina (infectious disease of the lymphatic pharyngeal ring).
  • Many times epidemic-like occurrence
  • Mild course of the disease for about 8 days

HI viral disease (HIV salivary gland desease).

  • Salivary glands quite often symmetrically enlarged (HIV salivary gland desease).
  • Severe xerostomia (dry mouth) in AIDS.

Acute bacterial sialadenitis

  • A prerequisite for the development of acute nonspecific bacterial sialadenitis is hyposialia (decreased salivary secretion).
  • Symptoms of acute bacterial sialadenitis:
    • Painful swelling in the area of the gland.
    • Redness of the skin
    • Swelling and redness of the excretory duct
    • Usually only unilateral infection
    • Sometimes putrid (purulent), flocculent and no longer clear saliva.
  • Affects the parotid gland after major surgery, such as laparotomy: postoperative parotitis. Parotitis can lead to fistula formation and spread to the pterygopalatine fossa or ear canal. The function of the facial nerve is mostly preserved.
  • Localization in the submandibular gland is often due to superinfection of an outflow obstruction caused by stone formation: sialolithiasis (salivary stones).

Chronic sialadenitis

  • Obstructive electrolyte sialadenitis – sialolithiasis (salivary stone disease): from the obstruction (complete occlusion) underlying chronic recurrent sialadenitis results the symptomatology of food intake-dependent, intermittent and acutely painful enlargement. Ascending (ascending) bacterial superinfection (secondary infection) results in acute purulent episodes. Spontaneous concrement discharge is possible.
  • In about half of the cases of disease, the so-called Küttner tumor of the submandibular gland is associated with sialolithiasis. The gland is sclerosed in the final stage and thus tumor-like hardened, little painful and permanently swollen. Palpatory (by palpation) Küttner’s tumor is difficult to distinguish from a neoplasia (neoplasm).
  • Chronic recurrent parotitis usually presents with unilateral or alternating, but rarely bilateral, parotid swelling. Salivation is decreased, and the saliva itself is milky-cloudy, granular, or purulent. There is often lockjaw during the inflammatory episode. After several attacks, the parotid gland may be indurated (hardened) and reduced in size due to fibrotic remodeling and loss of function as a result.
  • The autoimmune disease pattern of Sjögren’s or Sicca syndrome shows chronic course.The sialopenia (reduced salivary flow) resulting from atrophy (regression) of the glandular parenchyma is so pronounced in Sjögren’s syndrome that distressing dry mouth may be present, resulting in infections of the oral mucosa and caries. The mucous membranes are dry to atrophic-glossy and may show sticky mucous debris and bark. The parotid gland is bilaterally doughy, diffusely and only slightly dolently swollen, and chronically enlarged in one-third of cases. In the final stage, there is glandular atrophy.
  • In Heerfordt’s syndrome (sarcoidosis of the salivary glands), the parotid gland is usually characterized bilaterally by a medium-dense, constant, painless swelling. Xerostomia (dry mouth) is not nearly as marked as in Sjögren’s syndrome. In addition to the glandular parenchyma, intraglandular (located in the glandular body) lymph nodes and small salivary glands may be involved.
    • Triad of Heerfordt syndrome:
      • Undulating (“undulating”) fever.
      • Uveitis (inflammation of the middle skin of the eye) with iridocyclitis (inflammation of the iris/rainbow skin and the ciliary body/ring-shaped part of the middle skin of the eye, which is responsible for the suspension of the lens and its accommodation)
      • Parotid swelling (inflammation of the parotid gland).

      occasionally: facial nerve paresis or recurrent nerve paresis

  • Radiogenic sialadenitis (radiation sialadenitis): radiation-induced salivary gland inflammation is characterized by immediately triggered acute mucositis (inflammation of the oral mucosa). The serous acini are damaged, and the ductal epithelium undergoes inflammatory changes. Apoptosis (controlled cell death) and fibrotic remodeling follow. One week after the start of radiotherapy, salivary flow is already reduced. After a few weeks, the acute inflammatory symptoms subside, leaving xerostomia (dry mouth) with greatly reduced, viscous saliva with decreased enzyme activity. Xerostomia carries the risk of caries, Candida albicans (fungus of the Candida group) and ascending (ascending) bacterial infections of the gland.

Specific sialadenitis

In a very rare, chronic course of tuberculosis of the salivary glands, mainly the intraglandular (“inside a gland”) lymph nodes are affected, less the gland parenchyma itself. The chronic course of sialadenitis is also shown by a rarely occurring actinomycosis (radiation mycosis) of the salivary glands. It is characterized by a hard, painless swelling and typical reddish-livid skin discoloration in the area of the parotid gland or the submandibular gland, with secondary involvement of the glands. Pathognomonic (indicative of disease).

  • Parotitis: protruding earlobe in viral, purulent, or even autoimmune sialadenitis of the parotid gland.
  • Obstructive sialadenitis: swelling conditions associated with food intake.

Main symptoms

  • Pain
    • diffuse
      • Viral sialadenitis
    • strong
      • acute purulent sialadenitis
        • Parotitis: agonizing, dull, sometimes palpitating due to increase in pressure within the parotid capsule
    • Little painful: Sjögren’s or Sicca syndrome.
    • Depending on food intake
      • Obstructive (occlusion-related) sialadenitis
  • Swelling
    • acute
      • Acute bacterial sialadenitis
      • Concomitant parotid swelling in bacillary angiomatosis (cat scratch disease).
      • Viral sialadenitis
    • chronic
      • Sjögren’s or sicca syndrome
        • Partially severe swelling of the parotid gland
      • Heerfordt syndrome
      • Sialadenosis
      • Chronic sialadenitis
    • Both sides
      • viral sialadenitis
        • Parotitis epidemica with a few days delay.
        • Common in HIV
      • Acute bacterial sialadenitis
      • Sjögren’s or sicca syndrome
      • Sialadenosis
      • Sialolithiasis only in gangatypia
    • unilateral
      • Less frequently in viral sialadenitis
      • Acute bacterial sialadenitis
      • Chronic sialadenitis
      • Sialolithiasis
    • diffuse
      • Acute bacterial sialadenitis
    • Circumscribed
    • Collateral (Lat: con “together”; latus “side”; same side of body) cheek edema
      • Parotitis epidemica (mumps)
  • Skin redness
    • Parotitis epidemica
  • Papilledema
    • Acute bacterial sialadenitis
    • Sialolithiasis (salivary stones)
  • Abscess formation (tissue fusion).
    • If necessary, in acute bacterial sialadenitis.
  • Secretion disorder (reduced salivary secretion).
    • Parotitis epidemica
    • Strong in Sjögren’s syndrome or sicca syndrome.
    • Milder in Heerfordt syndrome
    • Obstructive (occlusion-related) sialadenitis
    • Radiogenic (radiation-induced) sialadenitis
    • Sialadenitis in AIDS
    • Drug-induced hyposialia
  • Salivary quality
    • increased viscosity
      • In radiogenic sialadenitis
      • To sticky in Sjögren’s or sicca syndrome.
    • cloudy-purulent
      • In acute bacterial sialadenitis
    • Clear
      • For viral sialadenitis
  • Jaw Clamp
    • In chronic recurrent parotitis in the interval.
    • Moderately in parotitis epidemica
  • Earache
    • In case of parotitis epidemica

Secondary symptoms

  • General feeling of illness
    • In viral sialadenitis
  • Anorexia (loss of appetite)
    • In parotitis epidemica
  • Cephalgia (headache)
    • In parotitis epidemica
  • Fever
    • Partly considerable in parotitis epidemica
    • Febrile episodes in cytomegaly
  • Gingivitis (inflammation of the gums)
    • In Coxsackie viral disease
  • Herpangina (infectious disease of the lymphatic pharyngeal ring).
    • In Coxsackie viral disease
  • Rheumatic complaints
    • In Sjögren’s syndrome
  • Sore throat
    • For parotitis epidemica
    • Difficulty swallowing in cytomegaly
  • Lymphadenopathy (lymph node enlargement).
    • In cytomegaly
  • Mastitis (inflammation of the mammary glands)
    • For parotitis epidemica
  • Meningitis (meningitis)/meningoencephalitis (combined inflammation of the meninges (meningitis) and the brain (encephalitis)).
    • In parotitis epidemica (mumps).
  • Earache
    • In case of parotitis epidemica
  • Ocular (“eye-related”) symptomatology (secretory disorder of the lacrimal glands).
    • In Sjögren’s or Sicca syndrome.
  • Orchitis (inflammation of the testicles)
    • In parotitis epidemica especially when the disease occurs after puberty.
  • Oophoritis (ovarian inflammation).
    • In parotitis epidemica (mumps).
  • Pancreatitis (inflammation of the pancreas).
    • In parotitis epidemica

Warning signs (red flags)

  • In Sjögren’s syndrome, high incidence (frequency of new cases) of non-Hodgkin’s lymphoma (cancer of the lymph glands).
  • In sicca symptomatology (symptomatology of dry eyes and/or a dry mouth) possibility of:
    • Rheumatoid disease / collagenosis
    • Hepatitis C infection
    • HIV infection
    • Primary biliary cholangitis (PBC, synonyms: nonpurulent destructive cholangitis; formerly: primary biliary cirrhosis) – relatively rare autoimmune liver disease that originates in the intrahepatic (“inside the liver”) bile ducts and is associated with inflammation; in the longer course, inflammation spreads to all liver tissue and eventually leads to scarring and even cirrhosis; 90% of cases involve the womanDetection of antimitochondrial antibodies (AMA); PBC is often associated with autoimmune diseases (autoimmune thyroiditis, polymyositis, systemic lupus erythematosus (SLE), progressive systemic sclerosis, rheumatoid arthritis); associated with ulcerative colitis in 80% of cases; long-term risk of cholangiocellular carcinoma is 7-15%.
  • In the case of secretory disturbance exclusion of a neoplastic event.
  • In the case of purulent parotitis risk of parotid gland infection
  • Paresis/paralysis of facial nerve (partial paresis of individual branches) in cases of deep inflammatory infiltration of the parotid gland