Sialadenitis

Sialadenitis, an inflammation of the salivary glands, represents a significant concern in otolaryngology. This condition can manifest acutely or chronically, affecting patients' quality of life through pain, swelling, and potential complications. Understanding the etiology, symptomatology, diagnostic measures, and treatment options is crucial for effective management.

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Causes of Sialadenitis

Sialadenitis can be triggered by various factors, primarily bacterial or viral infections. The most common bacterial cause is Staphylococcus aureus, although Streptococcus species and anaerobic bacteria are also implicated. Viral etiologies include mumps, influenza, and coxsackievirus. Additionally, autoimmune disorders such as Sjögren's syndrome, ductal obstructions from sialolithiasis (salivary stones), and reduced salivary flow due to dehydration or medications can precipitate this condition.

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Types of Sialadenitis

Acute Sialadenitis

Acute sialadenitis is typically sudden in onset, presenting with rapid glandular swelling, erythema, and severe pain. It predominantly affects the parotid gland and is often associated with systemic symptoms such as fever and malaise. This type necessitates prompt medical intervention to prevent abscess formation and systemic spread of infection.

Chronic Sialadenitis

Chronic sialadenitis, on the other hand, is characterized by recurrent or persistent glandular swelling and discomfort, often exacerbated by meals. The submandibular gland is most frequently affected. Chronic cases may evolve from untreated or inadequately managed acute sialadenitis and are often complicated by ductal strictures or recurrent infections.

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Symptoms of Sialadenitis

The clinical presentation of sialadenitis includes localized pain, swelling of the affected gland, and tenderness. Patients may experience purulent discharge from the ductal orifice, trismus, and dysphagia. In severe cases, systemic symptoms such as fever, chills, and general malaise may be evident, necessitating a thorough clinical evaluation.

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Diagnosis of Sialadenitis

The diagnostic approach to sialadenitis involves a combination of clinical assessment and imaging techniques. Ultrasonography is the first-line imaging modality, offering detailed visualization of glandular and ductal architecture. In cases where the diagnosis remains uncertain, sialography or magnetic resonance sialography (MR sialography) can provide additional insights. Laboratory tests, including complete blood count (CBC) and culture of purulent discharge, aid in identifying the causative pathogen and guiding antibiotic therapy.

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Treatment Options for Sialadenitis

Medical Management

The cornerstone of sialadenitis treatment is the administration of appropriate antibiotics, guided by culture results. Empirical therapy typically involves agents effective against Staphylococcus aureus, such as dicloxacillin or cephalexin. Hydration, sialogogues (agents that stimulate saliva flow), and warm compresses are supportive measures that alleviate symptoms and promote drainage.

Surgical Intervention

In refractory cases or when complications arise, surgical intervention may be warranted. Procedures such as ductal dilation, sialendoscopy, or gland excision are considered based on the severity and underlying cause of the condition. Sialendoscopy, a minimally invasive technique, allows for direct visualization and treatment of ductal obstructions and strictures.