Sialadenitis

Classification according to ICD-10
K11.2	Sialadenitis
ICD-10 online (WHO version 2019)

A sialadenitis or salivary gland inflammation (also sialoadenitis from Greek σίαλον , sialon , saliva, ἀδεν , ADEN , gland and -ίτις , itis , inflammation) is an inflammation ( adenitis ) of the salivary glands .

A distinction must be made between infectious and non-infectious causes. Pain and swelling determine the clinical picture. The diagnosis can often be made at a glance. Treatment depends on the cause and can include antibiotics, surgery or symptom-oriented measures.

causes

Histological picture of chronic sialadenitis with lymphocyte infiltration and fibrosis

Acute purulent inflammation of the salivary glands ( acute salivary gland inflammation ) is often caused by bacteria such as staphylococci or streptococci . They are favored - mainly in the parotid gland - by reduced salivation or - mainly in the submandibular gland - by salivary stones (sialolithiasis).

Viral pathogens of a salivary gland inflammation are among others the mumps virus (causative agent of mumps ), the influenza virus , the coxsackie virus and the cytomegalovirus .

A radiation- induced inflammation can at a radiotherapy in the head and neck region or a radioiodine occur.

Certain autoimmune diseases such as Sjogren's syndrome can cause inflammation of the salivary glands. Often, in chronic recurrent parotitis, no cause can be identified. (Chronic parotitis was observed with gout , uremia and some poisonings (mercury, iodine, copper, lead) and as a partial symptom of Sjogren's syndrome).

Clinical manifestations

Typically there is swelling of the affected glands, which is also painful. Depending on the cause, there are also general symptoms, such as a general feeling of illness or fever .

In the case of salivary stones or chronic, recurrent inflammation, the patient's symptoms are often one-sided, with mumps or Sjögren's syndrome they are usually bilateral.

Investigation methods and findings

Sialography for suspected Sjogren's syndrome .

The diagnosis can often be made at the first glance at the patient ("eye diagnosis").

In the area of the mouth of the duct of the affected gland in the oral mucosa, there is often swelling and reddening. Evacuating pus indicates bacterial inflammation, clear secretion indicates viral inflammation.

The sonography can support the diagnosis in uncertain cases. The sialography can provide valuable information for the differential diagnosis in chronic courses . Chronic recurrent sialadenitis looks like a “leafy tree”. In contrast, many gland ducts are destroyed (“rarefied”) in Sjögren's syndrome, resulting in the image of a “defoliated tree”. Sialography is contraindicated in acute salivary gland inflammation .

treatment

Treatment depends on the cause. Antibiotics are given if there is a bacterial infection . Occasionally, an abscess split and drainage is necessary. In the case of viral inflammation, treatment is given symptomatically (moist compresses, pasty food).

Acute sialadenitis that occurs during radioiodine therapy can usually be relieved well with cooling and anti-inflammatory drugs such as nonsteroidal anti-inflammatory drugs or glucocorticoids . However, the symptoms subside within a few days even without treatment.

In Sjogren's syndrome, the focus is on treating the underlying disease. The dry mouth that occurs with this disease and with radiation-related sialadenitis is alleviated with artificial saliva.

In the case of severe, chronically recurrent courses, it may be necessary to remove the affected salivary gland (sialadenectomy, e.g. parotidectomy ).

In the case of a blocked salivary stone in one of the ducts of a salivary gland, the duct can be expanded with a simple operation. The stone is mostly washed away. In most cases, the passage is cut with scissors. It is also recommended to drink a lot and, if necessary, to chew chewing gum so that the flow of saliva is stimulated.

Prospect of healing

The viral inflammation of the salivary glands heals as the infection is overcome. However, complications can occur, especially with mumps (see Mumps # Complications ).

Chronic recurrent sialadenitis often heals after puberty .

literature

Sialadenitis. In: Netters general medicine. Edited by Thomas Böttcher and Martin Kortenhaus. Stuttgart 2006 ISBN 3-13-135881-5 p. 1268
S2k guideline for obstructive sialadenitis of the German Society for Ear, Nose and Throat Medicine, Head and Neck Surgery. In: AWMF online (as of 2013)

Individual evidence

^ ^A ^b F. Grünwald, C. Menzel. Radioiodine therapy. In: T. Kuwert, F. Grünwald, U. Haberkorn, T. Krause: Nuclear medicine. Stuttgart, New York 2008, ISBN 978-3-13-118504-4 .
↑ Hans Adolf Kühn: Diseases of the salivary glands. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid 1961, p. 750 ( inflammation of the salivary glands ).

[Grünwald-1] A ^b F. Grünwald, C. Menzel. Radioiodine therapy. In: T. Kuwert, F. Grünwald, U. Haberkorn, T. Krause: Nuclear medicine. Stuttgart, New York 2008, ISBN 978-3-13-118504-4 .

[2] Hans Adolf Kühn: Diseases of the salivary glands. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid 1961, p. 750 ( inflammation of the salivary glands ).