Salivary Glands

 

Sialoadenitis:  inflammation of salivary glands

Can be infection, tumor or systemic disease [Sjoegren’s syndrome, diabetes, Cushings, etc.]

 

Sialolithiasis:  calculi in salivary gland or its duct

 

parotid gland, submandibular, sublingual glands

 

Sialoadenitis:

 

Mumps: parotitis epidemica

Non-suppurative parotitis  [no pus]

viral

Parotid  70% bilateral involvement

            The other salivary glands may also be involved

Droplet infection and spread by saliva

Most often found in late winter and early spring

Most often ages 5 to 15, but can occur at any age

Under one year of age- normally immune

Onset: chills, headache, anorexia, malaise and low to moderate fever for 24 hours prior to salivary gland involvement [prodrome may be absent in mild cases]

Significant pain

Painful swallowing, especially sour or acidic

Gland is swollen and warm

Swelling extends from posterior to the pinna pushing it anteriorly

Fever- moderate  103-104 degrees for 24 to 72 hours

Chills, malaise Leukopenia

Reddened Stenson’s duct

 

Elevated mumps titer

Orchitis- complication for postpubertal males [20%]

            With eventual sterility due to atrophy of testes

Incubation: 7-24 days

Meningitis- complication

Pancreatitis- complication after 1 wk

            Sudden severe nausea and vomiting

Facial paresis- complication from swelling

 

 

 

 

Acute suppurative parotitis

Usually unilateral parotid involvement

Pain

Swollen and warm

High fever

Leukocytosis

Pus

Extreme prostration

Usually secondary to other infections

 

 

Painless parotid swelling

Not warm, no fever, no pus

Can be unilateral or bilateral

Typically due to systemic disease or tumor

            Sjoegren’s syndrome, sarcoidosis, diabetes mellitus, gout, hypothyroidism, Cushings

Requires extensive labwork

 

 

 

 

 

Sialolithiasis

 

The calculi are typically composed of Calcium carbonate or Calcium phospate [componenets of plaque] and is due to poor dental hygeine.

It is quite alarming and uncomfortable because saliva is produced while eating but the caluli blocks the duct.  Since the saliva cannot escape, it builds up and swelling occurs quickly.  Over a short period of time, the gland will return to normal size as the saliva will slowly make its was past the calculi.

Fever, pus and warth are not present.

This usually occurs unilaterally.

 

The origice of the involved duct is red and swollen.

It may be possible to palpate the calculi.

Advise the patient to improve dental hygiene and chew gun or drink smally amounts of lemon juice to increase salivation and naturally express the calculi.

If this does not work, express it like a pimple with gloved fingers, gently.

Concurrent management with a dentist may be needed.

 

 

 

Tumors of the salivary glands

Tumors of the salivary glands can be benign or malignant.  As with any mass, it should be evaluated for size, location, fixation [skin tethering], lobulation, tenderness, and consistency.  A benign tumor of these glands may remain benign for years and suddenly become malignant.  Once malignant, these are very aggressive tumors.  Once a benign tumor is noted, it should be check several times a year.

 

The parotid gland is diagnosed with the most tumors.

The sublingual gland is found to have the fewest tumors.

But…

Most of the tumors of the parotid gland are benign while most of the sublingual tumors are malignant.

 

Note:  if you have a patient with a history of a benign parotid gland tumor and now they appear with a facial palsy, Bell’s, suspect the tumor has become malignant.  When the tumor changed, it engulfed the facial nerve.

Note:  if a patient with a history of a benign salivary gland tumor presents with a suppurative infection in the area, suspect a change to a malignant state and that the infection is secondary!