Salivary Gland Calculi/Sialadenitis

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Basics

Description

  • Inflammation of one or more salivary glands
  • Infectious, obstructive, or autoimmune.
  • “Sialolithiasis” is characterized by a painful swelling of the affected gland when eating due to an obstructing stones within the salivary glands or ducts.
  • “Sialadenitis” is inflammation of the salivary gland classified as acute or chronic sialadenitis.
    • Acute can be caused by a primary infection (viral/bacterial) or secondary infection.
    • Chronic sialadenitis is due to repeated episodes of inflammation resulting in progressive loss of salivary gland function.
  • Parotid gland and submandibular glands are commonly affected by sialadenitis. However, parotid gland is affected mostly by acute suppurative sialadenitis. The submandibular gland is more commonly affected (80–90% of cases) by stones than the parotid gland due to higher mucinous content of saliva, longer course of Wharton duct, and slow salivary flow against gravity.

Epidemiology

Incidence

  • Peak incidence is 30 to 60 years; rarely in children
  • Most common in debilitated and dehydrated patients
  • 70% of the stones are single; 30% bilateral

Etiology and Pathophysiology

  • Stagnation of salivary flow and elevated calcium concentrations are thought to be important.
  • Decreased salivary outflow from anticholinergics, dehydration, or radiation
  • Salivary calculi are composed of calcium phosphate and hydroxyapatite with smaller amounts of magnesium, potassium, and ammonium.
  • Predisposing factors include inflammation of the salivary gland or duct, salivary stasis, retrograde bacterial contamination from the oral cavity, increased alkalinity of saliva, and physical trauma to salivary duct or gland.
  • Gout associated with salivary stone development. In gout, sialoliths are composed of uric acid.
  • Bacterial sialadenitis tends to be unifocal caused by Staphylococcus aureus, Streptococcus viridans, Streptococcus pyogenes, Haemophilus influenzae, Escherichia coli, Pseudomonas aeruginosa, and group B streptococci (neonates and children).
  • Viral sialadenitis tends to be multifocal caused by mumps, cytomegalovirus, Epstein-Barr virus, HIV, and enteroviruses.
  • Other common causes include radioiodine use, positive pressure ventilation use with anesthesia, Sjögren syndrome, and sarcoidosis (1).

Pediatric Considerations
Common causes of sialadenitis in children are mumps and idiopathic juvenile recurrent parotitis.

Risk Factors

  • Anticholinergic use
  • Poor oral hygiene, malnutrition, smoking, dehydration
  • Head/neck radiation

General Prevention

  • Maintain proper oral care and hygiene.
  • Avoid anticholinergics and other causes of xerostomia.

Commonly Associated Conditions

  • Radiation or drug-induced xerostomia
  • Sjögren syndrome, Mikulicz syndrome
  • Hypercalcemia

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Basics

Description

  • Inflammation of one or more salivary glands
  • Infectious, obstructive, or autoimmune.
  • “Sialolithiasis” is characterized by a painful swelling of the affected gland when eating due to an obstructing stones within the salivary glands or ducts.
  • “Sialadenitis” is inflammation of the salivary gland classified as acute or chronic sialadenitis.
    • Acute can be caused by a primary infection (viral/bacterial) or secondary infection.
    • Chronic sialadenitis is due to repeated episodes of inflammation resulting in progressive loss of salivary gland function.
  • Parotid gland and submandibular glands are commonly affected by sialadenitis. However, parotid gland is affected mostly by acute suppurative sialadenitis. The submandibular gland is more commonly affected (80–90% of cases) by stones than the parotid gland due to higher mucinous content of saliva, longer course of Wharton duct, and slow salivary flow against gravity.

Epidemiology

Incidence

  • Peak incidence is 30 to 60 years; rarely in children
  • Most common in debilitated and dehydrated patients
  • 70% of the stones are single; 30% bilateral

Etiology and Pathophysiology

  • Stagnation of salivary flow and elevated calcium concentrations are thought to be important.
  • Decreased salivary outflow from anticholinergics, dehydration, or radiation
  • Salivary calculi are composed of calcium phosphate and hydroxyapatite with smaller amounts of magnesium, potassium, and ammonium.
  • Predisposing factors include inflammation of the salivary gland or duct, salivary stasis, retrograde bacterial contamination from the oral cavity, increased alkalinity of saliva, and physical trauma to salivary duct or gland.
  • Gout associated with salivary stone development. In gout, sialoliths are composed of uric acid.
  • Bacterial sialadenitis tends to be unifocal caused by Staphylococcus aureus, Streptococcus viridans, Streptococcus pyogenes, Haemophilus influenzae, Escherichia coli, Pseudomonas aeruginosa, and group B streptococci (neonates and children).
  • Viral sialadenitis tends to be multifocal caused by mumps, cytomegalovirus, Epstein-Barr virus, HIV, and enteroviruses.
  • Other common causes include radioiodine use, positive pressure ventilation use with anesthesia, Sjögren syndrome, and sarcoidosis (1).

Pediatric Considerations
Common causes of sialadenitis in children are mumps and idiopathic juvenile recurrent parotitis.

Risk Factors

  • Anticholinergic use
  • Poor oral hygiene, malnutrition, smoking, dehydration
  • Head/neck radiation

General Prevention

  • Maintain proper oral care and hygiene.
  • Avoid anticholinergics and other causes of xerostomia.

Commonly Associated Conditions

  • Radiation or drug-induced xerostomia
  • Sjögren syndrome, Mikulicz syndrome
  • Hypercalcemia

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