Salivary Gland Calculi/Sialadenitis

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Basics

Description

  • Inflammation or infection involving one or more salivary glands, most frequently involving the parotid, submandibular or sublingual glands.
  • Can be acute, chronic, or acute on chronic in presentation. Depending on the number of glands involved, it may be characterized as unifocal or multifocal.
  • Common types include infectious, obstructive (sialolithiasis), and autoimmune.
  • Sialolithiasis is the cause of ~90% of all obstructive salivary gland diseases and is characterized by a painful swelling of the affected gland when eating, known as “mealtime syndrome.”
  • The submandibular gland is more commonly affected (80–90% of cases) by sialolithiasis and infection than the parotid gland. Submandibular stones occur more commonly due to higher mucinous content of saliva, longer course of Wharton duct, slow salivary flow, and saliva flow against gravity.

Epidemiology

Incidence
  • Predominant age: Peak incidence is 30 to 60 years.
  • Most common in debilitated and dehydrated patients.
  • 49% men and 51% women, average age 47.5 years; 82% submandibular stones and 18% parotid stones; 44% had a positive smoking history, and 20% of patients were taking diuretics.

Prevalence
  • Salivary calculi can be found in 1.2% of the adult population.
  • Only 5% of all cases occur in the pediatric population.
  • In those with sialographic evidence of benign intraductal obstruction, the obstruction is caused by salivary calculi in >73% of cases.

Etiology and Pathophysiology

  • Decreased salivary outflow from anticholinergics, dehydration, or radiation is thought to allow bacterial infection of salivary glands.
  • Salivary calculi form by deposition of calcium phosphate. Predisposing factors include salivary stasis, retrograde bacterial contamination from the oral cavity, increased alkalinity of saliva, and physical trauma to salivary duct or gland.
  • Gout is a systemic disease known to be associated with salivary stone development. In gout, sialoliths are composed of uric acid.
  • Bacterial sialadenitis tends to be unifocal and is commonly caused by Staphylococcus aureus, Streptococcus viridans, Streptococcus pyogenes, Haemophilus influenzae, Escherichia coli, Pseudomonas aeruginosa, and group B streptococci (neonates and prepubescent children).
  • Viral sialadenitis tends to be multifocal and is commonly caused by mumps, cytomegalovirus (CMV), Epstein-Barr virus (EBV), HIV, and enteroviruses.
  • Other common causes include radioiodine use, positive pressure ventilation use with anesthesia, Sjögren syndrome, and sarcoidosis.

Pediatric Considerations
The two most common causes of sialadenitis in children are mumps and idiopathic juvenile recurrent parotitis.

Genetics
Polygenic cause, with several loci under investigation

Risk Factors

  • Dehydration
  • Anticholinergic use
  • Antihistamine use
  • Diuretic use
  • Poor oral hygiene
  • Malnutrition
  • Head/neck radiation
  • Tuberculosis (TB)
  • HIV
  • Failure to immunize (mumps)
  • Gout
  • Diabetes mellitus
  • Hypothyroidism
  • Renal failure
  • Duct strictures
  • Previous intraoral procedures

General Prevention

  • Adequate hydration
  • Maintain proper oral care and hygiene.
  • Avoid antihistamines, anticholinergics, and other causes of xerostomia, especially if other risk factors are present.

Commonly Associated Conditions

  • Postoperative dehydration
  • Radiation-induced xerostomia
  • Drug-induced xerostomia
  • Sjögren syndrome
  • Hypercalcemia

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Basics

Description

  • Inflammation or infection involving one or more salivary glands, most frequently involving the parotid, submandibular or sublingual glands.
  • Can be acute, chronic, or acute on chronic in presentation. Depending on the number of glands involved, it may be characterized as unifocal or multifocal.
  • Common types include infectious, obstructive (sialolithiasis), and autoimmune.
  • Sialolithiasis is the cause of ~90% of all obstructive salivary gland diseases and is characterized by a painful swelling of the affected gland when eating, known as “mealtime syndrome.”
  • The submandibular gland is more commonly affected (80–90% of cases) by sialolithiasis and infection than the parotid gland. Submandibular stones occur more commonly due to higher mucinous content of saliva, longer course of Wharton duct, slow salivary flow, and saliva flow against gravity.

Epidemiology

Incidence
  • Predominant age: Peak incidence is 30 to 60 years.
  • Most common in debilitated and dehydrated patients.
  • 49% men and 51% women, average age 47.5 years; 82% submandibular stones and 18% parotid stones; 44% had a positive smoking history, and 20% of patients were taking diuretics.

Prevalence
  • Salivary calculi can be found in 1.2% of the adult population.
  • Only 5% of all cases occur in the pediatric population.
  • In those with sialographic evidence of benign intraductal obstruction, the obstruction is caused by salivary calculi in >73% of cases.

Etiology and Pathophysiology

  • Decreased salivary outflow from anticholinergics, dehydration, or radiation is thought to allow bacterial infection of salivary glands.
  • Salivary calculi form by deposition of calcium phosphate. Predisposing factors include salivary stasis, retrograde bacterial contamination from the oral cavity, increased alkalinity of saliva, and physical trauma to salivary duct or gland.
  • Gout is a systemic disease known to be associated with salivary stone development. In gout, sialoliths are composed of uric acid.
  • Bacterial sialadenitis tends to be unifocal and is commonly caused by Staphylococcus aureus, Streptococcus viridans, Streptococcus pyogenes, Haemophilus influenzae, Escherichia coli, Pseudomonas aeruginosa, and group B streptococci (neonates and prepubescent children).
  • Viral sialadenitis tends to be multifocal and is commonly caused by mumps, cytomegalovirus (CMV), Epstein-Barr virus (EBV), HIV, and enteroviruses.
  • Other common causes include radioiodine use, positive pressure ventilation use with anesthesia, Sjögren syndrome, and sarcoidosis.

Pediatric Considerations
The two most common causes of sialadenitis in children are mumps and idiopathic juvenile recurrent parotitis.

Genetics
Polygenic cause, with several loci under investigation

Risk Factors

  • Dehydration
  • Anticholinergic use
  • Antihistamine use
  • Diuretic use
  • Poor oral hygiene
  • Malnutrition
  • Head/neck radiation
  • Tuberculosis (TB)
  • HIV
  • Failure to immunize (mumps)
  • Gout
  • Diabetes mellitus
  • Hypothyroidism
  • Renal failure
  • Duct strictures
  • Previous intraoral procedures

General Prevention

  • Adequate hydration
  • Maintain proper oral care and hygiene.
  • Avoid antihistamines, anticholinergics, and other causes of xerostomia, especially if other risk factors are present.

Commonly Associated Conditions

  • Postoperative dehydration
  • Radiation-induced xerostomia
  • Drug-induced xerostomia
  • Sjögren syndrome
  • Hypercalcemia

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