Salivary Gland Calculi/Sialadenitis

Salivary Gland Calculi/Sialadenitis is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Inflammation and/or infection involving one or more salivary gland
  • Sialolithiasis is the cause of ~90% of all obstructive salivary gland diseases.
  • Salivary obstruction is usually 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.
  • Can be acute or chronic
    • Types: infectious, obstructive (sialolithiasis), and autoimmune

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.
  • Sialadenitis occurs by recurrent inflammatory reactions that result in progressive acinar destruction with fibrous replacement and sialectasis.
  • Bacterial sialadenitis: Staphylococcus aureus, Streptococcus viridans, Streptococcus pyogenes, Haemophilus influenzae, Escherichia coli, Pseudomonas aeruginosa, and group B streptococci (neonates and prepubescent children)
  • Viral sialadenitis: mumps, cytomegalovirus (CMV), Epstein-Barr virus (EBV), HIV, and enteroviruses

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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