Acute Salivary Gland Disorders Flashcards
1
Q
Sialadenitis
A
etiology:
- acute bacterial sialadenitis most commonly affects either the parotid or submandibular gland (parotid > submandibular or sublingual)
- ductal obstruction, often by inspissated (thickened) mucous plug, is followed by salivary stasis and secondary infection
- most common organism recovered from purulent drainage = Staph aureus
epidemiology:
- often occurs in the setting of dehydration or in ass w/ chronic illness
- dehydrated! (post-op, debilitated, DM, anti-histamines)
- underlying Sjögren syndrome (autoimmune disease that causes dryness) may contribute
S/O:
- presents w/ acute swelling of gland, increased pain and swelling with meals, and tenderness and erythema of duct opening
- pus often can be massaged from the duct
A:
- DDX: Mumps, HIV
- also CMV, lymphoma, other neoplasms
- US or CT may be helpful in est DX
P/TX:
- if suppurative - abx: dicloxacillin, amox-clavulanic acid (Augmenin), cefuroxime (Ceftin)
- REHYDRATE
- measures to increase salivary flow, including hydration, warm compresses, sialagogues (ie lemon drops), and massage of the gland
- tx can usually be switched to oral agent based on clinical and microbio improvement to complete a 10 day tx course
- more severe may require IV abx
- complete resolution of parotid swelling and pain can take 2-3 weeks
- failure to improve and ultimately resolve on this tx suggests abscess formation, ductal stricture, stone, or tumor causing obstruction
- suppurative sialadenitis (severe and potentially life-threatening form) may develop in acute illness
- Staph aureus is usually causative organism, but no pus will drain from Stensen’s papilla
- these pts often do not respond to rehydration and IV abx and thus may require operative
