What is sialadenitis? - Mr. Kevin Smith
Article by: Mr. Kevin Smith
MA(Cantab), MBBS, MRCS, FRACS(ORLHNS)
Dysfunction of the major salivary glands is common and causes significant morbidity when present.
Inflammation of the affected gland is termed sialadenitis and most common aetiologies include acute viral or bacterial infection, obstruction or autoimmune causes.
Acute non-obstructive sialadenitis is characterised by painful swelling and is generally self-limiting or improves with supportive care including analgesia, hydration, and antibiotics when indicated. Chronic obstruction is characterized by intermittent, recurrent episodes of peri prandial tender swelling best known as the “meal-time syndrome”.
What causes sialadenitis?
Sialolithiasis (salivary calculi) is the most common cause of obstructive salivary disease, being present in 60-80% of cases, and involved in approximately 50% of major salivary gland disease. This condition is more frequent in males, with incidence peaking between the age of 30 and 60 years, and usually affects the submandibular gland. However, other causes include ductal stricture and stenosis, mucus plugging, or intraductal polyps and affect the parotid gland more often.
What treatments are available?
The mainstay of traditional surgery has been open or transoral stone extraction, or removal of the affected gland which carries the risk of nerve injuries, persistence of symptoms due to stones retained in the remaining duct, and poor cosmetic outcomes. The main complication after parotidectomy for obstructive salivary disorders is temporary (15-38%) or permanent (1-9%) facial nerve palsy; although sialocoele, salivary fistula and Frey’s syndrome are all reported. After submandibular gland excision there is a 1-8% of permanent marginal mandibular nerve palsy, and a 1-5% risk of lingual nerve injury.
What are the advantages of sialoendoscopy?
Sialoendoscopy is a minimally-invasive technique established over the last 15 years as an alternative to gland removal or open incisional procedures for stone removal. Sialoendoscopy is performed as a day-stay procedure and permits glandular preservation in 80-85% of patients with stone disease. Not only is it a diagnostic procedure capable of identifying pathology below the resolution limits of current imaging techniques, but also opens up an array of therapeutic options.
Advances in optical technology have permitted the development of precision 0.7 - 1.6mm endoscopes capable of navigating the narrow salivary ductal systems, and deploying fine graspers and mini-forceps, stone removing baskets or dilating instruments. For larger stones, combined approach surgery with targeted incisions at the site of disease is facilitated, minimizing nerve injury and recurrence. Ductal lavage, steroid instillation, or stent placement have also created therapeutic options in patients with Sjogren’s or radioiodine-induced sialadenitis for whom previously no effective treatments existed.
MercyAscot Salivary Pathology Clinic
Patients referred for the investigation of suspected salivary gland pathology complete a Chronic Obstructive Sialadenitis Symptoms (COSS) questionnaire and undergo a multidisciplinary assessment, including an initial diagnostic ultrasound, followed by a comprehensive surgical consultation. Further specialist imaging such as high-resolution CT scanning or MRI sialography may be organized depending on the suspected pathology. Treatment planning takes place with thorough discussion of all the medical and surgical options (traditional and sialoendoscopic).
- Chronic sialadenitis is characterized by recurrent, painful salivary gland swelling
- Majority of cases due to salivary stones
- Traditional sialadenectomy risks permanent nerve injury, ongoing symptoms, and suboptimal cosmesis
- Sialoendoscopy is gland preserving in 80-85% of patients
- Safe and effective
- Both diagnostic and therapeutic
- Daystay procedure
- Gland preservation in 80-85%
Fig 1. Photo of sialoendoscope
Fig 2. Endoscopic view of stone with extraction basket