Sialadenitis: Symptoms, Types, Causes and Treatment

Sialadenitis is an inflammatory condition affecting the salivary glands, which play a vital role in oral health and digestion. This condition can arise suddenly or develop slowly over time, and its impact ranges from mild discomfort to severe pain and swelling. Understanding sialadenitis is crucial for recognizing its symptoms early, identifying its various forms, and exploring the best treatment options. In this article, we'll delve into the symptoms, types, causes, and treatments of sialadenitis, drawing on the latest research.

Symptoms of Sialadenitis

Sialadenitis presents with a range of symptoms that can significantly affect quality of life. The signs can vary based on the underlying cause, severity, and whether the condition is acute or chronic. Early recognition of these symptoms is essential for timely diagnosis and effective management.

Symptom	Description	Severity	Source
Swelling	Gland enlargement, often visible in the cheek, jaw, or under the chin	Mild to severe	1 3 5 6 8 9 10 12
Pain	Localized, may worsen when eating or touching the area	Mild to severe	2 3 6 8 10
Fever	Elevated body temperature, often with acute infection	Moderate to high	3 10
Dry mouth	Reduced saliva leading to discomfort and difficulty swallowing	Mild to moderate	4 5 8 13
Tenderness	Sensitivity over affected gland	Mild to moderate	1 5 6 8
Discharge	Pus or cloudy saliva from duct opening	Mild to moderate	6 8 10

Table 1: Key Symptoms

Overview of Major Symptoms

Swelling is the most frequently reported symptom and can affect the parotid, submandibular, or sublingual glands. The swelling may be unilateral or bilateral, depending on the cause and type of sialadenitis 1 3 5 6 8 9 10 12.

Pain is another hallmark, particularly during eating, as saliva production is stimulated, causing pressure in an obstructed or inflamed gland 2 3 6 8 10. Pain can range from a dull ache to sharp, severe discomfort.

Fever tends to accompany acute bacterial infections, serving as a key sign of systemic involvement or abscess formation 3 10.

Dry mouth (xerostomia) develops due to reduced saliva flow, often in chronic or autoimmune types, leading to eating and speaking difficulties 4 5 8 13.

Tenderness is noted upon palpation of the affected area and often coincides with swelling and pain 1 5 6 8.

Discharge of pus or cloudy saliva, especially when massaging the gland, is a classic sign of bacterial infection or abscess formation 6 8 10.

Symptom Patterns and Clinical Course

• Acute sialadenitis tends to present with rapid onset of swelling, pain, and sometimes fever.
• Chronic forms may cause intermittent swelling and discomfort, especially during meals.
• Obstructive sialadenitis (due to stones) often leads to recurrent, meal-related symptoms.
• Autoimmune and allergic types may show persistent dryness and gland enlargement.

Recognizing these patterns is essential for differentiating sialadenitis from other salivary gland disorders and tailoring appropriate therapy.

Types of Sialadenitis

Sialadenitis is not a single entity but a group of disorders with varied etiologies, clinical features, and outcomes. Understanding the different types is key to accurate diagnosis and treatment.

Type	Major Features	Common Glands Affected	Source
Acute Suppurative	Sudden pain, swelling, fever	Parotid, submandibular	3 10
Chronic Obstructive	Recurrent swelling, meal-time pain	Submandibular, parotid	2 5 6 14
Viral	Parotitis (mumps), bilateral swelling	Parotid	8 9 10
Autoimmune (e.g., Sjögren’s, IgG4-RS)	Dry mouth, persistent swelling, systemic symptoms	Submandibular, parotid	4 5 13
Radioiodine-induced	Post-131I therapy, swelling, tenderness	Parotid, submandibular	5 12
Allergic (Eosinophilic sialodochitis)	Swelling, gelatinous plugs, allergy markers	Multiple	5
Pediatric (Juvenile recurrent)	Recurrent parotid swelling	Parotid	8

Table 2: Types of Sialadenitis

Acute Suppurative Sialadenitis

This type is characterized by rapid onset of pain, swelling, and often fever. Bacterial infection, especially by Staphylococcus aureus, is the usual cause. It mostly affects the parotid and submandibular glands and may be associated with dehydration, poor oral hygiene, or underlying illness 3 10.

Chronic Obstructive Sialadenitis

Chronic forms often result from obstruction, most commonly due to salivary stones (sialolithiasis). Symptoms include recurrent swelling and pain, typically triggered by eating. The submandibular gland is most frequently involved, but the parotid and even sublingual glands can be affected 2 5 6 14.

Viral Sialadenitis

Viruses such as mumps (paramyxovirus) and, more recently, coronaviruses (SARS-CoV-2, COVID-19) can cause acute sialadenitis, often presenting with bilateral parotid swelling. In children, viral parotitis and juvenile recurrent parotitis are common 8 9 10.

Autoimmune Sialadenitis

Conditions like Sjögren’s syndrome and IgG4-related sialadenitis (IgG4-RS) fall into this category. These are characterized by immune-mediated inflammation, leading to persistent swelling and dry mouth. IgG4-RS is marked by tumefactive lesions and is increasingly recognized in the last decades 4 5 13.

Radioiodine-induced Sialadenitis

A complication of radioactive iodine therapy (commonly after thyroid cancer surgery), this type presents with swelling and tenderness, often in the parotid or submandibular glands. Symptoms may resemble chronic obstructive sialadenitis 5 12.

Allergic (Eosinophilic Sialodochitis)

A newer recognized entity, allergic sialadenitis features multiple gland swelling, gelatinous ductal plugs, and elevated allergic markers (IgE, eosinophils). It is linked to underlying allergic diathesis 5.

Pediatric Sialadenitis

In children, sialadenitis accounts for about 10% of salivary gland disease, with viral and recurrent (juvenile) parotitis being most common. The clinical course and management differ from adults, and sialendoscopy is increasingly used for both diagnosis and treatment 8.

Causes of Sialadenitis

Sialadenitis arises from a diverse array of causes, each influencing disease course and therapeutic strategies. Identifying the underlying cause is fundamental for targeted intervention.

Cause	Mechanism/Trigger	Typical Presentation	Source
Bacterial	Ductal obstruction, poor hygiene, dehydration	Acute swelling, pain, fever	3 6 10
Viral	Mumps, influenza, coronaviruses	Parotid swelling, fever	8 9 10
Obstructive	Sialolithiasis, duct stenosis	Meal-time pain, swelling	2 5 6 14
Autoimmune	Sjögren’s, IgG4-RS	Dry mouth, persistent swelling	4 5 13
Iodide-induced	Reaction to contrast agents	Acute swelling post-contrast	1
Radioiodine	131I therapy for thyroid cancer	Swelling, tenderness	5 12
Allergic	Eosinophilic sialodochitis	Multiple gland swelling, allergy markers	5
Pediatric	Viral, anatomic variants, unknown	Recurrent swelling, variable symptoms	8

Table 3: Causes of Sialadenitis

Infectious Causes

Bacterial: Acute sialadenitis most often results from bacterial infection, especially when saliva flow is reduced due to dehydration, ductal obstruction, or poor oral hygiene. Staphylococcus aureus is the most common culprit 3 6 10.

Viral: Viruses such as the mumps virus, influenza, and more recently coronaviruses (including SARS-CoV-2) can infect salivary gland tissue, causing acute swelling, sometimes bilaterally 8 9 10.

Obstructive Causes

Obstruction by salivary stones (sialolithiasis) or ductal strictures is a leading cause of both acute and chronic sialadenitis. Obstruction leads to saliva stasis, secondary infection, and gland inflammation. The submandibular gland is particularly susceptible due to its duct anatomy 2 5 6 14.

Immune-Mediated and Allergic Causes

Autoimmune disorders, notably Sjögren’s syndrome and IgG4-related sialadenitis, result from immune attack on the glands, causing inflammation, destruction, and fibrosis. Allergic mechanisms, as seen in eosinophilic sialodochitis, involve hypersensitivity pathways with prominent eosinophil and IgE involvement 4 5 13.

Iatrogenic Causes

Iodide-induced (Iodide mumps): Rarely, exposure to iodinated contrast media during imaging can trigger acute gland swelling within hours to days after administration 1.

Radioiodine-induced: Patients receiving radioactive iodine treatment, especially for thyroid cancer, may develop sialadenitis as a complication, often presenting weeks to months after therapy 5 12.

Pediatric and Other Causes

Children experience sialadenitis due to viral infections, congenital duct anomalies, or idiopathic recurrent parotitis. In end-stage cancer patients, sialadenitis can also arise, often as a rare but significant complication 3 8.

Treatment of Sialadenitis

Managing sialadenitis requires a tailored approach, considering the underlying cause, severity, and chronicity. Treatment strategies range from conservative care to advanced interventions.

Approach	Key Treatments	Effectiveness/Notes	Source
Medical	Antibiotics, hydration, sialagogues, analgesics	Effective in most acute bacterial cases	3 10 11
Gland Massage	Stimulates flow, relieves obstruction	Useful adjunct, especially in mild cases	5 12
Sialendoscopy	Stone/plug removal, duct dilation	Effective, gland-preserving, especially for obstruction	2 8 12 14
Lithotripsy	Laser fragmentation of stones	High success, minimally invasive	14
Intraductal Therapy	Penicillin or saline instillation	Simple, effective for chronic cases	11
Steroids/Immunosuppressants	For autoimmune/IgG4-RS	Improves gland function, prevents relapse	5 13
Conservative Allergy Treatment	Antihistamines, self-care	For eosinophilic sialodochitis	5
Surgery	Stone/gland removal (if needed)	Reserved for refractory/severe cases	6 14

Table 4: Treatment Approaches

Medical Management

For acute bacterial sialadenitis, prompt initiation of antibiotics is crucial. Supportive measures include hydration, sialagogues (substances that stimulate saliva), pain control, and gland massage. Most cases respond within days, with rapid symptom relief 3 10 11.

Sialendoscopy and Minimally Invasive Procedures

Sialendoscopy has revolutionized management, particularly for obstructive and chronic sialadenitis. It allows direct visualization, duct dilation, removal of stones or plugs, and saline or steroid instillation. This technique preserves gland tissue and has high success rates 2 8 12 14.

Laser-assisted lithotripsy can fragment larger or difficult stones, facilitating removal via sialendoscopy. The procedure is minimally invasive and preserves gland function in most cases 14.

Intraductal Therapy

Intraductal instillation of penicillin or saline is a simple, effective technique for chronic sialadenitis, leading to long-lasting symptom relief in many patients 11.

Immunosuppressive and Steroid Therapy

Autoimmune sialadenitis (including IgG4-RS) is typically treated with glucocorticoids, often combined with steroid-sparing immunosuppressants. This approach not only reduces inflammation and gland swelling but also restores salivary function and reduces relapse risk 5 13.

Conservative Management

For radioiodine-induced and allergic sialadenitis, conservative approaches like gland massage, sialagogues, and allergy management (antihistamines, avoidance of triggers) are first-line. Sialendoscopy is an option for persistent ductal stenosis in radioiodine-induced cases 5 12.

Surgical Intervention

Surgery is reserved for cases where less invasive measures fail. This may involve removal of large, irretrievable stones or, rarely, excision of the affected gland in refractory or neoplastic cases. However, gland-sparing strategies are preferred whenever possible 6 14.

Conclusion

Sialadenitis encompasses a spectrum of salivary gland inflammatory disorders with diverse causes, presentations, and treatments. Early recognition and targeted therapy can prevent complications and preserve gland function.

Key Takeaways:

• Sialadenitis causes pain, swelling, and functional impairment of the salivary glands 1 3 5 6 8 9 10 12.
• Types include acute, chronic, obstructive, viral, autoimmune, post-radioiodine, allergic, and pediatric forms 2 3 4 5 6 8 9 10 12 13 14.
• Causes range from infections and obstructions to autoimmune, allergic, and iatrogenic factors 1 3 4 5 6 8 9 10 12 13 14.
• Treatment is tailored to the cause and severity, with sialendoscopy and minimally invasive therapies now central to management 2 5 8 11 12 13 14.

Understanding sialadenitis empowers patients and clinicians to address symptoms early and choose the most effective, least invasive interventions for optimal outcomes.