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Diseases of the salivary glands

Last updated: August 7, 2024

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Diseases of the salivary glands (e.g., parotid, submandibular, and sublingual glands) include sialadenosis, sialadenitis, and sialolithiasis. Sialadenosis and sialadenitis primarily affect the parotid gland. Sialadenosis is the recurrent, painless, and often bilateral swelling of salivary glands without inflammation; treatment is focused on management of the underlying disease. Sialadenitis is the painful acute inflammation of salivary glands and is generally categorized according to etiology. Acute suppurative sialadenitis is caused by bacterial infection, while nonsuppurative sialadenitis is due to viral infection (e.g., mumps) or chronic conditions (e.g., salivary stasis, autoimmune disorders). Management includes supportive care (e.g., pain control, sialagogues) and treatment of the underlying cause. Sialolithiasis is the formation of stones within the salivary ducts, which may cause swelling and pain associated with eating. Treatment can be conservative (e.g., pain control, sialogogues) or surgical (stone removal).

Salivary gland tumors manifest mainly in the parotid. Painless and progressive swelling of the gland is the cardinal symptom of benign as well as malignant tumors, while facial palsy is considered a criterion for malignancy. Generally, the smaller the gland, the greater the chance that the tumor is malignant. Clinical examination and ultrasound play the biggest role in diagnosis. For all parotid tumors, the preferred treatment is parotidectomy with retention of the facial nerve. A resection of the facial nerve is indicated only if it is infiltrated by the tumor. Postoperative radiation therapy may benefit patients with malignant tumors.

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Overview of salivary gland diseases [1][2]

Features Acute suppurative sialadenitis Viral sialadenitis (e.g., mumps) Sialolithiasis Sialadenosis Tumors of the salivary glands
Most common location
Swelling
  • Usually unilateral
  • Usually bilateral
  • Usually unilateral
  • Usually bilateral
  • Usually unilateral
Pain
  • Painful
  • Painful
  • Painful while eating
  • Usually painless
  • Usually painless
Fever
  • Present
  • Present
  • Usually absent
  • Absent
  • May be present
Other findings
  • Possible pus discharge
  • Possible redness of the gland
  • Protruding ears
  • Sudden pain while eating
  • Possible malignant symptoms of infiltrated structures (e.g., facial palsy)
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Sialadenitistoggle arrow icon

Acute suppurative sialadenitis [1][3][4]

Viral sialadenitis [1][3][4]

Chronic sialadenitis [1][3][4]

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Sialolithiasistoggle arrow icon

Sialolithiasis is the formation of stones within the salivary ductal system.

Etiology [4]

Clinical features [4]

Diagnostics [4][6]

Treatment [4][6]

Complications [3]

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Sialadenosistoggle arrow icon

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Ranulatoggle arrow icon

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Benign tumorstoggle arrow icon

Most salivary gland tumors are benign.

Pleomorphic adenoma (benign mixed tumor)

Other types of benign salivary gland tumors (monomorphic adenomas)

These benign salivary gland tumors fall under the umbrella term "monomorphic adenoma" because they usually originate in only one type of cell – as opposed to the pleomorphic adenomas, which consist of both epithelial and myoepithelial cells.

Warthin tumor (papillary cystadenoma lymphomatosum)

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Rare histologic subtypes

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Malignant tumorstoggle arrow icon

Malignant salivary gland tumors are referred to collectively because of their many etiological, epidemiological, and pathological similarities.

Submandibular gland tumors are less common but more frequently malignant than parotid tumors. Generally, the smaller the gland, the higher the risk a tumor is malignant!

References:[14][15]

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