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Sialadenitis - Coggle Diagram

- - - - mucoepidermoid carcinoma,
      - OSCC,
      - other malignant tumours of the salivary glands.
- - - - Submandibular 85%
      - Parotid 10%
      - Sublingual 5%
- - - - Salivary glands: bimanual palpation
        
        Asymmetries/ Erythema/ Tenderness to palation/ Swelling/ Warms
- - - - Poor oral hygiene.
      - Older adults are susceptible to sialadenitis, due to the frequent combination of medication-induced salivary hypofunction .
      - ↓SF results in diminished mechanical flushing, which allows bacteria to colonize the oral cavity and then to invade the salivary duct and cause an acute bacterial infection.
    - - The skin over the gland may be warm, red and tight.
      - The salivary duct may be red and may express purulent
        material output.
      - Diffuse, painful swelling of the affected gland, indurated and tender on palpation.
      - Trismus, xerostomia, fever and malaise may be present.
      - Patient usually presents an onset of unilateral or bilateral salivary gland enlargement.
    - - IV Amoxicillin-clavulanic acid every 6 hours.
      - In severe or refractory cases, or with an obvious abscess, it is necessary a surgical decompression by external drainage of the gland.
      - Must begin as soon as possible, without waiting for culture results.
    - - Magnetic resonance imaging (MRI)/computed
        tomography (CT); rule out sialoliths.
      - A purulent discharge may be expressed from the duct orifice and samples of this exudate should be cultured for aerobes and anaerobes.
      - Clinical features.
    - - Most commonly seen in patients with reduced salivary gland function.
      - Bacterial colonization may be retrograde route through salivary glands duct (the most frequent), hematic or lymphatic route.
      - Most frequently infects the parotid glands in debilitated, dehydrated or elderly patients.
      - Predisposing factors: diabetes mellitus, immunocompromised state , poor oral hygiene
      - Acute suppurative infection of salivary glands produced by bacteria colonization
  - - - etiology
        
        Trauma
        
        Foreign bodies
        
        Abnormality of the Stensen Duct
        
        Viral mumps
      - clinical feature
        
        Common in children (3 to 5 years); more common that recurrent sialadenitis in adults
        
        Recurrent episodes of unilateral or bilateral parotid swelling.
        
        It can produce some pain.
        
        Prodromal symptoms: pain in the preauricular area.
        
        Sometimes purulent saliva at the squeezing of the gland.
      - concept
        
        Frequent in parotid glands with bilateral and asymmetrical involvement.
        
        Bacteria most frequently involved include Streptococcus viridans, Streptococcus Proteus and Pneumococcus.
        
        The second most common salivary disease in children, after mumps
      - treatment
        
        Antibiotic treatment:Children→ 40 mg/kg amoxicillin/clavulanic acid, three times/day.
        
        Analgesics
        
        Hydration
        
        Many cases will resolve with conservative measures previous to puberty
    - - Diagnosis
        
        The clinical manifestations and evolution in repeated episodes of swelling accompanied by few symptoms can guide us in the diagnosis.
        
        In adults, the sialography shows the typical image of rosary or in birdshot.
        
        The diagnostic image test: MRI.
      - clinical features
        
        Recurrent episodes of unilateral or bilateral parotid swelling.
        
        It can produce some pain.
        
        Prodromal symptoms: pain in the preauricular area.
        
        Sometimes purulent saliva at the squeezing of the gland.
        
        Semisolid material obstruct the parotid duct
      - Clinical situations:
        
        Persistent bacterial sialadenitis for at least one
        month.
        
        Refractory sialadenitis; Acute bacterial sialadenitis
        without resolution after the treatment
        
        Recurrent fully treated sialadenitis; periods of
        remission separated recurrent episodes
        
        Frequent in parotid glands with bilateral and asymmetrical involvement.
        
        Bacteria: streptococci and staphylococci
      - Treatment
        
        Antibiotic treatment
        
        875/125 mg amoxicillin-clavulanic acid every 8hrs
        
        300mg clindamycin every 8hours
        
        Analgesics: Paracetamol 650 mg -1 gr, Ibuprofen 400-600mg
        
        Hydration
        
        Surgical intervention: severe cases
- - - - Common in children (6-8y)
      - Spread by saliva.
      - 24 - 48 h prodromal symptoms: fever, malaise, headache, pre- auricular tenderness
      - The contagious period extends from 3-5 days before the onset of symptoms until 4-10 days after disappearing.
      - Bilateral/unilateral painful parotid gland enlargement; redness, tenderness and trismus.
      - Intraoral examination: swelling in Stensen's duct and not purulent output of saliva.
      - Evolutuion
        
         Resolution in 7-10 days without sequel.
        
         It can cause complications (epididymo-orchitis in young men
        
        and oophoritis in woman).
    - - Diagnosis is made at clinical level.
      - Antibodies to the nucleoprotein core of the virus
    - - The incidence has decreased (by vaccination at 15 months)./Incubation period: 12-25 days.
      - Paramyxovirus.
      - MOMPEN: mumbling (difficulty in speech due to the inflammation and trismus)
    - - Not specific treatment.
      - Soft diet, hydration, analgesic and antipyretic.
  - - - Nontender swelling of one or more salivary glands
      - Persistent swelling that may fluctuate
      - ↓ salivary flow
      - Diagnosis:
        
        Immunosuppression, CD8 antibodies
    - - Diffuse enlargement of the salivary glands
      - Any stage of the infection; may be the initial manifestation