Mandibular trismus is a rare finding but may be present with larger swellings. Dysphagia may also be present in some cases. Fever may also be noted, whilst spiking temperatures may be suggestive of an abscess formation. Chronic recurrent sialadenitis
The occurrence of chronic recurrent episodes may be due to underlying Sjogrens syndrome or ductal abnormalities. Prodrome of tingling in the gland preceding pain and swelling may be reported in such cases. Chronic sclerosing sialadenitis
Typically presents unilaterally in submandibular gland that cannot be differentiated clinically from a neoplasm, with pain an inconsistent finding. Obstructive sialadenitis
Formation of stones in glandular ducts (sialoliths) can result in the development of obstructive sialadenitis. There may be a history of abrupt episodic swelling of the parotid or submandibular gland which is usually painful. These episodes typically occur around meal times, lasting 2 – 3 hours and gradually subsides. Autoimmune sialadenitis
Characterised by persistent, asymptomatic bilateral swelling of parotid glands, and may represent as a manifestation of more widespread systemic disease. Dry eyes and dry mouth are commonly present and may be indicative of concomitant connective tissue disease (e.g. SLE, RA, or scleroderma). Oral candidiasis may also be present. Common key diagnostic factors
1. Fever – may present with an acute infective sialadenitis or autoimmune aetiology suggestive of an infection or inflammation. 2. Pain and dysphagia (ie. difficulty swallowing) – usually unilateral affecting the parotid or submandibular regions, with worse pain during eating and swallowing. 3. Facial swelling – usually unilaterally and affecting parotid region, under the tongue, or below the jaw.
Some common bacterial causes are S. aureus, S. pyogenes, viridans streptococci and H. influenzae.Autoimmune conditions that can cause sialadenitis include Sjögren’s syndrome, sarcoidosis, and granulomatosis with polyangiitis. Sjögren’s syndrome and Sarcoidosis are the most common causes of chronic sialadenitis and are often closely associated with it, and in many cases are believed to be the primary cause, although often with other contributing factors present also. One well known form of sarcoidosis is known as Heerfordt’s syndrome which is characterized by facial nerve palsy, enlargement of the parotid and anterior uveitis. One study came to the conclusion that the presence of salivary calculi is the main indicator for the removal of the submandibular gland, in patients where neoplasia is absent. This was because 82% of glands removed in an ENT department in Stockholm were found to have salivary calculi within them and all of these cases but one had chronic sialadenitis. A mucous retention cyst was found in one patient, but this was not considered to have contributed to the sialadenitis in this case.The duration of the sialadenitis was found to be closely linked to atrophy, fibrosis and the degree of the inflammation in another study, which looked primarily at microliths found in the ducts and glands. Liths were also found to be related to the duration that the individual had symptoms of sialadenitis, whereas microliths were found in normal glands and varied with age.