Microliths could possibly form reservoirs, thus allowing infection to ascend further towards the glands but this could not be confirmed due to the liths and microliths being distinct in this study. However, many glands did show only very minimal variations, which could allow the opportunity for more conservative treatment instead of the surgical removal of the affected gland in the future. Histopathology
Initial stage of acute bacterial sialadenitis involves the accumulation of bacteria, neutrophils and inspissated fluid in lumen of ductal structures. Damage to ductal epithelium results in sialodochitis (periductal inflammation), accumulation of neutrophils in glandular stroma, followed by acini necrosis with microabscesses formation. Recurrent episodes results in chronic stage, which involves the establishment of periductal lymph follicles and further destruction of salivary acini. Infective sialadenitis
Generally, in acute bacterial and viral sialadenitis cases, the lobular architecture of the gland is maintained or may be slightly expanded. Areas of liquefaction, indicating presence of abscess, may also be seen microscopically. In Acute bacterial sialadenitis, acinar destruction with interstitial neutrophil infiltrates is observed. Small abscesses with necrosis are common.
If there are attacks more than approximately 3 times per year or severe attacks, surgical excision of the affected gland should be considered. Epidemiology
Sialadenitis of the parotid gland accounts for a much larger percentage of hospital admissions than sialadenitis of the submandibular gland. Submandibular sialadenitis has been said to only account for 10% of all cases diagnosed as sialadenitis. Chronic sialadenitis has been classified as a relatively common presentation, whereas bacterial sialadenitis and sclerosing polycystic sialadenitis are defined as rare. Chronic sclerosing sialadenitis has been shown to affect predominantly males who are over the age of 50, with 40% of cases having an allergic disease, such as chronic sinusitis or bronchial asthma.One study found that 112 patients from England and Wales ranging from 12 to 81 years of age complained of symptoms from their diagnosed sialadenitis, with the group having a mean age of 39 and a standard deviation of 16 years. The study also found that more patients underwent surgery to treat their sialadenitis between the ages of 20 and 69 years but that there were many more patients who complained of symptoms between the ages of 20 and 49, and then went on to be diagnosed with sialadenitis. In each group studied, most patients suffered from sialadenitis in their twenties but there was also found to be a significant number of females whose symptoms started in their thirties and forties.