Disease Description (Causes and Symptoms)
- Definition: A general term for inflammation occurring in the salivary glands (the parotid, submandibular, and sublingual glands, as well as the minor salivary glands in the oral cavity).
- Major causes
- Infection: bacterial (suppurative sialoadenitis), viral (e.g., mumps)
- Obstruction: obstruction of the salivary duct by a sialolith (salivary stone) → salivary stasis and secondary infection
- Reduced secretion: decreased saliva production due to dehydration, anticholinergic drugs, etc.
- Autoimmune: chronic salivary gland inflammation in conditions such as Sjögren syndrome
- Rarely, compression caused by radiation or radionuclide therapy, or tumors
- Pathophysiology summary: When saliva becomes stagnant due to duct obstruction or reduced secretion, bacterial growth and inflammation are triggered, and repeated inflammation may lead to fibrosis and reduced function of the salivary gland tissue.
- Major symptoms
- Pain and swelling in the area below the ear (parotid gland) or below the jaw (submandibular gland), especially worsening during meals
- Fever, tenderness, localized warmth, and purulent discharge (pus draining through the duct)
- In chronic cases, intermittent swelling and discomfort, and reduced saliva production (dry mouth)
Treatment Methods and Precautions
- General principles
- Identify the cause and provide cause-specific treatment (infectious vs. obstructive vs. autoimmune, etc.)
- Conservative and symptomatic treatment
- Adequate fluid intake (correction of dehydration), warm wet compresses, and massage of the salivary gland area (in the direction of the duct)
- Improve oral hygiene and stimulate saliva production with sialogogues (lemon, candy, etc.) — however, use caution when a sialolith is present and pain is severe
- Pain control: anti-inflammatory analgesics such as NSAIDs
- Infectious (bacterial) sialoadenitis
- Initial treatment: oral antibiotics covering gram-positive cocci/staphylococci and anaerobes; adjust antibiotics based on culture when necessary
- Severe cases or suspected cellulitis or abscess: intravenous antibiotics after hospitalization; drain any abscess
- Viral sialoadenitis (including mumps)
- Specific antiviral drugs have limited use; provide conservative treatment (rest, fluids, and analgesia) and monitor for complications
- Treatment of obstruction (sialolith)
- Small stones: encourage passage with conservative treatment (fluids, sialogogues, and massage)
- Endoscopic stone removal (sialendoscopy) — often successful and may preserve the salivary gland
- Some institutions offer lithotripsy (ESWL)
- If the stone is large or recurrent or chronic inflammation is severe, consider surgical removal (stone removal or salivary gland resection)
- Autoimmune sialoadenitis (e.g., Sjögren syndrome)
- Treatment of dry mouth (saliva stimulants such as pilocarpine and cevimeline); rheumatologic treatment (immunomodulation) when necessary
- Prevention of complications and precautions
- Seek emergency medical care immediately if high fever or systemic symptoms, progressively worsening swelling, difficulty breathing, or difficulty swallowing or moving the tongue occurs
- If a sialolith is suspected, indiscriminate use of sialogogues (saliva stimulants) may worsen pain — consult a doctor
- In cases of chronic recurrence, consider imaging and endoscopic examination
Outpatient Visit Checklist (Including Preparation Items and Sample Questions)
- Recommended items to bring
- A list of currently used medications (including prescription and nonprescription drugs, herbal medicines, and supplements)
- Medical history (especially radiation therapy, salivary gland surgery, rheumatic or autoimmune disease, and recent dehydration or surgery)
- Symptom record: onset, location (one or both sides), relationship to meals, presence of fever, presence of pus discharge, and factors that worsen or relieve symptoms
- Copies of previous examination or imaging results (ultrasound or CT), if available
- Key items the doctor will check during the outpatient visit
- Location of the swelling and findings on palpation, whether discharge is coming from the duct, and signs of systemic infection
- If necessary, ultrasound or CT, blood tests (inflammatory markers), and duct culture may be performed
- Information that may be helpful to provide to the medical staff during the visit
- Whether difficulty swallowing or breathing is present, recent dehydration or use of anticholinergic medications, and a history of repeated recurrence
Examples of General Questions to Ask the Doctor
- "What do you think is causing this condition?"
- "Could any medications I am taking (or any underlying condition) affect this disease?"
- "What imaging or additional tests do you recommend?"
- "What are the side effects and recovery period of the medication (or surgery) you plan to prescribe or perform?"
- "What lifestyle changes or preventive measures can help reduce recurrence?"
Examples of Condition-Specific Questions
- If a sialolith is suspected:
- "The pain is severe during meals. If a sialolith is confirmed on imaging, can it be treated with endoscopic removal (sialendoscopy)? What are the criteria for requiring surgery?"
- When an autoimmune association (Sjögren syndrome) is suspected:
- "What tests (such as blood antibodies, a salivary gland biopsy, or measurement of salivary flow) are needed to determine whether reduced salivary gland function is associated with Sjögren syndrome?"
Additionally, in an emergency (immediate medical attention recommended): Please visit the emergency room if you have rapidly worsening facial or neck swelling, difficulty breathing, high fever or chills, severe difficulty swallowing, or decreased consciousness.