Sialadenitis is inflammation or infection of a salivary gland, most often the parotid or submandibular gland. It usually follows reduced saliva flow from dehydration, medicines or a stone, which lets bacteria climb up the duct.
Key symptoms
- Painful swelling of the gland under the jaw or in front of the ear
- Swelling that worsens at meals when a stone is present
- Fever
- Foul taste or pus in the mouth
- Dry mouth
What you find on exam
- Tender, firm, swollen gland
- Pus from the duct opening on gland massage
- Stone felt in the floor of the mouth along the submandibular duct
- Hydration and medicines that cause dry mouth
- Neck cellulitis or signs of airway compromise
Tests
- Culture of pus from the duct
- Ultrasound to look for stones or an abscess
- CT with contrast if an abscess or deep spread is suspected
- Blood count
- Autoimmune tests for Sjogren syndrome if episodes recur
Treatment basics
- Hydration, warm compresses and gland massage
- Sour candies to increase saliva flow
- Antibiotics covering staph and mouth bacteria, such as amoxicillin-clavulanate or clindamycin
- Pain control with ibuprofen or acetaminophen
- Stone removal or sialendoscopy; drainage of an abscess
Red flags
- Floor of mouth swelling that lifts the tongue (Ludwig angina)
- Fluctuant mass or spreading neck redness
- Trouble breathing or swallowing
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.