Submandibular Sialadenitis/Sialadenosis Treatment & Management

Management of submandibular sialadenitis and sialadenosis involves a wide range of approaches, from conservative medical management to more aggressive surgical intervention.

• One management scheme is as follows:

  • Acute sialadenitis
    • Medical management - Hydration, antibiotics (oral versus parenteral), warm compresses and massage, sialogogues
    • Surgical management - Consideration of incision and drainage versus excision of the gland in cases refractory to antibiotics, incision and drainage with abscess formation, gland excision in cases of recurrent acute sialadenitis
  • Salivary calculi
    • Medical management - Hydration, compression and massage, antibiotics for the infected gland
    • Surgical management - Duct cannulation with stone removal, gland excision in recurrent cases
  • Sjögren disease
    • Medical management - Hydration, dental hygiene, rheumatology and dental referral
    • Surgical management - Gland excision not usually needed unless recurrent acute sialadenitis
  • Sialadenosis
    • Medical management - Treatment of underlying cause
    • Surgical management - Not indicated
• Medical management centers on eliminating the causative factor.

  • Acute sialadenitis
    • In cases of acute sialadenitis, adequate hydration should be ensured and electrolyte imbalances corrected.
    • Patients are most often treated on an outpatient basis, with the administration of a single dose of parenteral antibiotics in an emergency department, followed by oral antibiotics for a period of 7-10 days. Clindamycin (900 mg IV q8h or 300 mg PO q8h) is an excellent choice and provides good coverage against typical organisms.
    • Patients who exhibit significant morbidity, are significantly dehydrated, or are septic should be admitted to hospital. In this latter group of patients, CT scanning of the area should be performed. If a large abscess is noted, incision and drainage should be considered. Small abscesses typically respond to conservative methods.
    • In cases refractory to antibiotics, viral and atypical bacterial causes should be considered.
  • Sialolithiasis
    • Patients with sialolithiasis should be initially treated with hydration, warm compresses, and gland massage.
    • Antibiotics are indicated in patients exhibiting infection.
  • Sjögren disease
    • In those patients with Sjögren disease, hydration and prevention of complications should be undertaken.
    • Dental hygiene should be strictly maintained in order to prevent carries, and dental and rheumatology consults should be sought. Gland excision is rarely indicated.
  • Sialadenosis: Sialadenosis should be managed expectantly. Treatment should be directed towards managing the underlying problem and achieving homeostasis. Gland excision is not indicated.

• Acute sialadenitis

  • Patients who exhibit significant morbidity, are significantly dehydrated, or are septic should be admitted to hospital. In this latter group of patients, CT scanning of the area should be performed. If a large abscess is noted, incision and drainage should be considered. Small abscesses typically respond to conservative methods.
  • In patients with recurrent acute attacks, gland excision during a period of quiescence should be considered. Serial CT scanning is often useful.
  • Endoscopic management of sialadenitis frequently obviates the need for gland removal. Results follow a learning curve.^[3]
• Sialolithiasis

  • In patients with calculi in proximity of the opening of the Wharton duct, the duct can be cannulated, dilated, and the stone removed via a transoral approach.
  • Patients with deep intraparenchymal stones or multiple stones should have their glands excised on an elective basis. Ultrasonic lithotripsy is rarely effective and is not offered at the authors' institution.