Submandibular Sialadenitis/Sialadenosis Workup

  • Author: Adi Yoskovitch, MD, MSc; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Sep 27, 2011
 

Laboratory Studies

  • In evaluating the patient with sialadenitis, steps should be taken in the following order: history, physical examination, culture, laboratory investigation, radiography, and if indicated, fine-needle aspiration biopsy (see History and Physical).
  • Laboratory investigations should begin with culture of the offending gland (if possible, prior to the administration of antibiotics).
  • Blood cultures should be obtained in the patient exhibiting bacteremia or sepsis.
  • As a rule, needle aspiration of a suspected abscess is not indicated.
  • Routine electrolytes and complete blood cell count with differential should be obtained to assess for any evidence of dehydration or systemic infection.
  • If a diagnosis of autoimmunity is entertained, serum analysis for antinuclear antibody, SS-A, SS-B, and erythrocyte sedimentation rate should be conducted.
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Imaging Studies

  • Numerous radiologic techniques are available in submandibular imaging. Deciding which study to obtain first is often difficult. Examination selection should be based in part on the suspected cause of the problem. The authors' institution tends to begin with plain radiography, followed by the use of computed tomography scanning with combined sialography.
  • Of all the radiologic examinations available, one of the simplest is conventional plain radiography.[1] Anteroposterior, lateral, and oblique intraoral occlusal views are used. This technique is particularly valuable in evaluating the presence of calculi, which are radio-opaque in approximately 70% of cases. These radiographs are limited in that they do not provide any information about the ductal system or soft tissues.
  • Sialography can be used to evaluate sialolithiasis or other obstructive entities, as well as inflammatory and neoplastic disease.
    • In this technique, a water-soluble medium such as meglumine diatrizoate is injected into the Wharton duct and lateral, oblique, and anteroposterior plain radiographs are obtained in order to assess the ductal arborization.
    • Contraindications for this test are iodine allergy and acute sialadenitis.
    • Any filling defects (eg, calculi), retained secretions (eg, chronic sialadenitis), stricture formation (eg, inflammation), extravasation (eg, Sjögren disease), or irregularly contoured borders (eg, neoplasm) are noted.
  • Ultrasonography can be used to differentiate between solid versus cystic lesions of the gland. It can also be used to differentiate intrinsic from extrinsic disease and can be helpful in identification of abscess formation. A 2009 study by Bozzato et al determined that application of ascorbic acid (vitamin C) as a contrast agent can aid in the ultrasound assessment of obstructive sialadenitis of the parotid and submandibular glands.[2]
  • Computed tomography scanning is an excellent modality in differentiating intrinsic versus extrinsic glandular disease. It is also extremely valuable in defining abscess formation versus phlegmon. It is limited in evaluating the ductal system unless combined with simultaneous sialography.
  • Magnetic resonance imaging is of little utility in sialadenitis or sialadenosis. It does not allow evaluation of the ductal system, and it is not helpful in defining calcifications. It is an excellent tool for soft tissue definition and is invaluable in instances of suspected neoplasia.
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Procedures

  • Fine-needle aspiration and biopsy
    • Open biopsy of the lip should be considered when the diagnosis of Sjögren disease is contemplated.
    • If suspicion of a solid neoplasm masquerading as sialadenitis is significant, a fine-needle aspiration with biopsy should be undertaken. The management and differential diagnosis of submandibular neoplasms is beyond the scope of the current discussion.
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Contributor Information and Disclosures
Author

Adi Yoskovitch, MD, MSc  Chief, Department of Otolaryngology - Head and Neck Surgery, Fleury Hospital, Canada

Adi Yoskovitch, MD, MSc is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, Canadian Academy of Facial Plastic and Reconstructive Surgery, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard V Smith, MD  Director of Clinical Affairs, Associate Professor, Department of Otolaryngology, Division of Head and Neck Surgery, Einstein College of Medicine, Montefiore Medical Center

Richard V Smith, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Laryngological Rhinological and Otological Society, American Medical Association, American Medical Student Association/Foundation, Medical Society of the District of Columbia, New York Academy of Medicine, and Vermont State Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Dominique Dorion, MD, MSc, FRCSC, FACS  Vice Dean and Associate Dean of Resources, Professor of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Sherbrooke Faculty of Medicine, Canada

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

  1. Isacsson G, Isberg A, Haverling M, Lundquist PG. Salivary calculi and chronic sialoadenitis of the submandibular gland: a radiographic and histologic study. Oral Surg Oral Med Oral Pathol. Nov 1984;58(5):622-7. [Medline].

  2. Bozzato A, Hertel V, Koch M, Zenk J, Iro H. [Vitamin C as contrast agent in diagnosis of salivary duct obstruction]. Laryngorhinootologie. May 2009;88(5):290-2. [Medline].

  3. Gillespie MB, Koch M, Iro H, Zenk J. Endoscopic-Assisted Gland-Preserving Therapy for Chronic Sialadenitis: A German and US Comparison. Arch Otolaryngol Head Neck Surg. Sep 2011;137(9):903-8. [Medline].

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  7. Ching AS, Ahuja AT, King AD, et al. Comparison of the sonographic features of acalculous and calculous submandibular sialadenitis. J Clin Ultrasound. Jul-Aug 2001;29(6):332-8. [Medline].

  8. Gayner SM, Kane WJ, McCaffrey. Infections of the salivary glands. In: Cummings CW, et al, eds. Otolaryngology Head and Neck Surgery. 3rd ed. St. Louis, Mo:. Mosby;1998:1234-1246.

  9. Guerrissi JO, Taborda G. Endoscopic excision of the submandibular gland by an intraoral approach. J Craniofac Surg. May 2001;12(3):299-303. [Medline].

  10. Haynes RC. Adrenocorticotropic hormone: adrenocortical steroids and their synthetic analogs; inhibitors of the synthesis and actions of adrenocortical hormones. In: Goodman LS, Gilman AG, eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 8th ed. New York, NY:. Pergamon Press;1990:1431-1462.

  11. Kaneda T, Minami M, Ozawa K, et al. MR of the submandibular gland: normal and pathologic states. AJNR Am J Neuroradiol. Sep 1996;17(8):1575-81. [Medline].

  12. Matthews TW, Dardick I. Morphological alterations of salivary gland parenchyma in chronic sialadenitis. J Otolaryngol. Dec 1988;17(7):385-94. [Medline].

  13. Rice DH. Diagnostic imaging. In: Cummings CW, et al, eds. Otolaryngology Head and Neck Surgery. 3rd ed. St. Louis, Mo:. Mosby;1998:1223-1233.

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  15. Sande MA, Mandell GL. Antimicrobial agents. Tetracyclines, chloramphenicol, erythromycin, and miscellaneous antibacterial agents. In: Goodman LS, Gilman AG, et al, eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 8th ed. New York, NY:. Pergamon Press;1990:1117-1145.

  16. Saunders JR Jr, Hirata RM, Jaques DA. Salivary glands. Surg Clin North Am. Feb 1986;66(1):59-81. [Medline].

  17. Silvers AR, Som PM. Salivary glands. Radiol Clin North Am. Sep 1998;36(5):941-66, vi. [Medline].

  18. Sumi M, Izumi M, Yonetsu K, Nakamura T. The MR imaging assessment of submandibular gland sialoadenitis secondary to sialolithiasis: correlation with CT and histopathologic findings. AJNR Am J Neuroradiol. Oct 1999;20(9):1737-43. [Medline].

 
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Submandibular calculus.
Sialogram with stenosis secondary to chronic sialadenosis.
Submandibular abscess and associated Ludwig angina.
Submandibular neoplasm.
 
 
 
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