Further Outpatient Care
See the list below:
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For patients with acute sialadenitis not requiring admission, follow-up visit should be 3 days from the first visit and then 1 week later (with improvement).
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Patients with chronic sialadenitis/sialolithiasis and autoimmune sialadenitis or sialadenosis should be seen on a regular basis and if acute exacerbation of the problem occurs.
Further Inpatient Care
See the list below:
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Patients requiring inpatient management should be monitored on a daily basis and preferably twice daily.
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In order to ascertain the progression or improvement of acute sialadenitis, serial CT scanning may be warranted.
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Patients with sialolithiasis should be treated conservatively during the acute exacerbation stage and should be monitored after discharge for definitive surgical intervention.
Inpatient & Outpatient Medications
See the list below:
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In addition to the antibiotics, patients may be treated with any form of nonsteroidal anti-inflammatory medications. Narcotics may be needed in severe cases, and increasing pain refractory to medications is often an indication for admission for further evaluation.
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In addition, medications predisposing to xerostomia should be avoided where possible. These include antiparkinsonian, antiemetics, antinauseants, over-the-counter and prescription cold medications, antidepressants, antihypertensive agents, diuretics, anticholinergics, antianxiety agents, and decongestants.
Complications
See the list below:
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The most serious complication of acute sialadenitis is the formation of an abscess. Management is described above.
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Complications of chronic sialadenitis and autoimmune sialadenitis are most often dental in nature because of the decreased function of the gland and the protective effect provided against caries.
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Chronic inflammation of the gland with or without calculi often renders the gland difficult to excise because of the loss of normal tissue planes.
Prognosis
See the list below:
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The prognosis of acute sialadenitis is very good. Most cases are easily treated with conservative medical management, and admission is the exception, not the rule. Acute symptoms resolve within 1 week; however, edema in the area may last several weeks.
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Postsurgery, patients are often already admitted with appropriate intravenous antibiotics. These patients have a similar prognosis.
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Patients with chronic sialadenitis often have a relapsing and remitting course. Prognosis is dependent on the etiology.
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Patients with sialolithiasis require definitive surgical treatment in most cases, which results in an excellent prognosis.
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Patients with Sjögren or other autoimmune diseases are likely to have a protracted course related to systemic involvement.
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Patients with sialadenosis have a good prognosis, if their underlying problem is adequately controlled. Even if control is attained, bilateral swelling may be persistent.
Patient Education
See the list below:
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Patients with any form of sialadenitis should be educated as to the value of hydration and excellent oral hygiene. This lessens the severity of the attacks and prevents dental complications. Patients with sialadenosis should be educated regarding the mechanism of their underlying pathology and methods of maintaining control over them.
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For excellent patient education resources, visit eMedicineHealth's Oral Health Center.
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Submandibular calculus.
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Sialogram with stenosis secondary to chronic sialadenosis.
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Submandibular abscess and associated Ludwig angina.
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Submandibular neoplasm.
