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Question answered:10/01/08 Warning! this question is over two years old.
We searched the NLH ENT and Audiology Specialist Library and the TRIP database but found no guidance on the management of sialadenitis. For both sialadenitis and salivary gland calculi, the Specialist Library states:
“Currently there are no guidelines or systematic reviews available for this topic. If you would like the Library team to conduct a search for primary literature please contact us with your clinical question.” [1]
GPNotebook has an entry on chronic sialadenitis in which it states:
“Chronic inflammation of a salivary gland is usually caused by partial obstruction from a ductal calculus. Since salivary calculi are far more common in the submandibular gland, it also follows that chronic sialadenitis more commonly affects the submandibular gland…
…Treatment is via removal of the duct obstruction. Additionally, antibiotics, e.g. cephalexin, may be given. Prolonged obstruction may damage the gland irreversibly.” [2]
The Merck Manual does not distinguish between acute and chronic sialadentis:
“Sialadenitis is bacterial infection of a salivary gland, usually due to an obstructing stone or gland hyposecretion. Symptoms are swelling, pain, redness, and tenderness. Diagnosis is clinical. CT, ultrasound, and MRI may help identify the cause. Treatment is with antibiotics…”
“Initial treatment is with antibiotics active against S. aureus (eg, dicloxacillin, 250 mg po qid, a 1st-generation cephalosporin, or clindamycin), modified according to culture results. With the increasing prevalence of methicillin-resistant S. aureus, especially among the elderly living in extended-care nursing facilities, vancomycin is often required. Hydration, sialagogues (eg, lemon juice, hard candy, or some other substance that triggers saliva flow), warm compresses, gland massage, and good oral hygiene are also important. Abscesses require drainage. Occasionally, a superficial parotidectomy or submandibular gland excision is indicated for patients with chronic or relapsing sialadenitis.” [3]
References
1. NLH ENT and Audiology Specialist Library. (http://www.library.nhs.uk/ent/ContactUs.aspx)
2. GPNotebook. Sialadenitis. (http://www.gpnotebook.co.uk/simplepage.cfm?ID=1221591063&linkID=30796&cook=yes)
3. Merck Manual. Sialadenitis. November 2005. (http://www.merck.com/mmpe/sec08/ch090/ch090h.html)
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