Salivary Gland Enlargement

 

• Differential diagnosis

  • Infectious: mumps, HIV, EBV, Coxsackie.
  • Autoimmune and infiltrative: Sjogren's, sarcoidosis, granulomatosis with polyangiitis, amyloidosis.
  • Masses: stones, tumours.
  • Psychiatric: bulimia, alcoholic liver disease. Both cause sialadenosis, a non-inflammatory, non-neoplastic salivary gland swelling.

• Sialadenitis

  Pathophysiology

  Inflammation of the salivary gland, most commonly the parotid (parotitis).

  Causes:

  • Infective (usually acute): bacteria (Staph. aureus, TB), viral (mumps, HIV, Coxsackie).
  • Chronic: features salivary stasis, and may be secondary to stone or chronic inflammation.
  • Autoimmune: Sjogren's, which may also affects the submandibular gland.

  Signs and symptoms

  • Infective: bilateral acute pain, swelling, mild fever, skin lesions (e.g. cellulitis, pus exudate).
  • Chronic: less pain, unilateral, postprandial.
  • Sjogren's: chronic bilateral swelling, plus dry eyes and mouth.

  Investigations

  Inflammatory markers.

  Management

  • Symptomatic: sialogogues (e.g. citrus drinks), hydration, gentle massage.
  • Antibiotics for bacterial infection.
  • Treat underlying condition.

• Sialolithiasis

  Pathophysiology

  • Stone formation in a salivary gland.
  • Usually in the submandibular gland duct (Wharton's duct). Less commonly, in Stensen's duct of the parotid gland.

  Signs and symptoms

  Recurrent, postprandial, unilateral pain and swelling.

  Investigations

  • X-ray
  • Sialogram: contrast injection into salivary duct.

  Management

  • Remove stone via mouth or excise gland if deep.
  • If small: hydration, NSAIDs.

• Salivary gland tumours

  Pathophysiology

  • 80% are parotid superficial lobe pleomorphic adenomas, which are benign, slow-growing tumours. Small risk of malignant transformation.
  • 5% are adenolymphomas (Warthin's tumour), a benign cystic growth. Commoner in middle age and older men.
  • 15% are malignant: mucoepidermoid carcinoma, adenoid cystic carcinoma.

  Signs and symptoms

  • Typically present as a painless lump.
  • Swelling may cause deflection of ear lobe.
  • Malignant nerve invasion may cause pain or CN7 palsy.

  Investigations

  • US with FNA.
  • MRI if US or history suggest malignancy.

  Management

  Excision, which also provides histological confirmation:

  • Superficial parotidectomy for benign tumours.
  • Total parotidectomy and radiotherapy for carcinoma.