A Synopsis of AAFPs "Salivary Gland Disorders"

A Synopsis of:
Salivary Gland Disorders
KEVIN F. WILSON, MD; JEREMY D. MEIER, MD; and P. DANIEL WARD, MD, MS, University of Utah School of Medicine, Salt Lake City, Utah
Am Fam Physician. 2014 Jun 1;89(11):882-888.
http://www.aafp.org/afp/2014/0601/p882.pdf

     The salivary glands include the parotid, submandibular, sublingual, and some minor ones that line the mouth. The three types of disorders include obstruction, neoplasm, and infection. The initial typical symptom is inflammation. If there are systemic findings (fever, joint pain) then the inflammation may be due to sjogren's syndrome, lymphoma, fungal, or mycobacterial. Acute localized inflammation may be either viral or bacterial. Recurrent localized inflammation will need to be evaluated for duct obstruction.
     Acute suppurative sialadenitis is bacterial inflammation of the parotid gland. Risk factors include diabetes, hypothyroidism, use of anticholinergic medications, renal failure, and sjogren's. Treatment includes empiric antibiotics (amoxicillin-clavulanate), warm compresses, sialagogues, hydration, oral hygiene, and salivary gland massage.
     Recurrent parotitis of childhood appears as fever malaise, pain, and swelling of the parotid gland. Treatment is the same as above.
     Chronic sialadenitis is thought to be due to obstruction of the parotid gland. Treatment consists of sialagogues, hydration, massage and anti-inflammatory medication.
     Sialolithiasis are stones in the submandibular gland. Symptoms include postprandial pain and swelling. A stone may be found through palpation (under anesthesia) or imaging. Stones in the parotid duct may require surgery.
     Viral infections include mumps and HIV. Mumps occur mostly in children less than 15 years old. It is highly contagious and spreads through respiratory droplets. It is nonsuppurative and diagnosed through viral serology. Treatment is supportive. HIV is associated with cysts in the salivary glands and xerostomia.
     Neoplasms present as painless, asymptomatic, and slow-growing. Diagnosis is made with biopsy and imaging. Pleomorphic adenomas are the most common tumor. They are found in the parotid gland and can become malignant with time. Warthin tumors are benign tumors found in older male smokers. Mucoepidermoid carcinoma is a low grade tumor with excellent prognosis if treated. Adenoid cystic carcinoma invades the nerves and can cause facial weakness. Treatment is resection.