What is Sialadenitis?
Sialadenitis is an inflammation of the salivary glands, which can be acute or chronic. It affects the production and secretion of saliva, leading to various clinical symptoms including pain, swelling, and sometimes infection.
Histological Features
In
histological examination, sialadenitis presents several distinctive features. Acute sialadenitis is characterized by the infiltration of neutrophils, edema, and sometimes abscess formation. In chronic sialadenitis, you will observe lymphocytic infiltration, acinar atrophy, and fibrosis.
Types of Sialadenitis
There are several types of sialadenitis, each with unique histological characteristics: Acute Bacterial Sialadenitis: Often caused by bacterial infections such as Staphylococcus aureus, it shows intense neutrophilic infiltration and sometimes necrosis.
Chronic Sialadenitis: Characterized by lymphocytic infiltration, acinar atrophy, and fibrosis. This can be due to chronic infections or autoimmune conditions like
Sjogren's syndrome.
Granulomatous Sialadenitis: Caused by conditions like tuberculosis and sarcoidosis, it shows granuloma formation with multinucleated giant cells.
Pathogenesis
The pathogenesis of sialadenitis involves multiple factors such as bacterial or viral infections, autoimmune reactions, and blockage of salivary ducts. The blockage can be due to
sialoliths (salivary stones), mucus plugs, or tumors. The resultant stasis of saliva predisposes the gland to secondary infections.
Clinical Manifestations
Clinically, sialadenitis presents with pain, swelling, and sometimes fever. On palpation, the affected gland may feel firm, and pus may be expressed from the duct orifice. In chronic cases, the gland might be hard due to fibrosis.
Diagnosis
Diagnosis is often made based on clinical examination and confirmed with histological studies. Imaging techniques like ultrasonography, CT, or MRI can also be useful. Fine needle aspiration cytology (FNAC) and biopsy are commonly used for histological examination.
Treatment
Treatment depends on the underlying cause. Acute bacterial sialadenitis is treated with antibiotics and sometimes surgical drainage. Chronic sialadenitis may require addressing the underlying autoimmune condition and managing symptoms with salivary substitutes and gland massage. In cases caused by blockages, removal of the obstruction is necessary.
Prognosis
The prognosis of sialadenitis varies. Acute cases usually resolve with appropriate treatment, but chronic sialadenitis can lead to persistent symptoms and gland dysfunction. Complications like abscess formation, ductal stricture, and chronic pain can occur if not managed appropriately.
