Sialadenitis (a.k.a. spit gland infection, salivary gland infection, salivary stone, parotitis)
by Dr. Christopher Chang, last modified on
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Sialadenitis is when one of the spit gland(s) becomes infected resulting in sudden painful swelling in the areas denoted by the letters "B" and "C" in the image. To learn about the other areas of swelling, click here.
Area "B" corresponds to the parotid gland and area "C" corresponds to the submandibular gland (also called submaxillary gland). When the parotid gland becomes infected, the term "parotitis" may be used. The swelling can become quite enormous reaching the size of an orange with overlying skin redness and severe pain. The swelling also can fluctuate. It usually becomes much larger immediately before and during eating followed by some shrinkage between meals.
The fluctuation in swelling does not always occur, but if it does, it may be due to a blockage in the salivary duct whether due to a stone or scar tissue. Why? The best way to think of the salivary gland is a cluster of grapes with the "stem" being the duct through which saliva produced by the "grapes" travels into the mouth. When there is a blockage, there is backflow resulting in accumulation of saliva behind the blockage. When this occurs, the salivary gland swells in size. Over time (as in between meals), the body re-absorbs the access saliva and the gland shrinks back down until the next meal which again triggers the gland to produce more saliva resulting in swelling (again).
Initial treatment is as follows:
- Apply warm compresses to the enlarged area two to three times a day. After applying the warm compress, massage the gland and swollen areas. Massage in a motion working it from back to front towards the mouth.
- Suck on hard sour candy, such as lemon drops or tarts continuously. Such candy stimulates salivary production.
- Increase your plain water intake to at least two quarts a day. Try to eliminate caffeine; it works as a diuretic and can dehydrate the body.
- The gland may or may not be infected. If infected, the doctor will prescribe an antibiotic usually for as long as 3 weeks. Use the antibiotic as directed, and complete the full course even if symptoms subside
With this conservative treatment course, the symptoms should slowly subside over a period of weeks... yes... weeks (not days).
At some point as the swelling subsides, a stone may be appreciated under the jaw line or under the tongue inside the mouth. Sometimes, with massaging the area, the stone may come out in small pieces. Image taken from Wikipedia
If the stone does not come out on its own, but if close to the duct opening, a stone extraction may be considered which is a relatively simple procedure where the opening of the duct is enlarged to the point that the stone can be grabbed and removed. This procedure usually can be performed in the clinic under local anesthesia.
However, if the stone is further away from the opening, the duct may need to be incised (filleted open like a hot dog bun) in order to remove the stone. This procedure is usually performed under general anesthesia.
As a last resort, especially when the gland keeps getting infected or keeps producing stones, complete surgical excision of the gland may be recommended. There are risks involved with surgical excision including permanent tongue and lower lip paralysis (for the submandibular gland exicison) or facial paralysis (for the parotid gland excision).
Recently, in only a few centers in the United States, a minimally invasive procedure called sialendoscopy can be performed which may negate the need for surgical removal of the offending salivary gland.
Related Blog Articles
- Video of Endoscopic Salivary Stone Removal (Sialendoscopy)
- Sialendoscopy: Minimally Invasive Treatment for Salivary Gland Stones
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