A bacterial salivary gland infection (sialadenitis) is usually based on a duct obstruction by saliva stones or Hyposecretion. As symptoms a painful or pressure-sensitive swelling and redness. The diagnosis is made clinically. CT, ultrasound and MRI can help in finding the cause. Treatment is with antibiotics.
A bacterial salivary gland infection (sialadenitis) is usually based on a duct obstruction by saliva stones or Hyposecretion. As symptoms a painful or pressure-sensitive swelling and redness. The diagnosis is made clinically. CT, ultrasound and MRI can help in finding the cause. Treatment is with antibiotics. Etiology A Sialadenitis usually occurs as a result of Hyposecretion or obstruction of an excretory duct, but can also develop for no apparent reason. Of the major salivary glands (parotid, submandibular glands and sublingual) most commonly the parotid gland is affected. The Sialadenitis is most common in the parotid gland and usually occurs in patients in their 50s and 60s Chronically ill patients with xerostomia patients with Sjögren’s syndrome adolescents and young adults with anorexia Staphylococcus aureus is the most common pathogen, next to still play streptococci, coliforms and various anaerobic bacteria play a role. An inflammation of the parotid gland can also develop in patients who had Although sometimes described as Sialadenitis radiotherapy of the oral cavity or radioiodine therapy to thyroid cancer, this inflammation is rare bacterial infection, especially if no fever occurs. Symptoms and discomfort accompanied by fever and chills, a unilateral painful salivary gland swelling develops. Under the reddened, swollen edematous skin, the diffuse touch-sensitive gland feels hard. Under pressure pus often exits the gland duct, from which you should create a culture. A focal enlargement could indicate a Drüsenabszess. Diagnostic CT, ultrasound or MRI if the diagnosis clinically does not clearly provide help CT, ultrasound and MRI to detect a Sialadenitis or an abscess; an obstructive stone in ductal is with MRI does not, however, be evident. If pus can be expressed from the duct of the gland in question, it is returned for Gram staining and for applying a culture. Therapy staphylococci-effective antibiotics Local measures (z. B. Sialagoga, warm compresses) After initial treatment (with a S. aureus-effective antibiotic z. B. dicloxacillin, 4 times 250 mg / day po, a cephalosporin of the first generation or clindamycin ) is modified according to the therapy as soon as the results of the culture are present. The increasing prevalence of methicillin resistant S. aureus (MRSA) – especially among the elderly in nursing homes – often makes the administration of vancomycin required. Mouthwashes me Chlorhexidine 0.12% to 3 times daily to reduce the bacterial load in the oral cavity and support the Miundhygiene. it is important also for adequate hydration, stimulation of the salivary flow (with Sialagoga, z. B. lemon juice, lozenges, or the like, warm compresses, glands massage) and good oral hygiene care. Abscesses must be drained by drainage. In chronic or recurrent sialadenitis sometimes a superficial parotidectomy or excision of the submandibular gland is indicated. Other infections of the salivary gland often leads to a mumps parotid swelling (see Table: Causes of the parotid or other salivary gland enlargement). In HIV-infected patients, the parotid gland can often be increased by one or more lymphoepithelial cysts. As it often leads to an invasion parotisnaher lymph nodes in the cat-scratch disease, which is caused by a Bartonella infection, the parotid gland may become infected by a pathogen dissemination in the immediate vicinity. Although the cat scratch disease is self-limiting, it is often treated with antibiotics; if nevertheless forms an abscess, it must be opened and emptied. From an infection in the tonsils or teeth atypical mycobacteria can spread to adjacent salivary glands. The tuberculin test may be negative, and the diagnosis a biopsy and tissue culture for acid-fast bacilli may be necessary. The therapeutic recommendations diverge. As options, surgical debridement with curettage, complete excision of the infected tissue and a Antituberkulotikatherapie to (rarely necessary) offer.