Submandibular Gland Sialadenitis Secondary to Submandibular Calculus

A. Mahalakshmi

Physician Assistant, Kauvery Hospital, Cantonment, Trichy

Abstract

Various conditions impact the salivary glands, with sialadenitis representing an infectious or inflammatory disorder that can manifest as acute or chronic. The precise prevalence of submandibular sialadenitis remains uncertain. Acute cases often involve the parotid and submandibular glands, with 10% occurring in the submandibular gland. This report details a resistant case of submandibular gland sialadenitis in a 27-year-old male, successfully managed surgically after unsuccessful medical treatment, with no postoperative complications.

Background

Salivary gland conditions affect diverse tissues, affecting both adults and children, with increased susceptibility in the elderly and dehydrated individuals. Sialadenitis can result from bacterial or viral infections, reduction in saliva production, allergic reactions, trauma, and autoimmune disorders. Symptoms include swelling, pain, gland tenderness, fever, and occasional difficulty in mouth opening. Pain exacerbates during eating, stimulating saliva flow and causing gland swelling. Initial treatment involves rehydration and oral antibiotics, with hygiene and gland massage post-tenderness alleviation. Sialolithiasis involves calculi in salivary glands or ducts, formed due to saliva stagnation and typically composed of calcium phosphate.

Case Presentation

A 27-year-old male presented with a right-sided swelling in the floor of the mouth persisting for 20 days, accompanied by pain during swallowing. Purulent discharge subsided with medication. No history of fever or speech difficulty. History includes childhood asthma. The patient adhered to a soft diet due to pain. normal sleep pattern.

 

Clinical Examination

  1. Multiple rounded swellings in the right submandibular region, extending from 1.5 cm posterior to the chin up to the angle of the mandible.
  2. Soft swelling with diffuse margins, normal skin colour, and temperature.
  3. Tender on palpation.
  4. Radiological Findings:
  5. CECT neck revealed multiple well-defined hyper-dense lesions (21.5 cm) in the right submandibular region, ductal dilatation, and lymph node enlargement (1210 cm). Final diagnosis: submandibular sialadenitis due to multiple duct calculi.

Treatment History

Started with Amoxicillin + Clavulanic acid and Paracetamol for 5 days, no significant improvement so planned for excisional therapy.

Surgical Procedure

Operated under general anesthesia with a transverse incision below the mandible. Subplatysmal flaps elevated, facial vein and gland duct ligated, and calculi removed. Postoperative antibiotics and anti-inflammatory drugs were administered. Satisfactory healing without complications.

Sialadenitis
Sialadenitis-1

Discussion

  1. Sialadenitis is a painful inflammation that occurs in repeated episodes. It may be due to decreased salivary flow due to salivary stasis. The initiating factor is salivary gland obstruction from stones. Patients with sialadenitis are evaluated with the help of proper history, and physical and Radiographic examination. Physical examination shows an enlargement of gland swelling.
  2. The radiographic diagnostic tools include CT plain and CECT, Sialography are recently introduced diagnostic method.
  3. Management of submandibular gland sialadenitis conservative management to more aggressive surgical procedure. Generally, if no cause is found, treatment is conservative. Excision of the salivary gland can be considered an extremely severe cause.
  4. Patients with any form of sialadenitis should be educated as to the value of hydration and oral hygiene. If sialadenitis is refractory to medical therapy then surgical intervention should be done.

Gland-wise distribution

  1. 80-90% Submandibular gland
  2. 6-20% Parotid
  3. 1-2% Sublingual and minor salivary glands.

Sialadenitis, marked by painful inflammation, may result from decreased salivary flow and gland obstruction. Evaluation involves history, physical examination, and radiographic tools such as CT and CECT. Management ranges from conservative to surgical, depending on severity and causative factors.

Conclusion

Patients with sialadenitis should prioritize hydration and oral hygiene. Surgical intervention is considered refractory to medical therapy, especially in severe cases. Education on preventive measures is crucial for managing and preventing recurrence.

A.-Mahalakshmi

A. Mahalakshmi

Physician Assistant

Journals

Kauvery Hospital
Find Doctor
Book Appointment