Acute Submandibular Sialadenitis

Several bacteria have been isolated in infectious submandibular sialadenitis, the most common pathogens being Staphylococcus aureus. However, streptococci, Pseudomonas aeruginosa, Moraxella catarrhalis, and Escherichia coli bacteria have also been identified in cases of infectious submandibular sialadenitis.⁵

Viral etiologies of sialadenitis, such as mumps, are generally bilateral and nonsuppurative. The human immunodeficiency virus can also cause bilateral nonsuppurative salivary gland infections.⁶

Imaging Studies

As illustrated in our case, CT imaging can assist in confirming the diagnosis of acute submandibular sialadenitis by defining the anatomic involvement and identifying the presence of an abscess. Ultrasound can also be used and has been described as a first-line imaging procedure.^7,8

Treatment

Surgical Intervention. Abscesses may require surgical intervention. However, most cases without abscess formation respond to outpatient treatment with antibiotics.⁵ If ductal obstruction is identified, removal of the calculus may be needed. This may involve ductal dilation, sialolithectomy, or even ductoplasty if a stricture is identified.¹

Antibiotic Therapy. With respect to antibiotic selection, Chandak et al⁵ recommend oral amoxicillin-clavulanic acid. Other antistaphylococcal coverage recommendations have been made in the literature. Gland massage may be helpful after the tenderness has resolved,⁵ and sialogogues (eg, lemon drops, vitamin C lozenges) can also provide some relief.⁶ In addition, to avoid disease recurrence and prevent dental complications, Chandak et al⁵ emphasize the crucial role of hydration and excellent oral hygiene.

Conclusion

We suspected acute submandibular sialadenitis in our patient based on clinical findings, which were confirmed on CT imaging. Patients with acute submandibular sialadenitis may present with submandibular gland obstruction in the absence of bacterial infection. Noninfectious obstruction typically presents as pain associated with eating and swallowing, whereas infectious cases include constant pain and tenderness in the affected area. In addition, patients with infectious etiology may also have purulent discharge from Wharton’s duct, fever, chills, and an elevated WBC. Several bacteria have been isolated, the most common being S aureus. However, streptococci, P aeruginosa, M catarrhalis and E coli have also been identified. Computed tomography studies are helpful in confirming the diagnosis, defining anatomical involvement, and in identifying abscess formation.

Abscesses may require surgical intervention. However, most cases without abscess formation respond to outpatient treatment with antibiotics. Antibiotic selection involves antistaphylococcal coverage, such as amoxicillin-clavulanic acid. Glandular massage may be helpful after the tenderness has resolved. In addition, the literature emphasizes the crucial role of hydration and excellent oral hygiene in disease recurrence and to prevent dental complications.