Head and Neck A15


Salivary gland conditions

Acute bacterial sialadenitis is a suppurative infection of the salivary glands, most commonly the parotid gland. Patients who are elderly, debilitated, dehydrated, or postoperative are at increased risk. Additionally, patients with diabetes mellitus, poor oral hygiene and immunocompromised may develop acute sialadenitis. 

Acute bacterial sialadenitis is an ascending bacterial infection from oral cavity due to stasis of salivary flow. Medications such as diuretics, beta blockers, antidepressants, and anticholinergics can also reduce salivary flow. The most commonly cultured organism is Staphylococcus aureus. 

The initial treatment of acute bacterial sialadenitis depends on the presentation. Significant soft tissue swelling can cause airway compromise, with definitive airway management being the priority. 

First-line treatment includes a course of empiric broad-spectrum antibiotics after cultures (blood and pus from duct orifice) have been taken as well as supportive care, including hydration, pain relief, and sialagogues (medication promoting secretion of saliva). Corticosteroids and surgical drainage may be required but do not constitute first-line management. 

Patients with high fever, trismus (inability to open mouth fully), or signs of cranial nerve involvement should be admitted for intravenous antibiotics and careful monitoring for signs of airway compromise.

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