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Submandibular Sialadenitis
Carmen C. Cho, MBBS, FRCR; Evelyn W. K. Tang, MBBS, FRCR; Anil T. Ahuja, MD, FRCR
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Diagnostic Checklist

        TERMINOLOGY

        • Abbreviations

          • Submandibular gland (SMG) sialadenitis
        • Definitions

          • SMG sialadenitis: SMG inflammation ± submandibular (SM) duct calculus or stenosis
          • Acute sialadenitis (AS): Acute SMG inflammation; SM > > parotid involvement
            • Most common organism is Staphylococcus aureus
              • Others include Streptococcus viridans, Haemophilus influenzae, and Escherichia coli
          • Chronic sialadenitis (CS): Chronic SMG inflammation
            • Associated with conditions linked to ↓ salivary flow, including calculi and salivary stasis
          • Chronic sclerosing sialadenitis (CSS), Kuttner tumor
            • Tumor-like condition of salivary glands, SM > parotid involvement
            • Periductal sclerosis, lymphocytic infiltration, reduction of secretory gland parenchyma, fibrosis, associated sialolithiasis (30-83%)
          • Secondary SMG sialadenitis: SMG inflammation resulting from ductal obstruction from anterior floor of mouth (FOM) squamous cell carcinoma
            • Swollen SMG often mistaken for malignant node
          • Sialolithiasis: Formation and deposition of concretions within SMG ductal system
            • Secondary to salivary stagnation, precipitation of calcium salts ± epithelial injury along duct leading to sialolith formation (nidus for stone formation)
          • Autoimmune sialadenitis: Sialadenitis associated with autoimmune diseases
            • Autoimmune diseases (e.g., Sjögren syndrome) associated with salivary gland enlargement, keratoconjunctivitis sicca, and xerostomia (dry mouth)
          • Sialadenosis: Nonneoplastic noninflammatory swelling with acinar hypertrophy ± ductal atrophy
            • Can be inflammatory, autoimmune, drug induced, endocrine, or metabolic

        IMAGING

        • General Features

          • Ultrasonographic Findings

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Other Modality Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Orlandi MA et al: Ultrasound in sialadenitis. J Ultrasound. 16(1):3-9, 2013
                                        2. Harnsberger HR et al: Diagnostic Imaging: Head & Neck. 1st ed. Salt Lake City: Amirsys. III-4-22-25, 2004
                                        3. Terraz S et al: How reliable is sonography in the assessment of sialolithiasis? AJR Am J Roentgenol. 201(1):W104-9, 2013
                                        4. Ahuja AT et al: Kuttner tumour (chronic sclerosing sialadenitis) of the submandibular gland: sonographic appearances. Ultrasound Med Biol. 29(7):913-9, 2003
                                        5. Kalinowski M et al: Comparative study of MR sialography and digital subtraction sialography for benign salivary gland disorders. AJNR Am J Neuroradiol. 23(9):1485-92, 2002
                                        6. Ching AS et al: Comparison of the sonographic features of acalculous and calculous submandibular sialadenitis. J Clin Ultrasound. 29(6):332-8, 2001
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Diagnostic Checklist

                                              TERMINOLOGY

                                              • Abbreviations

                                                • Submandibular gland (SMG) sialadenitis
                                              • Definitions

                                                • SMG sialadenitis: SMG inflammation ± submandibular (SM) duct calculus or stenosis
                                                • Acute sialadenitis (AS): Acute SMG inflammation; SM > > parotid involvement
                                                  • Most common organism is Staphylococcus aureus
                                                    • Others include Streptococcus viridans, Haemophilus influenzae, and Escherichia coli
                                                • Chronic sialadenitis (CS): Chronic SMG inflammation
                                                  • Associated with conditions linked to ↓ salivary flow, including calculi and salivary stasis
                                                • Chronic sclerosing sialadenitis (CSS), Kuttner tumor
                                                  • Tumor-like condition of salivary glands, SM > parotid involvement
                                                  • Periductal sclerosis, lymphocytic infiltration, reduction of secretory gland parenchyma, fibrosis, associated sialolithiasis (30-83%)
                                                • Secondary SMG sialadenitis: SMG inflammation resulting from ductal obstruction from anterior floor of mouth (FOM) squamous cell carcinoma
                                                  • Swollen SMG often mistaken for malignant node
                                                • Sialolithiasis: Formation and deposition of concretions within SMG ductal system
                                                  • Secondary to salivary stagnation, precipitation of calcium salts ± epithelial injury along duct leading to sialolith formation (nidus for stone formation)
                                                • Autoimmune sialadenitis: Sialadenitis associated with autoimmune diseases
                                                  • Autoimmune diseases (e.g., Sjögren syndrome) associated with salivary gland enlargement, keratoconjunctivitis sicca, and xerostomia (dry mouth)
                                                • Sialadenosis: Nonneoplastic noninflammatory swelling with acinar hypertrophy ± ductal atrophy
                                                  • Can be inflammatory, autoimmune, drug induced, endocrine, or metabolic

                                              IMAGING

                                              • General Features

                                                • Ultrasonographic Findings

                                                  • Radiographic Findings

                                                    • CT Findings

                                                      • MR Findings

                                                        • Other Modality Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Gross Pathologic & Surgical Features

                                                                  • Microscopic Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Orlandi MA et al: Ultrasound in sialadenitis. J Ultrasound. 16(1):3-9, 2013
                                                                              2. Harnsberger HR et al: Diagnostic Imaging: Head & Neck. 1st ed. Salt Lake City: Amirsys. III-4-22-25, 2004
                                                                              3. Terraz S et al: How reliable is sonography in the assessment of sialolithiasis? AJR Am J Roentgenol. 201(1):W104-9, 2013
                                                                              4. Ahuja AT et al: Kuttner tumour (chronic sclerosing sialadenitis) of the submandibular gland: sonographic appearances. Ultrasound Med Biol. 29(7):913-9, 2003
                                                                              5. Kalinowski M et al: Comparative study of MR sialography and digital subtraction sialography for benign salivary gland disorders. AJNR Am J Neuroradiol. 23(9):1485-92, 2002
                                                                              6. Ching AS et al: Comparison of the sonographic features of acalculous and calculous submandibular sialadenitis. J Clin Ultrasound. 29(6):332-8, 2001