Monday 18 March 2013
Decreased salivary flow with stasis is a key factor in chronic sialadenitis. Like acute sialadenitis, this condition is more common in the parotid gland. Its development is often associated with a previous episode of acute suppurative inflammation with subsequent glandular destruction. Another possibility is the recurrent parotitis of childhood which has continued into adulthood.
With the onset of the chronic inflammatory process, alterations in salivary chemistry and enzyme and immunoglobulin content take place.
Sialectasis, ductal ectasia, and acinar atrophy occur, accompanied by a lymphocytic infiltrate.
Symptoms include recurrent mildly painful swelling of the parotid which often accompany eating. Approximately 80% of patients experience permanent xerostomia.
Treatment is initially conservative with acute exacerbations treated similarly to acute sialadenitis.
A thorough search is made for treatable predisposing factors such as a calculus or stricture. If conservative measures fail, ductal dilatation, ligation of the duct, tympanic neurectomy, irradiation of the gland, or excision of the gland may be performed. Only the last of these has been predictably effective.