Diseases of the salivary glands

Sialadenosis

• Pathophysiology: Non-inflammatory, non-neoplastic acinar cell hypertrophy secondary to autonomic neurodysfunction.
• Etiologies & Risk Factors:
  • Chronic alcohol use disorder (AUD) / Alcoholic cirrhosis. c
  • Eating disorders: Bulimia nervosa (binge-purge cycle), anorexia nervosa, severe malnutrition.
  • Metabolic/Endocrine: Diabetes mellitus (DM), metabolic syndrome.
• Clinical Presentation:
  • Bilateral, symmetric, painless swelling of salivary glands (predominantly parotid glands).
  • Exam: Glands are soft-to-firm, non-tender, non-erythematous; no fever, no purulent discharge (clear saliva).
  • Stigmata of underlying disease: Russell sign / dental erosion (Bulimia), palmar erythema / spider angiomas (AUD/Cirrhosis).
• Diagnosis:
  • Primary approach: Clinical diagnosis based on exam + predisposing history.
  • Targeted Labs: BMP (hypokalemia, metabolic alkalosis in purging), LFTs (AUD), HbA1c (DM), serum amylase.
  • Imaging/FNA: Only indicated if atypical features (e.g., unilateral mass, rapid enlargement) to exclude neoplasm.
• High-Yield Differentials:
  • Suppurative Sialadenitis: Unilateral, exquisitely painful, fever, purulent ductal discharge (S. aureus).
  • Sialolithiasis: Postprandial colicky pain and swelling; predominantly submandibular gland.
  • Sjögren Syndrome: Bilateral swelling + sicca symptoms (xerophthalmia, xerostomia) + (+) anti-Ro/SSA & anti-La/SSB.
  • Salivary Gland Neoplasm: Unilateral, discrete, hard/firm nodule ± CN VII palsy.
• Management:
  • First-line: Treat the underlying etiology (alcohol cessation, CBT for bulimia, glycemic control for DM).
  • Supportive: Sialogogues (sour lozenges), oral hygiene, warm compresses.
  • Refractory/Cosmetic only: Intraglandular botulinum toxin or partial parotidectomy (rare).