Diseases of the salivary glands in infants and adolescents

Resident: Cho

Author(s): Ellies et al.

Journal: Head & Face Medicine

Year. Volume (number). Page #’s: 2010. 6. 1-7.

Major topic: Acute and Chronic Sialadenitis, Sialolithiasis, Neoplasms

Type of Article: Review Article

Main Purpose: To review salivary gland diseases in infants and adolescents.

Key points/Summary: Salivary gland diseases are rare in infants and children (with the exception of viral diseases such as parotitis epidemica aka mumps and cytomegaly – abnormal enlargement of cells). Therefore, it is difficult to establish universally valid therapeutic guidelines.

The predominant cause of parotid swelling in infancy is mumps. Evidence of Staph. Aureus with an underlying systemic disease accompanied by fever, dehydration, immunosuppression and general morbidity is seen. The predominant cause of acute swelling in the submandibular gland is due to a congenital anomaly of a salivary duct or an excretory duct obstruction. However, sialolithiasis (salivary duct stones) are rare in children. In a review covering 100 years, there were only 21 documents cases of sialolithiasis of the submandibular gland in children. As in adults, the leading symptom of sialolithiasis is painful swelling of the afflicted gland that is most painful at mealtimes. Treatment of sialolithiasis is submandibulectomy or slitting of the Wharton’s duct to remove the stones.

Acute and chronic sialadenitis (inflammation of the salivary gland) require surgical treatment most of the time. Acute forms of sialadenitis are mainly caused by viral or bacterial infections, such as group A streptococci and Staph. Aureus. In childhood, the parotid gland is most frequently affected by acute bacterial inflammation. Chronic sialadenitis are mostly caused by secretion disorders and immunological reactions. Chronic recurrent sialadenitis can heal spontaneously close to the age of puberty, however, frequent and extremely prolonged incidences require surgery. When total parotidectomy is performed to treat chronic recurrent parotitis, there is a risk of temporary facial paresis (impaired movement) and the development of Frey’s disease (sweating on one side of face when eating).

Salivary gland tumors are rare in children and adolescents compared to salivary gland inflammations. The incidences are 1 to 2 tumor cases in 100,000 persons. 79% of all benign lesions were in the parotid gland, with pleomorphic adenoma being the most common epithelial benign tumor. The most common nonepithelial benign neoplasms were hemangioma and lymphangioma. 66.6% of hemangiomas and lymphangiomas were seen in infants.

80-90% of all malignant lesions of salivary glands in children are made up by mucoepidermoid carcinomas, adenoid-cystic carcinomas, and acinic cell carcinomas. Malignant salivary gland tumors are more frequent in young persons than adults, therefore, should be diagnosed early.

Assessment of Article: Good overview of salivary gland diseases. Would have liked more information on signs and symptoms and diagnosis of the diseases. This article focused more on the treatment modalities of the diseases.