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Sialosis / Sialadenosis
What is it?
‘Sialadenosis’ is a non-specific term used to describe an
uncommon, benign, non-inflammatory, non-neoplastic
enlargement of a salivary gland, usually the parotid gland
but occasionally affects the submandibular glands and
rarely, the minor salivary glands.
This enlargement is bilateral, symmetrical and painless (it
is often painless but not invariably so).
In general, the enlargement is asymptomatic and the cause
is idiopathic.
In this disorder, both parotid glands may be diffusely
enlarged with only modest symptoms. Patients are aged
30 - 69 years at onset and the sexes are equally involved.
The glands are soft and non-tender.
What is it?
‘Sialadenosis’ is a non-specific term used to describe an
uncommon, benign, non-inflammatory, non-neoplastic
enlargement of a salivary gland, usually the parotid gland
but occasionally affects the submandibular glands and
rarely, the minor salivary glands.
This enlargement is bilateral, symmetrical and painless (it
is often painless but not invariably so).
In general, the enlargement is asymptomatic and the cause
is idiopathic.
In this disorder, both parotid glands may be diffusely
enlarged with only modest symptoms. Patients are aged
30 - 69 years at onset and the sexes are equally involved.
The glands are soft and non-tender.
| Photos of Sialosis / Sialadenosis |
Causes:
Several causes have been recorded, most of which are
associated with (mal)nutrition, metabolism or drugs and
have a unifying feature in autonomic neuropathy.
Changes in salivary aquaporin water channels may also
be involved.
Drugs
Among the wide range of drugs that may induce sialosis,
anti-hypertensive agents are prominent.
Endocrine (Hormonal)
Nutritional Disorders
Any disorder that affects the digestion of food or its
absorption over a prolonged period, can result in sialosis,
and malnutrition may contribute to sialosis in alcoholics.
Multiple emetic episodes (bulimia) cause an autonomic
neuropathy. With sympathetic nerve impairment,
individual acinar cells enlarge because of zymogen
granule engorgement.
One explanation is that the sympathetic nerve supply to
the secreting acinar cell is concerned with the production
and secretion of zymogen, the precursor of amylase.
Because of sympathetic nerve dysfunction, there may be
an increase in zymogen storage in the cell, owing to
increased production, decreased secretion of the granules
or both. The ensuing cellular enlargement, which is
evidenced by fine-needle aspiration biopsy and electron
microscopy, leads to the clinically visible gland
enlargement.
Clinical Findings:
Soft, painless, general enlargement of both parotids.
Investigations & Imaging:
Blood Tests:
Sialochemistry:
Ultrasound, MRI & Sialography:
Helps differentiate space occupying lesions
Biopsy:
Rarely indicated. If done, the biopsy shows the acinar
cells to be enlarged to almost twice the normal diameter
and the cytoplasm packed with enzyme granules.
Treatment:
None necessary.
Sialosis may resolve if diabetes mellitus- & alcoholism-
related sialosis is treated
If the glands are disfiguring, superficial parotidectomy to
improve the appearance could be considered (though
seems a bit radical). By the same token, anorexic or
bulimic patients may attend seeking advice about surgical
removal of the glands. The anorexia or bulimia would
need to be treated before any such surgery could be
contemplated.
Useful Articles:
J Am Dent Assoc 1997. Alcoholic parotid sialadenosis
J Oral Maxillofac Surg 2002. Sialadenosis Associated
With Diabetes Mellitus - A Case Report
J Am Dent Assoc 2004. Case report. Diagnosing bulimia
nervosa with parotid gland swelling
J Oral Maxillofac Surg 2005. Alcoholic (Beer) Sialosis
BJOMS 2008. Sialosis - 35 cases of persistent parotid
swelling from two countries
Useful Website:
Emedicine.com
Several causes have been recorded, most of which are
associated with (mal)nutrition, metabolism or drugs and
have a unifying feature in autonomic neuropathy.
Changes in salivary aquaporin water channels may also
be involved.
Drugs
Among the wide range of drugs that may induce sialosis,
anti-hypertensive agents are prominent.
- Alcohol abuse ± liver cirrhosis + hepatic steatosis
and alcoholic hepatitis. (Previous reports have
indicated that between 30% and 80% of patients with
alcoholic cirrhosis have sialosis but, if that were
universally true, one would expect sialosis to be seen
more often than it is) - Sympathomimetics such as isoprenaline
- Phenylbutazone
- Anti-thyroids & phenothiazines
Endocrine (Hormonal)
- Diabetes Mellitus (reported prevalence of sialosis in
diabetes ranging from 10% to 80%) - Pregnancy
- Acromegaly
- Following oophorectomy
Nutritional Disorders
Any disorder that affects the digestion of food or its
absorption over a prolonged period, can result in sialosis,
and malnutrition may contribute to sialosis in alcoholics.
- Malnutrition - pellagra or kwashiorkor
- Cystic Fibrosis & pancreatitis
- Anorexia Nervosa
- Bulimia
Multiple emetic episodes (bulimia) cause an autonomic
neuropathy. With sympathetic nerve impairment,
individual acinar cells enlarge because of zymogen
granule engorgement.
One explanation is that the sympathetic nerve supply to
the secreting acinar cell is concerned with the production
and secretion of zymogen, the precursor of amylase.
Because of sympathetic nerve dysfunction, there may be
an increase in zymogen storage in the cell, owing to
increased production, decreased secretion of the granules
or both. The ensuing cellular enlargement, which is
evidenced by fine-needle aspiration biopsy and electron
microscopy, leads to the clinically visible gland
enlargement.
Clinical Findings:
Soft, painless, general enlargement of both parotids.
Investigations & Imaging:
Blood Tests:
- ↑ glucose levels
- Abnormal liver function tests
Sialochemistry:
- ↑ potassium levels
- ↑ calcium levels
Ultrasound, MRI & Sialography:
Helps differentiate space occupying lesions
Biopsy:
Rarely indicated. If done, the biopsy shows the acinar
cells to be enlarged to almost twice the normal diameter
and the cytoplasm packed with enzyme granules.
Treatment:
None necessary.
Sialosis may resolve if diabetes mellitus- & alcoholism-
related sialosis is treated
If the glands are disfiguring, superficial parotidectomy to
improve the appearance could be considered (though
seems a bit radical). By the same token, anorexic or
bulimic patients may attend seeking advice about surgical
removal of the glands. The anorexia or bulimia would
need to be treated before any such surgery could be
contemplated.
Useful Articles:
J Am Dent Assoc 1997. Alcoholic parotid sialadenosis
J Oral Maxillofac Surg 2002. Sialadenosis Associated
With Diabetes Mellitus - A Case Report
J Am Dent Assoc 2004. Case report. Diagnosing bulimia
nervosa with parotid gland swelling
J Oral Maxillofac Surg 2005. Alcoholic (Beer) Sialosis
BJOMS 2008. Sialosis - 35 cases of persistent parotid
swelling from two countries
Useful Website:
Emedicine.com
| Last Updated 10th May 2011 |
