Salivary Gland Enlargement

Salivary gland enlargement in pediatric patients is usually associated with an inflammatory or infectious process. Benign tumors are more common than malignancies, but the probability for malignancy in a solid mass is higher in children than adults. Facial nerve weakness is highly suggestive of malignancy.

Differential Diagnosis

• Congenital
  –First branchial cleft cyst
  –Retention cyst
  –Ectopic rests of salivary tissue
• Infectious/inflammatory
  –Mumps (before immunization) was the most common salivary gland inflammatory disease
  –HIV
  –Coxsackie A
  –Echovirus
  –Viral sialoadenitis
  –Acute bacterial sialoadenitis: Typically Staphylococcus aureus or Streptococcus viridans
  –Sialolithiasis
  • Vascular lesions
    –Hemangiomas: Most common salivary gland mass in children
    –Lymphangioma
  • Benign tumors
    –Pleomorphic adenomas: Most common solid benign tumor
    –Warthin tumors
    –Oncocytoma
    –Adenomas
  • Malignant tumors
    –Mucoepidermoid carcinoma: Most common
    –Acinic cell carcinoma
    –Adenoid cystic carcinoma
    –Undifferentiated carcinoma
    –Lymphoma
    –Rhabdomyosarcoma
    –Squamous cell carcinoma
  • Trauma (may often be associated with facial nerve injury)
  • Systemic diseases
    –Diffuse bilateral salivary gland enlargement: often associated with diabetes mellitus, cystic fibrosis, thyroid disease, malnutrition, obesity, autoimmune disorders (Sjögren)
    –Granulomatous disease: tuberculosis, atypical Mycobacterium, sarcoidosis, cat-scratch disease
    • Drugs such as methimazole, thiourea, phenothiazine, thiocyanate

    Workup and Diagnosis

    • History
      –Duration, onset, pain, change in size with meals, prior history of recent weight loss or gain, joint tenderness
      –Past medical history of systemic disease: CF, diabetes, autoimmune disorders
      –Exposure: Immunization, radiation, cat-scratch disease
    • Physical exam
      –Size, character: Firm, soft, cystic, tenderness, warmth, redness, bilaterality, oral cavity exam, pus from Stenson or Wharton duct, palpable stone, neck mass, facial nerve function (paresis or paralysis is highly suggestive of malignancy)
    • Culture of drainage may guide antibiotic therapy
    • Plain film X-rays: Limited utility but may identify salivary duct stone; 80–90% of submandibular stones are radio-opaque
    • Ultrasound: May differentiate between cystic and solid lesions, ductal dilations, and intra- and extraparenchymal lesions
    • CT or MRI: Provides better resolution of salivary gland lesions and surrounding tissues; MRI gives superior details for salivary gland neoplasms
    • Fine-needle aspiration: 90% sensitivity and 95–100% specificity for identifying malignancy with experienced pathologist
    • Sialography: Limited in children, contraindicated in acute infections

    Treatment

    • Supportive treatment for viral adenitis
    • Bacterial sialoadenitis requires antibiotic therapy with warm compresses and sialogogues to help promote salivary flow; IV antibiotic therapy may be required in severe cases
    • Sialolithiasis is treated with surgical excision of the stone or the gland
    • Hemangiomas are simply observed unless rapid growth, functional impairment, infection, bleeding, or severe cosmetic deformity is present
    • Tumors are treated surgically
      –Parotid neoplasms that are lateral are treated with superficial parotidectomy; submandibular neoplasms require total submandibular gland excision
      –If malignancy is suspected, neck dissection is performed when palpable lymphadenopathy is present and considered for high-grade lesions
      –Possible radiation therapy based on final pathology

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Swollen neck lymph nodes

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Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Swollen neck lymph nodes

• Back to symptom: Swollen neck lymph nodes: Introduction (review 58 causes)
• Next Book Extract About Swollen neck lymph nodes: NECK PAIN (Differential Diagnosis in Primary Care)
• All Book Extracts: All Online Book Extracts for Swollen neck lymph nodes

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: NECK PAIN (Differential Diagnosis in Primary Care)

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