Sialosis

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Sialosis
Sialosis.jpg
Used with permission (Scully et al. 2008)[1]
  • Sialosis (sialadenosis) is a chronic, bilateral, diffuse, non-inflammatory, non-neoplastic swelling of the major salivary glands that primarily affects the parotid glands

Epidemiology[edit]

  • ♀ > ♂
  • Peak age of presentation is 30-60 years old

Clinical Features[edit]

  • Bilateral swellings usually of parotid (hamster-like)
    • Uncommonly involves submandibular gland and rarely involves minor salivary glands
  • Painless

Differential Diagnosis[edit]

  • Inflammatory conditions of salivary glands
    • Sialolithiasis and obstructive sialadenitis
    • Infective sialadenitis
    • Granulomatous disorders
    • Sjögren syndrome
    • Human immunodeficiency virus (HIV) sialopathy
    • Recurrent sialadenitis of childhood
    • Radiation-induced sialadenitis
    • Sialocele
    • Kimura and Kikuchi disease

Aetiology and Pathogenesis[edit]

Aetiology[edit]

  • Largely Unknown, but may be associated with:
    1. Diabetes mellitus
    2. Obesity
    3. Chronic alcoholism
    4. Hormonal disturbances
      • Ovarian – pregnancy and lactation
      • Thyroid – hypothyroidism
    5. Malnutrition (protein deficiencies/avitaminosis)
    6. Cirrhosis
    7. Bulimia nervosa/starvation
    8. Drugs:
      • Antihypertensives/diuretics
      • Steroids
      • Iodine
      • Isoprenaline

Investigations[edit]

  • No investigations are needed if clinical diagnosis is obvious

Imaging[edit]

  • Not usually needed if clinical diagnosis is obvious
  • Ultrasound
    • Fatty deposition in the parotid glands results in a hyperechoic gland with reduced through transmission of sound waves
  • Sialography
    • Normal
  • MRI
    • Enlarged gland
    • Varies in echotexture andattenuation depending on histological change

Histopathology[edit]

  • Acinar cell hypertrophy (granular, vacuolated, mixed)
  • Compression of striated ducts
  • Fatty replacement in long-standing cases

Other investigations[edit]

  • Largely academic:
    • Elevated salivary potassium
    • Stimulated salivary flow rate is normal

Management[edit]

  • There is no specific treatment for sialosis
  • If an underlying cause has been identified then successful treatment of that cause may reduce the swelling of the salivary glands

Prognosis and Complications[edit]

  • There is limited evidence that any particular treatment or whether addressing underlying aetiology is of notable benefit

References[edit]