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Table 1. CT Findings and Glandular Involvements of Acute Sialadenitis in 50 Child-Adolescent I (n=16) II (n=20) III (n=14) p value Abscess 8 (50.0%) 0 0 <0.05 Stone 0 9 (45.0%) 01 (7.1%) <0.05 Bilaterality 01 (6.3%) 2 (10.0%) 5 (35.7%) <0.09 Cellulitis 7 (43.8%) 5 (25.0%) 14 (100%). <0.05 Lymph node (LN) 3 (18.8%) 6 (30.0%) 6 (42.9%) <00.4 I : Involvement of parotid gland II : Involvement of submandibular gland III : Involvements of both salivary glands Table 2. Clinical Features and Glandular Involvements I (n=16) II (n=20) III (n=14) p value Age (year) 5.3 (117) 12.9 (717) 15.2 (818) <0.05 Sex (M : F) 11 : 5 14 : 6 9 : 5 0.9 Palpable LN 10/15 (66.6%) 5/16 (31.3%) 0 0.07 Pain 12 (75.0%) 10 (50.0%) 12 (85.7%) 0.08 Swelling 6/15 (40.0%) 17 (85.0%) 13 (92.9%) <0.05 Palpable mass 10 (62.5%) 5 (25.0%) 7 (50.0%) <0.05 Tonsillitis 2 (12.5%) 6 (30.0%) 2 (14.3%) 0.446 Duration of therapy 8.9 6.4 6.8 <0.05 Operation 13 (81.3%) 13 (65.0%) 13 (92.9%) 0.165 156
Fig. 1. Statistically significant difference between glandular involvements. Fig. 2. Parotid abscess in a 3 year-old girl. A. Postcontrast axial CT scan shows well enhancing thick walled abscess in the right parotid gland(arrows). B. Postcontrast coronal CT scan shows large abscess in the globular enlarged right parotid gland(arrows). A B 157
Fig. 3. Bilateral parotid sialadenitis in a 3 year-old boy. Postcontrast CT scan shows homogenous enhancement in bilateral parotid glands. It also shows no abscess associated. Fig. 5. Bilateral submandibular sialadenitis in a 17 year-old boy. Postcontrast CT scan demonstrates globular enlarged bilateral submandibular glands with homogeneous enhancement and associated lymph nodes enlargement (arrows). Fig. 4. Left submandibular sialadenitis with multiple sialolithiasis in a 18 year-old boy. A. Precontrast CT scan shows tiny stones along the left Wharton s duct (arrows). B. Postcontrast CT scan shows globular enlarged left submandibular gland. A B 158
Fig. 6. Sialadenitis in the right parotid and bilateral submandibular glands in a 9 year-old boy. A. Postcontrast CT scan shows a globular enlarged right parotid gland with homogenous enhancement, compared to normal left side. B. Postcontrast CT shows bilateral globular enlarged submandibular glands with homogeneous enhancement. Multiple lymph nodes, linear, ill-defined infiltration in the subcutaneous fat layer and thickened fascia are around submandibular glands. A B 1. Even-Tov E, Niv A, Kraus M, Nash M. Candida parotitis with abscess formation. Acta Otolaryngol 2006;126:334-336 2. Ueta E, Tanida T, Doi S, Osaki T. Regulation of Candida albicans growth and adhesion by saliva. J Lab Clin Med 2000;136:66-73 3. Krippaehne WW, Hunt TK, Dunphy JE. Acute suppurative paroti- 159
tis: a study of 161 cases. Ann Surg 1962;156:251-257 4. Brook I. Aerobic and anaerobic microbiology of suppurative sialadenitis. J Med Microbiol 2002;51:526-529 5. Bova R, Walker P. Neonatal submandibular sialadenitis progressing to submandibular gland abscess. Int J Pediatr Otorhinolaryngol 2000;53:73-75 6. Som PM, Curtin HD. Head and Neck Imaging. 4th Ed. St Louis: Mosby, 2003;2026-2029 7. Bryan RN, Miller RH, Ferreyro RI, Sessions RB. Computed tomography of the major salivary glands. AJR Am J Reontgenol 1982;139:547-554 8. Mandel L, Bijoor R. Imaging (computed tomography, magnetic resonance imaging, ultrasound, sialography) in a case of recurrent parotitis in children. J Oral Maxillofac Surg 2006;64:984-988 9. Williams MF. Sialolithiasis. Otolaryngol Clin North Am 1999;32: 819-834 10. Huisman TA, Holzmann D, Nadal D. MRI of chronic recurrent parotitis in childhood. J Comput Assist Tomogr 2001;25:269-273 11. Becker M, Marchal F, Becker CD, Dulguerov P, Georgakopoulos G, Lehmann W, et al. Sialolithiasis and salivary ductal stenosis: diagnostic accuracy of MR sialography with a three-dimensional extended-phase conjugate-symmetry rapid spin-echo sequence. Radiology 2000;217:347-358 12. Mandel L, Hatzis G. The role of computerized tomography in the diagnosis and therapy of parotid stones: a case report. J Am Dent Assoc 2000;131:479-482 13. Laskawi R, Schaffranietz F, Arglebe C, Ellies M. Inflammatory diseases of the salivary glands in infants and adolescents. Int J Pediatr Otorhinolaryngol 2006;70:129-136 14. Stong BC, Sipp JA, Sobol SE. Pediatric parotitis: a 5-year review at a tertiary care pediatric institution. Int J Pediatr Otorhinolaryngol 2006;70:541-544 15. Saarinen RT, Kolho KL, Pitkaranta A. Cases presenting as parotid abscesses in children. Int J Pediatr Otorhinolaryngol 2007;71:897-901 16. Nahlieli O, Eliav E, Hasson O, Zagury A, Baruchin AM. Pediatric sialolithiasis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:709-712 17. Leung AK, Choi MC, Wagner GA. Multiple sialoliths and a sialolith of unusual size in the submandibular duct: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:331-333 18. Lustmann J, Regev E, Melamed Y. Sialolithiasis: a survey of 245 patients and a review of the literature. Int J Oral Maxillofac Surg 1990;19:135-138 19. Chung MK, Jeong HS, Ko MH, Cho HJ, Ryu NG, Cho DY, et al. Pediatric sialolithiasis: what is different from adult sialolithiasis? Int J Pediatr Otorhinolaryngol 2007;71:787-791 20. Waseem Z, Forte V. An unusual case of bilateral submandibular sialolithiasis in a young female patient. Int J Pediatr Otorhinolaryngol 2005;69:691-694 21. Faure F, Querin S, Dulguerov P, Froehlich P, Disant F, Marchal F. Pediatric salivary gland obstructive swelling: sialendoscopic approach. Laryngoscope 2007;117:1364-1367 22. Lee YY, Wong KT, King AD, Ahuja AT. Imaging of salivary gland tumours. Eur J Radiol 2008;66:419-36 23. Laikui L, Hongwei L, Hongbing J, Zhixiu H. Epithelial salivary gland tumors of children and adolescents in west China population: a clinicopathologic study of 79 cases. J Oral Pathol Med 2008;37:201-5 24. Lowe LH, Stokes LS, Johnson JE, Heller RM, Royal SA, Wushensky C, et al. Swelling at the angle of the mandible: imaging of the pediatric parotid gland and periparotid region. Radiographics 2001;21:1211-1227 160
Acute Sialadenitis in Children and Adolescents: CT Findings and Clinical Manifestations according to Glandular Involvement 1 A Leum Lee, M.D., Young Tong Kim, M.D. 2, Jong Kyu Han, M.D. 2, Sung Shick Jou, M.D. 2, Du Shin Jung, M.D. 3 1 Department of Radiology, Soonchunhyang University Bucheon Hospital 2 Department of Radiology, Soonchunhyang University Chunan Hospital 3 Department of Neurology, Soonchunhyang University Chunan Hospital Purpose: This study was designed to compare the CT findings and clinical manifestations in children and adolescents with acute sialadenitis according to the involved salivary glands. Materials and Methods: The study included fifty children and adolescents (34 boys, 16 girls) with acute sialadenitis that was diagnosed during the past five years. All of the subjects were divided into three groups: group I (parotid gland involvement, n = 16), group II (submandibular gland involvement, n = 20) and group III (involvement of both glands, n = 14). We analyzed the presence of an abscess, sialolith, bilaterality, cellulitis and lymphadenopathy on CT scans. The analyzed clinical data were age, sex, lymphadenopathy, pain, swelling, presence of a mass, tonsillitis, treatment period and surgical treatment if it was performed. Results: The presence of an abscess, sialolith, cellulitis, swelling, age, presence of a palpable mass and treatment period were statistically significant factors for the patients in the three groups. An abscess was combined only in group I patients. There was a high rate of sialolith in group II patients and cellulitis in group III patients as seen on CT scans. Swelling in group II patients and group III patients and the presence of a palpable mass in group I patients were identified as clinical manifestations. Age was younger in group I patients (mean age, 5.3 years) than in group II patients (mean age, 12.9 years) and group III patients (mean age, 15.2 years). The treatment period was longer for group I patients. Conclusion: For acute sialadenitis in children and adolescents, age, presence of an abscess, sialolith, cellulitis, swelling, presence of a palpable mass and treatment period were different according to the involved salivary glands. Index words : Tomography Salivary glands diseases Child Adolescent Address reprint requests to : Young Tong Kim, M.D., Department of Radiology, Soonchunhyang University Chunan Hospital Bongmyung-dong, Chunan-si, Chungnam 330-721, Korea. Tel. 82-41-570-3513 Fax. 82-41-572-9026 E-mail: ytokim@schch.co.kr 161