SALIVARY GLAND DISEASES IN CHILDREN

SALIVARY GLAND DISEASES in children are not a common occurrence. Clinical examination and investigations need to be carried out to determine whether the presentation is due to salivary gland cysts , inflammation or tumors.

Diseases of the salivary glands in children usually presents as salivary gland swelling which can be due to inflammatory processes, autoimmune destruction, duct translocation or obstruction among other processes.

Malignant parotid gland tumors are especially rare/ virtually absent in infants and adolescents. These are much more common in the juvenile population.

Acute and chronic sialadenitis due to viral and bacterial infections , Obstruction and inflammation associated with sialolithiasis are the most common causes in the small number of cases that present in this manner.

Inflammatory salivary gland diseases associated commonly with infections and benign neoplasms, are the most common cause of salivary gland swelling in children.

Bacterial causes of salivary gland infections commonly include group A strep and Staphylococcus aureus. Viral causes are parotitis epidemica and cytomegaly.

Sialolithiasis again is an extremely rare entity in infants. In a clinical review over a period of approx 100 years there were 21 cases of sialolithiasis of the submandibular gland  documented in children between age 3 weeks and 15 years of age. The most common presentation is a painful swelling of the affected gland in this population of patients.

Salivary gland inflammatory disorders are extremely rare in neonates. The cases that do get reported have one common factor, PRE TERM BABIES. There are also reports of maternal use of methyldopa being related to the development of subsequent parotitis.

A practical approach in this regard would be to take a proper history and clinically examine the swelling. The mother should be asked about the appearance of the swelling and its progression till date. Drug history w.r.t the pregnancy period should also be obtained including any past medical history of the mother and child e.g exposure to radiation etc.

On examination the exact location should be ascertained. The texture of the swelling should be determined whether its hard, soft, smooth, granular or irregular. Tenderness and erythema should be looked for. Trans illumination testing can be done if the location of the swelling permits. Systemic signs and symptoms should be looked for including fever , irritability and general outlook of the child.

Complete blood count should be done to look for a possibly raised TLC  (total leucocyte count) with left shift. ESR (Erythrocyte Sedimentation Rate) should also be done as its a marker of inflammation. Ultrasound of the swelling should be advised to determine whether its a cyst or a node or an enlarged gland. Integrity of the surrounding structures is also looked for.

If the swelling persists or increases in size or the ultrasound findings remain inconclusive or suspicious for neoplastic cause then the swelling should be biopsied to determine its nature. An excisional biopsy is much better than FNAC (Fine Needle Aspiration Cytology) in this regard as its more sensitive and specific.