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Journal of Peking University (Health Sciences) ›› 2026, Vol. 58 ›› Issue (3): 650-657. doi: 10.19723/j.issn.1671-167X.2026.03.027

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Clinical and imaging characteristics and etiology of 544 cases with chronic sialadenitis

Jing YANG, Xiaoyun XU, Danni ZHENG, Xiaotong LING, Liuyang QU, Denggao LIU*()   

  1. Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
  • Received:2024-04-18 Online:2026-06-18 Published:2025-03-07
  • Contact: Denggao LIU

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Abstract:

Objective: To investigate the etiology of chronic sialadenitis, and to analyze their clinical and imaging characteristics. Methods: This retrospective analysis reviewed the clinical and imaging data of patients with chronic sialadenitis who underwent sialendoscopy at the Peking University Hospital of Stomatology between January 2021 and August 2023. Inclusion criteria: (1) with a history of recurrent swelling of major salivary glands; (2) complete medical records with detailed information about potential causes; (3) sialography images were available; and (4) patients had undergone interventional endoscopy. Exclusion criteria: (1) salivary stones; (2) juvenile recurrent parotitis; (3) IgG4-related sialadenitis; (4) Sjögren syndrome; and (5) neoplastic diseases. Based on the latest research results and clinical data, chronic sialadenitis was classified into radioactive iodine-induced sialadenitis (RAIS), allergy-related sialodochitis (ARS), adult chronic recurrent parotitis (ACRP), sialadenosis with sialodochitis, and idiopathic sialadenitis. Idiopathic sialadenitis was defined as a type of chronic sialadenitis with duct stenosis of unknown etiology (allergic causes, autoimmune disorders, radioactive iodine exposure, history of "parotitis" in childhood, etc.). The proportions of five types of sialadenitis were calculated, and their relationships with age, gender, type of affected glands, number of affected glands, duration of symptoms, and imaging characteristics were statistically analyzed. Results: A total of 544 consecutive patients diagnosed with chronic sialadenitis were enrolled in this study. They consisted of 192 males and 352 females, and their ages ranged from 14 to 83 years [mean age: (47.44±13.52) years]. Idiopathic sialadenitis accounted for the largest proportion (71.7%, 390 cases), followed by ARS (12.5%, 68 cases), RAIS (6.4%, 35 cases), ACRP (4.8%, 26 cases), and sialadenosis with sialodochitis (4.6%, 25 cases). Among the 2 176 available glands of the 544 patients, 1 120 (51.5%) glands were affected, including 880 (78.6%) parotid glands and 240 (21.4%) submandibular glands. These five types of sialadenitis exhibited significant differences in gender, age, type and number of affected glands, and duration of symptoms (P < 0.05). Among them, RAIS patients showed the lowest male to female ratio (male ∶ female=1 ∶ 4.83), ARCP patients were the youngest [(32.50±8.60) years], and RAIS and ARS patients had relatively higher number of affected glands. Sialography showed ductal atresia in 23.2% of affected glands with ARIS, "snowflake" pattern in 46.5% of affected glands with ARS, "punctate and globular" ectasia of terminal ducts in 80.4% of affected glands with ARCP, and clustered branch ducts in 71.4% of affected glands with sialadenosis with sialodochitis. Moreover, stenosis and/or dilatation of the main and branch ducts represented the most typical sialography appearance of idiopathic sialadenitis. Conclusion: Idiopathic sialadenitis, RAIS, ARS, ACRP, and sialadenosis with sialodochitis are the five common types of chronic sialadenitis. Among these, idiopathic sialadenitis is the most common type of chronic sialadenitis. Clarification of the etiology, clinical manifestations and imaging characteristics of chronic sialadenitis is important for clinicians to develop personalized treatment plans and improve treatment outcomes.

Key words: Sialadenitis, Iodine radioisotopes, Hypersensitivities, Parotid gland, Submandibular gland

CLC Number: 

  • R781.72

Figure 1

Sialogram of radioactive iodine-induced sialadenitis A 48-year-old female patient with recurrent swelling of bilateral parotid and submandibular glands for a period of 8 months. These symptoms occurred one year after surgery for thyroid cancer and radioactive iodine therapy. Sialogram of the right parotid gland showed stenosis of distal duct (black arrow), ectasia of hilum duct (blue arrow) and atresia of intraglandular duct (red arrow)."

Figure 2

Sialogram of allergy-related sialodochitis A 29-year-old female with comorbid allergic rhinitis complained of recurrent swelling and mucus plug exudation of four major salivary glands for 3 years. Laboratory tests showed an elevated level of immunoglobulin E (128.9 IU/mL; Normal range: ≤100 IU/mL). Sialogram of the right parotid gland showed ectasia of the main duct and "snowflake" appea-rance of the branch ducts (black arrow)."

Figure 3

Sialogram of adult chronic recurrent parotitis A 24-year-old male patient with recurrent swelling and pain of the left parotid gland for half a year. He complained of a history of "parotitis" 10 years ago. Sialography showed "punctate and globular" ectasia of the terminal ducts of the left parotid gland."

Figure 4

Sialogram and CT images of sialadenosis with sialodochitis A 45-year-old male with long-term drinking and smoking habits complained of persistent swelling of bilateral parotid glands for 7-8 years. A, enlarged bilateral parotid glands on the axial CT image; B, stenosis (red arrow) and ectasia (black arrow) of the main duct, and clustered branch ducts on the sialogram of the right parotid gland; C, persistent contrast media on the functional film."

Figure 5

Sialogram of idiopathic sialadenitis A 72-year-old female with a 3-month history of recurrent swelling of the right parotid gland. A, sausage-like appearance of the main duct of the right parotid gland; B, persistent contrast media on the functional film."

Table 1

Clinical features of five types of chronic sialadenitis"

Item Total (n=544) Idiopathic sialadenitis (n=390) ARS (n=68) RAIS (n=35) ACRP (n=26) Sialadenosis (n=25) P value
Gender, n(%) 0.025
  Male 192 (35.3) 137 (35.1) 23 (33.8) 6 (17.1) 12 (46.2) 14 (56.0)
  Female 352 (64.7) 253 (64.9) 45 (66.2) 29 (82.9) 14 (53.8) 11 (44.0)
Age/years, $\bar x \pm s$ 47.44±13.52 49.15±13.47 46.16±11.82 39.71±10.56 32.50±8.60 50.72±13.36 < 0.001
Type of affected glands, n(%) < 0.001
  PG only 417 (76.7) 319 (81.8) 28 (41.2) 19 (54.3) 26 (100.0) 25 (100.0)
  SMG only 73 (13.4) 53 (13.6) 20 (29.4) 0 (0.0) 0 (0.0) 0 (0.0)
  PG & SMG 54 (9.9) 18 (4.6) 20 (29.4) 16 (45.7) 0 (0.0) 0 (0.0)
Number of affected glands, n(%) < 0.001
  1 68 (12.5) 61 (15.6) 3 (4.4) 2 (5.7) 1 (3.8) 1 (4.0)
  2 424 (77.9) 313 (80.3) 45 (66.2) 17 (48.6) 25 (96.2) 24 (96.0)
  3 or 4 52 (9.6) 16 (4.1) 20 (29.4) 16 (45.7) 0 (0.0) 0 (0.0)
Duration of symptoms/years, n(%) < 0.001
  ≤1 282 (51.8) 215 (55.1) 21 (30.9) 30 (85.7) 0 (0.0) 16 (64.0)
  ＞1 & ≤10 205 (37.7) 148 (37.9) 42 (61.8) 5 (14.3) 2 (7.7) 8 (32.0)
  ＞10 57 (10.5) 27 (6.9) 5 (7.4) 0 (0.0) 24 (92.3) 1 (4.0)
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