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Sialosis or Sialadenosis of the Salivary Glands

last modified on: Sun, 08/07/2022 - 12:25

Sialosis or Sialadenosis of the Salivary Glands

see also: Sialosis or sialadenosis Case example of surgical treatment

return to: Salivary Swelling 

Sialosis (Sialadenosis) Sialogram

see also: Sialosis - Rads

Sialosis (sialadenosis) is a chronic, bilateral, diffuse, non-inflammatory, non-neoplastic swelling of the major salivary glands that primarily affects the parotid glands, but occasionally involves the submandibular glands and rarely the minor salivary glands (Scully 2008).  This can be painless or in some instances tender.

Sialosis may be idiopathic or may be associated with the following:

  1. chronic malnutrition
  2. obesity
  3. diabetes mellitus
  4. alcoholism
  5. liver disease
  6. eating disorders
  7. drugs (ie antihypertensives)
    (Duggan 1957 from Chen 2013)

From Chen et al (2013):
Authors (notably Merlo et al and Carda et al as cited by Chen) have identified different histopathology pictures in diabetic and alcoholic sialosis.
Diabetics with sialosis were found to have smaller acini, greater fatty infiltration in the glandular stroma, and normal-appearing epithelium.
Alcoholic sialosis identified a reduction in the proportion of fatty tissue of stroma with an enlargement in ductal epithelium felt to contribute to an increased caliber of the striated ducts. Also noted in alcoholic sialosis are accumulation of secretory granules in the acinar cells’ cytoplasm and enlarged excretory ducts

Mahler (1993) and Park (2009) identified that "Pilocarpine has proved to be beneficial in the treatment of sialadenosis in bulimic patients" and "This article presents a case of painful sialoadenomegaly associated with hyperamylasemia in a bulimic patient successfully managed with pilocarpine".

Among the drug or toxin exposure that has been associated with sialosis in the past Scully et al (Scully 2008) identified through literature review association of sialosis with

Antihypertensives  Lead 
Guanacline  Mercury 
Isoprenaline  Iodine 
Naproxen  Thiocyanate
Oxphenbutazone Thiouracil
Phenylbutazone Valproic acid

In the 35 cases reported by Scully et al, 4 patients were on antihypertensive medications - with 3 recorded as taking Ramipril also known as Altace (an angiotensin-converting enzyme (ACE) inhibitor)




  1. Pape SA, MacLeod RI, McLean RN and Soames JV: Sialadenosis of the salivary glands. Brit J. of Plastic Surgery (1995), 48, 419-22
  2. Scully C, Bagan JV, Eveson JW, Barneard N, and Turner Fioan:  Sialosis: 35 cases of persistent parotid swelling from two countries. British Journal of Oral and Maxillofacial Surgery 46 (2008) 468-72
  3. Chen S, Benjamin C and Myssiorek D: An Algorithm Approahc to Diagnosin Bilateral Parotid EnlargementOtolaryngology – Head and Neck Surgery 148(5) 732-739
  4. Duggan J and Rothbell E: Asymptomatic enlargement of the parotid glands. NEJM 1957;257:1262-1267
  5. Carda C et al Structural and functional salivary disorders in type 2 diabetic patietns. Med oarl patol Oral Cir Bucal. 2006; 11:E 309-E314
  6. Merlo C et al Parotid sialosis: morphometrical analysis of the glandular parenchyme and stroma among diagbetic and alchoholic patients. J Oral Pathol Med. 2010;39:10-15
  7. Mehler PS and Wallace JA: Sialadenosis in bulimia. A new treatment Arch Otolaryngol Head Neck Surg. 1993 Jul;119(7):787-8.
  8. Park KK1, Tung RC, de Luzuriaga AR. Painful parotid hypertrophy with bulimia: a report of medical management. J Drugs Dermatol. 2009 Jun;8(6):577-9.
  9. Scully C1, Bagán JV, Eveson JW, Barnard N, Turner FM. Sialosis: 35 cases of persistent parotid swelling from two countries.Br J Oral Maxillofac Surg. 2008 Sep;46(6):468-72. doi: 10.1016/j.bjoms.2008.01.014. Epub 2008 Mar 17.
  10. Davis AB, Hoffman HT. Management Options for Sialadenosis. Otolaryngol Clin North Am. 2021 Jun;54(3):605-611. doi: 10.1016/j.otc.2021.02.005. PMID: 34024487.