sialectasis

Sialectasis is the dilation or ectasia of the salivary duct system, most often involving the ducts of the parotid or submandibular glands. It reflects chronic obstruction or inflammation that causes widening of the duct proximal to the blockage. The condition can be unilateral or bilateral and may be symptomatic or found incidentally on imaging.

Common causes include sialolithiasis (stones in the salivary ducts), ductal strictures or scarring from inflammation, chronic sialadenitis, and less commonly radiation damage, trauma, or congenital duct anomalies. Ductal dilation results from increased intraductal pressure and weakening of the duct walls; long-standing sialectasis can lead to saliva stasis and recurrent infections.

Clinically, patients may present with episodic or persistent swelling of the affected gland, often related to meals due to increased salivary flow. Pain and fever can accompany acute obstruction or infection. Some cases are asymptomatic, detected when imaging for another reason.

Diagnosis relies on imaging. Sialography historically demonstrated ductal dilation; today ultrasound and MRI sialography are common. Sialendoscopy allows direct visualization, assessment, and treatment of the ducts. Imaging typically shows dilated ducts, irregular calibers, and sometimes diverticula; stones or strictures may be identified.

Management targets the underlying cause and maintaining drainage. Stone removal or ductal dilation via sialendoscopy, antibiotics for infection, and measures to prevent recurrence are used. Severe, nonfunctional glands may require gland-preserving procedures or, rarely, gland excision. The prognosis depends on the cause and the success of restoring ductal patency.