Iranian Journal of Otorhinolaryngology

Iranian Journal of Otorhinolaryngology

Primary tubercular sialadenitis – A diagnostic dilemma

Document Type : Original

Authors
Nitish Virmani 1
Jyoti Dabholkar 2
1 Department of Otorhinolaryngology and Head-Neck Surgery, Dr. Baba Saheb Ambedkar Hospital, Delhi, India
2 Department of Otorhinolaryngology and Head-Neck Surgery, Seth G.S Medical College and KEM Hospital
10.22038/ijorl.2018.32584.2073
Abstract
Introduction:
Involvement of the salivary glands in tuberculosis is rare, even in countries where tuberculosis is endemic. It can occur by systemic dissemination from a distant focus or, less commonly, as primary involvement. This article focuses on its myriad clinical presentations that pose a diagnostic challenge to the clinician. We discuss the schema of investigations required to confirm the diagnosis and the limitations faced in the low-cost setting of a developing country.
 
Materials and Methods:
Medical records, including history, physical examination and imaging findings, and the results of cytological, microbiological and histopathological studies of patients diagnosed with primary tubercular sialadenitis were retrieved and analyzed.
Results:
Seven patients were treated over a 2-year period. The most common mode of presentation was a painless mass of the involved gland in four patients. One patient each presented with chronic non-obstructive sialadenitis, sialolithiasis, and acute suppurative sialadenitis. Fine needle aspiration cytology was diagnostic in five out of seven cases (71.4%), while mycobacterial culture was positive in two patients (28.6%). In one patient, a diagnosis could only be reached on histopathological examination of the resected gland.
Conclusion:
We recommend cytology studies, acid-fast bacilli staining, and mycobacterial culture as the initial investigation on the aspirate in suspected patients, while polymerase chain reaction should be reserved for negative cases. A high index of suspicion, early diagnosis, and timely institution of anti-tuberculosis treatment is essential for establishing cure. The role of surgery in diagnosed cases of tuberculosis is limited.
Keywords
Parotid gland
Sialadenitis
Tuberculosis
Submandibular gland
Salivary gland calculi
Salivary fistula
Subjects
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Iranian Journal of Otorhinolaryngology
Volume 31, Issue 1
January and February 2019
Pages 45-50