Neonatal submandibular sialadenitis in the absence of traditional risk factors

CASE REPORTS

Neonatal Submandibular Sialadenitis in the Absence of Traditional Risk Factors

Priyaba Chudasama, Mradul Varshney, R.K. Bishnoi.

Department of Pediatrics, Government Medical College Pali and associated Bangur Hospital, Pali, Rajasthan, India.

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Abstract
Background: Neonatal suppurative sialadenitis is a rare diagnosis. The parotid gland is the most commonly involved gland and involvement of the submandibular gland is very rare.
Case: A 10-day-old male neonate presented with fever and reduced oral intake. He was a term infant, exclusively breastfed, and had no perinatal complications. On examination, a firm, erythematous swelling was noted in the left submandibular region. Investigations revealed submandibular sialadenitis with cellulitis and Staphylococcus aureus infection. Initial antibiotic therapy showed limited improvement, necessitating incision and drainage, which yielded purulent material. The baby recovered well with continued antibiotics and was discharged. At follow-up, the swelling resolved with no recurrence at 3 months post-discharge.
Conclusion: All submandibular swellings, even in the neonatal period, should be worked up for sialadenitis so that early diagnosis and treatment can be initiated. With early intervention the need for surgical intervention can be reduced significantly and the complication rate can be minimized.

Why this article important?

This case is important because neonatal submandibular suppurative sialadenitis is extremely rare and may not be immediately considered when a neonate presents with submandibular swelling. Early recognition is essential because delayed diagnosis can allow progression from localized inflammation and cellulitis to abscess formation, potentially requiring surgical drainage. The case demonstrates the value of careful clinical examination and ultrasonography in distinguishing sialadenitis, cellulitis, and abscess. Culture of ductal secretions or pus is also important for identifying the causative organism and guiding antimicrobial therapy. Although commonly reported risk factors include prematurity, dehydration, prolonged tube feeding, maternal infection, and sialolithiasis, this infant had none of these. The report therefore highlights the importance of considering submandibular sialadenitis even in term, otherwise healthy neonates and assessing potentially modifiable factors such as breastfeeding and caregiver hygiene.

Summary of article

Neonatal suppurative sialadenitis is a rare bacterial infection of the salivary glands, with the parotid being most commonly affected. Isolated submandibular involvement is particularly uncommon. The manuscript describes a 10-day-old term male neonate who presented with fever, reduced oral intake, and a unilateral left submandibular swelling. Ultrasound showed submandibular sialadenitis with surrounding cellulitis and cervical lymphadenopathy. Staphylococcus aureus was isolated from the submandibular duct, while blood culture was sterile. Despite intravenous cefotaxime and vancomycin, the swelling progressed and developed into an abscess. Incision and drainage yielded purulent material, with pus culture confirming methicillin-sensitive S. aureus. The infant subsequently improved with prolonged antimicrobial therapy and was discharged in good condition. There was complete resolution of the swelling and no recurrence at three months.

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