302 - Sialadenitis in the Setting of Oropharyngeal Dysphagia following Acute Ischemic Stroke

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

CD

Christian Diaz, MD

Resident Physician
University of Miami / Jackson Health System
Miami, Florida, United States

Co-Author(s)

MW

Madeline Winter, BA

First Year Medical Student
University of Miami
Miami, Florida, United States
SG

Sean Goldman, DO

Resident Physician
University of Miami
Boca Raton, Florida, United States

Corresponding Author(s)

GA

Gemayaret Alvarez, MD

Associate Professor
University of Miami
Miami, Florida, United States

Submitter(s)

CD

Christian Diaz, MD

University of Miami / Jackson Health System
Miami, Florida, United States

Case Diagnosis: Sialadenitis in the setting of oropharyngeal dysphagia following acute ischemic stroke.

Case Description: A 62-year-old female with hypertension presented for management of bilateral ophthalmic aneurysms identified during evaluation of left-sided vision loss. She underwent left internal carotid artery pipeline stenting, complicated by post-operative right upper extremity hemiplegia and dysarthria. Imaging revealed an intraparenchymal hemorrhage with midline shift and uncal herniation, requiring emergent intubation and decompressive craniectomy. The patient developed persistent oropharyngeal dysphagia, necessitating transition from nasogastric to gastric tube feeding. During acute rehabilitation, she developed sepsis secondary to rapidly expanding left-sided neck swelling. Flexible endoscopy confirmed left-sided sialadenitis with purulent drainage, but without abscess or airway compromise.  She was managed with broad-spectrum antibiotics and dexamethasone, followed by a 7-day course of cefazolin after airway edema subsided.

Discussions: Sialadenitis is a significant but underrecognized complication in post-stroke patients with severe dysphagia. Impaired oral clearance, reduced swallowing frequency, and salivary stasis predispose to retrograde bacterial infection of salivary ducts. Dysphagia exacerbates this risk by impairing bolus propulsion and compromising oral hygiene. Additional factors in this case include prolonged enteral tube feeding, prior intubation and nasogastric tube placement with associated mucosal trauma, and reduced mobility, all of which increase susceptibility to oral and salivary infections. While pneumonia is the most emphasized infectious complication after stroke, sialadenitis can similarly contribute to morbidity, airway risk, and delayed rehabilitation.

Conclusions: This case highlights how severe dysphagia and enteral dependence after stroke can predispose patients to sialadenitis. Early recognition, targeted antibiotics, and aggressive oral care are essential for management and prevention. Staff education and training, standardized oral health assessment tools, structured aggressive oral hygiene, and multidisciplinary management are crucial in preventing and treating such complications, reducing morbidity, and optimizing rehabilitation outcomes.