Acute Parotitis

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Please note that the following is a general guideline only. For a full assessment, exclusion of any other underlying cause for your symptoms and an individualised treatment approach, you will need to be seen by a qualified specialist.

Epidemiology

50 - 60 years

male = female 

parotid gland most common

associated with medically debilitated and postoperative patients

Aetiology

Systemic

    -DM, hypothyroidism, renal failure, and 

Local

    reduced salivary flow-Medications/ Sjögren's syndrome

    mechanical impairment - stenosis / sialolithiasis → more common in SMG ducts

Microbiology  

    most commonly -penicillin-resistant Staphylococcus aureus,

    Streptococcus species,S pyogenes, S viridans, and S pneumoniae

    Hemophilus influenzae

    Anaerobic and gram-negative bacteria in acute suppurative sialadenitis

Pathophysiology

stasis of salivary flow secondary to dehydration 

→ retrograde bacterial contamination of the salivary ducts from the oral cavity 

→ suppurative infection of the gland parenchyma

Why parotid> SMG

parotid gland produces saliva that is mainly serous, as opposed to saliva from the SMG and SLGs that is primarily mucoid

serous saliva, unlike mucinous saliva, is deficient in lysosomes, IgA antibodies, and sialic acid, which have antimicrobial properties

Saliva of SMG and SLGs contains high molecular weight glycoproteins that competitively inhibit bacterial attachment to the epithelial cells of the salivary ducts

Clinical

systemic- fever, chills, and malaise 

rapid onset of pain and swelling over the affected salivary gland

tenderness to palpation, with warmth and induration of the overlying skin

suppurative discharge from the duct orifice

multiple glands-bilateral involvement of up to 25% of cases

Duct opening is lateral to second upper molar, notable discharge on massage

Parotid swelling

Treatment

Supportive

Hydrate/ oral hygiene/ sialagogues/ external and bimanual massage/analgesics and local heat application 

Antibiotics 

     gram-positive and anaerobic bacteria

     augmentin or a first-generation cephalosporin

     +/-clindamycin or the addition of metronidazole to the first-line agents to broaden anaerobic coverage 

     should continue for 1 week after resolution of symptoms

Surgical-Indications

     failure to eradicate the infection

     surgical drainage of a loculated abscess is necessary