Parotitis Clinical Presentation

  • Author: Jerry W Templer, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Aug 24, 2011
 

History

Symptoms include the following:

  • Infectious parotitis
    • Acute bacterial parotitis: The patient reports progressive painful swelling of the gland and fever; chewing aggravates the pain.
    • Acute viral parotitis (mumps): Pain and swelling of the gland last 5-9 days. Moderate malaise, anorexia, and fever occur. Bilateral involvement is present in most instances.
    • HIV parotitis: Nonpainful swelling of the gland occurs; otherwise, patient is asymptomatic.
    • Parotitis in tuberculosis: Chronic nontender swelling of one parotid gland occurs, or a lump is noted within the gland. Symptoms of tuberculosis are found in some cases.
  • Chronic punctate parotitis (chronic autoimmune parotitis)[11]
    • Mikulicz disease: This is a historical disease only; it should not be diagnosed today.
    • Sjögren syndrome: Recurrent or chronic swelling of one or both parotid glands with no apparent cause is noted. It is frequently associated with autoimmune disease. Discomfort is modest in most cases and is related to dry mouth and eyes.
    • Lymphoepithelial lesion of Godwin: This is a historical category that is not used today.
  • Diseases of uncertain etiology
    • Recurrent parotitis of childhood: Repetitious episodes of unilateral or bilateral mumps like episodes in a young child are indicative.
    • Sarcoidosis: Chronic nontender swelling of parotid gland occurs.
    • Chronic nonspecific parotitis: Most commonly, patients experience episodes of painful parotid inflammation that last for hours to weeks with relative asymptomatic periods between. Pain varies from mild to incapacitating.
Next

Physical

  • Physical examination of the parotid gland consists of visual examination for swelling and erythema of the overlying skin.
  • The acutely inflamed gland is exquisitely tender, while the gland is usually nontender in chronic autoimmune parotitis.
  • Massaging the gland from posterior to anterior expresses clear saliva from the parotid duct in normal glands.
  • Purulent saliva is expressed with bacterial parotitis, and clear saliva with small yellow curds is expressed in chronic punctate (autoimmune) parotitis.
Previous
Next

Causes

  • In the vast majority of instances, risk factors are unknown.
  • Occasionally, drugs such as iodides or guanethidine cause transient swelling of the gland.
  • Autoimmune disease causes most cases of chronic parotitis.
  • Recurring bacterial parotitis may be caused by stone formation or stenosis of the duct, but this also occurs in a minority of cases of chronic parotitis.
  • HIV may cause a type of indolent parotitis that suggests an autoimmune process.
  • Dehydration with stasis of salivary flow may cause of acute parotitis. Drugs with an atropine effect (eg, antihistamines) may precipitate parotitis on rare occasions.
Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Jerry W Templer, MD  Professor of Otolaryngology, University of Missouri Medical Center at Columbia

Jerry W Templer, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, Missouri State Medical Association, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Benjamin Daniel Liess, MD  Assistant Professor, Department of Otolaryngology, University of Missouri-Columbia School of Medicine

Benjamin Daniel Liess, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Laryngological Rhinological and Otological Society, American Medical Association, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Ted L Tewfik, MD, FRCSC  Professor, Department of Otolaryngology-Head and Neck Surgery, Director of Continuing Medical Education of Otolaryngology, McGill University Medical School; Director of Professional Affairs of Otolaryngology, Division of Otolaryngology, Montreal Children's Hospital; Senior Staff, Montreal General Hospital and Royal Victoria Hospital

Ted L Tewfik, MD, FRCSC, is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Society of Pediatric Otolaryngology, Canadian Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Dominique Dorion, MD, MSc, FRCSC, FACS  Vice Dean and Associate Dean of Resources, Professor of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Sherbrooke Faculty of Medicine, Canada

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

  1. Lilienthal HA. A method of incising parotid abscess without injury to the facial nerve distribution. Am J Surg. 1917;31(4):101-2.

  2. Hemenway WG, English GM. Surgical treatment of acute bacterial parotitis. Postgrad Med. Oct 1971;50(4):114-9. [Medline].

  3. Cope VZ. Acute necrotic parotitis. Br J Surg. 1919;7:130-3.

  4. Blair VP, Padgett EC. Pyogenic infection of the parotid glands and ducts. Arch Surg. 1923;7(1):1-36.

  5. Spiegel R, Miron D, Sakran W, Horovitz Y. Acute neonatal suppurative parotitis: case reports and review. Pediatr Infect Dis J. Jan 2004;23(1):76-8. [Medline].

  6. Baurmash HD. Chronic recurrent parotitis: a closer look at its origin, diagnosis, and management. J Oral Maxillofac Surg. Aug 2004;62(8):1010-8. [Medline].

  7. Beitler JJ, Vikram B, Silver CE, et al. Low-dose radiotherapy for multicystic benign lymphoepithelial lesions of the parotid gland in HIV-positive patients: long-term results. Head Neck. Jan-Feb 1995;17(1):31-5. [Medline].

  8. Henderson SO, Mallon WK. Tuberculosis as the cause of diffuse parotitis. Ann Emerg Med. Sep 1995;26(3):376-9. [Medline].

  9. Shaffer AJ, Jacobsen AW. Mikulicz's syndrome, a report of ten cases. Amer J Dis Child. 1927;34:342-6.

  10. Sjogren H. Keratoconjunctivitis sicca. Acta Ophthalmologica. 1933;Supplement 2:1-145.

  11. Hemenway WG. Chronic punctate parotitis. Laryngoscope. Apr 1971;81(4):485-509. [Medline].

  12. Papadaki ME, McCain JP, Kim K, Katz RL, Kaban LB, Troulis MJ. Interventional sialoendoscopy: early clinical results. J Oral Maxillofac Surg. May 2008;66(5):954-62. [Medline].

  13. Gillespie MB, Intaphan J, Nguyen SA. Endoscopic-assisted management of chronic sialadenitis. Head Neck. Sep 2011;33(9):1346-51. [Medline].

  14. Iro H, Zenk J, Escudier MP, et al. Outcome of minimally invasive management of salivary calculi in 4,691 patients. Laryngoscope. Feb 2009;119(2):263-8. [Medline].

  15. Marchal F, Dulguerov P. Sialolithiasis management: the state of the art. Arch Otolaryngol Head Neck Surg. Sep 2003;129(9):951-6. [Medline].

  16. Koch M, Iro H, Zenk J. Role of sialoscopy in the treatment of Stensen's duct strictures. Ann Otol Rhinol Laryngol. Apr 2008;117(4):271-8. [Medline].

  17. Ericson S, Zetterlund B, Ohman J. Recurrent parotitis and sialectasis in childhood. Clinical, radiologic, immunologic, bacteriologic, and histologic study. Ann Otol Rhinol Laryngol. Jul 1991;100(7):527-35. [Medline].

  18. Ferraro FJ Jr, Rush BF Jr, Ruark D, Oleske J. Enucleation of parotid lymphoepithelial cyst in patients who are human immunodeficiency virus positive. Surg Gynecol Obstet. Nov 1993;177(5):524-6. [Medline].

  19. Fox RI, Kang HI. Pathogenesis of Sjögren's syndrome. Rheum Dis Clin North Am. Aug 1992;18(3):517-38. [Medline].

  20. Godwin JT. Benign lymphoepithelial lesion of the parotid gland adenolymphoma, chronic inflammation, lymphoepithelioma, lymphocytic tumor, Mikulicz disease. Cancer. Nov 1952;5(6):1089-103. [Medline].

  21. Mandel L, Witek EL. Chronic parotitis: diagnosis and treatment. J Am Dent Assoc. Dec 2001;132(12):1707-11; quiz 1727. [Medline].

  22. Morgan WS, Castleman B. A clinicopathologic study of Mikulicz's disease. Am J Pathol. May-Jun 1953;29(3):471-503. [Medline].

  23. Shaha AR, DiMaio T, Webber C, Thelmo W, Jaffe BM. Benign lymphoepithelial lesions of the parotid. Am J Surg. Oct 1993;166(4):403-6. [Medline].

  24. Wang S, Li J, Zhu X, et al. Gland atrophy following retrograde injection of methyl violet as a treatment in chronic obstructive parotitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Mar 1998;85(3):276-81. [Medline].

  25. Watkin GT, Hobsley M. Natural history of patients with recurrent parotitis and punctate sialectasis. Br J Surg. Sep 1986;73(9):745-8. [Medline].

 
Previous
Next
 
Elderly man with parotid abscess.
Six-year-old girl with recurrent parotitis of childhood.
Sialogram of patient with sialectasis. Notice the appearance of a tree with leaves.
Incision outlined for incision and drainage of parotid abscess.
Parotid gland anatomy.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.