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Parotitis Treatment & Management

  • Author: Jerry W Templer, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: May 05, 2016
 

Medical Care

 

Most episodes of chronic parotitis are treated symptomatically. Sialogogues, local heat, gentle massage of the gland from posterior to anterior, and hydration provide variable symptomatic relief. When pus is expressed from the Stensen duct, culture and sensitivity studies guide antibiotic selection. Treatment of the primary disease (eg, HIV, rheumatoid arthritis) is all that is required. Some authors advocate intermittent irrigation of the ductal system with saline, steroid solution, and/or an antibiotic to treat the infection and mechanically remove inspissated mucous or pus from the ducts. This may retard the disease progression. The rationale is stronger for those with the dilated “sausage-shaped” ducts.

This treatment is advocated for those patients not responding to symptomatic treatment and should be attempted before considering surgery. Baurmash advocates a Decadron (dexamethasone) and penicillin solution in saline to cleanse the ducts and for topical therapy.[9] If successful, this irrigation is repeated as needed.

Acute bacterial parotitis is caused by bacteria that ascends from the mouth and most frequently occurs in chronically ill patients. The patient quickly becomes extremely ill. In the hospital setting, S aureus is apt to be methicillin resistant (MRSA). Gram stains and culture and sensitivity testing is ordered. Intravenous vancomycin at 500 mg every 6 hours is begun empirically. Therapy may be altered based upon cultures or infectious disease consultation.

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Surgical Care

The treatment of chronic parotitis is based on the symptoms of the patient and decisions are, by definition, subjective. Recurring parotitis, an unpleasant and distressing condition, is managed conservatively in most instances but occasionally requires surgery to end the frequent and severe episodes of infection. The decision for surgery is based on subjective symptoms.

The swollen inflamed gland makes surgery more difficult, and the incidence of injury to the facial nerve may be slightly higher than for removal of benign tumors.

The standard treatment is superficial parotidectomy, but if CT scanning or surgery reveals significant involvement of the deep lobe, that portion of the gland is dissected from beneath the nerve.

Fibrosis makes the tensile strength of the surrounding gland much greater than the nerve itself. Surgery is difficult and expensive. Parotidectomy is still the most acceptable treatment in the United States.

In tympanic neurectomy, the parasympathetic supply to the parotid gland is sectioned within the middle ear so as to cause gland atrophy. Success is not uniform, but the magnitude of the surgery is less. If one believes that decreased salivary flow is the cause of chronic parotitis, the treatment is irrational.

In ligation of the parotid duct, the duct can be ligated so as to cause atrophy of the gland and prevent ascending bacterial infections from entering the mouth. The duct should be dissected for a short distance within the cheek and severed. The duct should be oversewn to ensure that the soft tissue heals. Simple ligation frequently results in recanalization of the duct. The procedure is based on assumptions that may not be true, and the rationale is weak.

Intermittent reports of another treatment technique, instillation of methyl violet into the parotid duct to destroy the gland, have been made for more than 40 years. The procedure is not commonly performed in the United States, however, possibly because of the fear that the chemical may be carcinogenic. The gland is massaged to remove saliva, and the duct is cannulated with a 1-3 mm polyethylene tube. One to 3 mL of 1% methyl violet is instilled until the ducts are full and the patient complains of pressure. The tube is occluded for 30 minutes and then removed. The gland swells for 1-2 weeks, and the duct system should be obliterated in 2-4 weeks. If symptoms persist after this time, a second injection may be performed. This method is much cheaper than parotidectomy and should prevent ascending infections from the mouth. Whether the acini involute and disappear is not certain. Other substances such as tetracycline have been shown to cause necrosis of the gland when instilled into the ductal system.

A literature review by Ramakrishna et al indicated that sialendoscopy can be used to safely and effectively treat juvenile recurring parotitis. The investigators reported that the weighted pooled proportions of success rates as measured by the occurrence of no additional episodes of parotitis were 73% (by patient; n=120) and 81% (by gland; n=165). The weighted pooled proportion of success rates as measured by the need for no additional sialendoscopy was 87% (by patient).[26]

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Consultations

Patients with autoimmune parotitis experience xerostomia and excessive tooth decay. These patients should have dental consultation and frequent dental care.

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Diet

The diet does not significantly affect cases of parotitis.

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Contributor Information and Disclosures
Author

Jerry W Templer, MD Professor, Department of Otolaryngology, University of Missouri-Columbia School of Medicine

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, 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, The Triological Society, American Medical Association, Missouri State Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ted L Tewfik, MD Professor of Otolaryngology-Head and Neck Surgery, Professor of Pediatric Surgery, McGill University Faculty of Medicine; Senior Staff, Montreal Children's Hospital, Montreal General Hospital, and Royal Victoria Hospital

Ted L Tewfik, MD is a member of the following medical societies: American Society of Pediatric Otolaryngology, Canadian Society of Otolaryngology-Head & Neck Surgery

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, 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, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

Ted L Tewfik, MD Professor of Otolaryngology-Head and Neck Surgery, Professor of Pediatric Surgery, McGill University Faculty of Medicine; Senior Staff, Montreal Children's Hospital, Montreal General Hospital, and Royal Victoria Hospital

Ted L Tewfik, MD is a member of the following medical societies: American Society of Pediatric Otolaryngology, Canadian Society of Otolaryngology-Head & Neck Surgery

Disclosure: Nothing to disclose.

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. 1971 Oct. 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. 2004 Jan. 23(1):76-8. [Medline].

  6. van Boven M, Ruijs WL, Wallinga J, O'Neill PD, Hahné S. Estimation of vaccine efficacy and critical vaccination coverage in partially observed outbreaks. PLoS Comput Biol. 2013 May. 9(5):e1003061. [Medline]. [Full Text].

  7. Waaijenborg S, Hahné SJ, Mollema L, Smits GP, Berbers GA, van der Klis FR, et al. Waning of Maternal Antibodies Against Measles, Mumps, Rubella, and Varicella in Communities With Contrasting Vaccination Coverage. J Infect Dis. 2013 May 8. [Medline].

  8. McLean HQ, Fiebelkorn AP, Temte JL, et al. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2013 Jun 14. 62:1-34. [Medline].

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

  10. 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. 1995 Jan-Feb. 17(1):31-5. [Medline].

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

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

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

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

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

  16. Xie LS, Pu YP, Zheng LY, Yu CQ, Wang ZJ, Shi H. Function of the parotid gland in juvenile recurrent parotitis: a case series. Br J Oral Maxillofac Surg. 2016 Apr. 54 (3):270-4. [Medline].

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

  18. Wu CB, Xi H, Zhou Q, Zhang LM. The diagnostic value of technetium 99m pertechnetate salivary gland scintigraphy in patients with certain salivary gland diseases. J Oral Maxillofac Surg. 2015 Mar. 73 (3):443-50. [Medline].

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

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

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

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

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

  24. Mikolajczak S, Meyer MF, Beutner D, et al. Treatment of chronic recurrent juvenile parotitis using sialendoscopy. Acta Otolaryngol. 2014 May. 134(5):531-5. [Medline].

  25. Roby BB, Mattingly J, Jensen EL, Gao D, Chan KH. Treatment of juvenile recurrent parotitis of childhood: an analysis of effectiveness. JAMA Otolaryngol Head Neck Surg. 2015 Feb. 141 (2):126-9. [Medline].

  26. Ramakrishna J, Strychowsky J, Gupta M, Sommer DD. Sialendoscopy for the management of juvenile recurrent parotitis: A systematic review and meta-analysis. Laryngoscope. 2015 Jun. 125 (6):1472-9. [Medline].

 
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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.
 
 
 
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