eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Salivary Glands

Parotitis: Treatment & Medication

Author: Jerry W Templer, MD, Professor of Otolaryngology, University of Missouri Medical Center at Columbia
Coauthor(s): Benjamin Daniel Liess, MD, Assistant Professor, Department of Otolaryngology, University of Missouri-Columbia School of Medicine
Contributor Information and Disclosures

Updated: Jul 6, 2009

Treatment

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.6 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.

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.
  • Installation of methyl violet into the parotid duct to destroy the gland: Intermittent reports of this method have been reported for more than 40 years, but it is not commonly performed in the United States, 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.

Consultations

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

Diet

The diet does not significantly affect cases of parotitis.

Medication

Parotitis occurs in a variety of situations, and the drugs prescribed are those to treat the underlying disease.

More on Parotitis

Overview: Parotitis
Differential Diagnoses & Workup: Parotitis
Treatment & Medication: Parotitis
Follow-up: Parotitis
Multimedia: Parotitis
References
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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.

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  13. 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].

  14. 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].

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

  16. 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].

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

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

  19. 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].

  20. 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].

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

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Further Reading

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Keywords

parotitis, sialadenitis, acute bacterial parotitis, chronic bacterial parotitis, chronic recurrent parotitis, infectious parotitis, acute parotitis in neonates, acute viral parotitis, mumps, HIV parotitis, HIV parotitis in children, acute surgical parotitis, lymphoepithelial lesion, chronic punctate parotitis, autoimmune parotitis, Mikulicz disease, Sjögren disease, lymphoepithelial lesion of Godwin, recurrent parotitis of childhood, EBV infection, Epstein-Barr virus infection, parotitis in tuberculosis, sarcoidosis

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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.

Medical Editor

Ted L Tewfik, MD, FRCS(C), Professor, Department of Otolaryngology, Director of Continuing Medical Education of Otolaryngology, McGill University Medical School; Director, Director of Professional Affairs of Otolaryngology, Department of Otolaryngology, Montreal Children's Hospital; Senior Staff, Montreal General Hospital and Royal Victoria Hospital
Ted L Tewfik, MD, FRCS(C) 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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Dominique Dorion, MD, MSc, FRCSC, Program Director and Division Chair, Professor of Surgery, Division of Otolaryngology, University of Sherbrooke, Canada
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, 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 unstricted 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

 
 
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