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| ==Viral Parotitis (Mumps)== | | ==Types== |
| ===Background===
| | [[File:Illu quiz hn 02.jpg|thumb|Salivary glands: #1 Parotid gland, #2 Submandibular gland, #3 Sublingual gland.]] |
| *Acute infection of the parotid glands
| | {{Salivary gland DDX}} |
| *Most often caused by the mumps virus; less commonly by influenza, parainfluenza, coxsackie, echo, HIV
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| *Most common in children <15yrs
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| *Contagious for 9d after onset of parotid swelling
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| ===Clinical Features=== | | ==Differential Diagnosis== |
| *Prodrome of fever, malaise, HA, myalgias, arthralgias
| | {{Facial swelling DDX}} |
| *Unilateral or bilateral parotid swelling
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| *Unilateral orchitis (20-30% of male pts)
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| ===Treatment=== | | ==See Also== |
| *Supportive | | *[[Oropharynx and Jaw Diagnoses]] |
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| ===Complications=== | | ==References== |
| *Mastitis, pancreatitis, aseptic meningitis, hearing loss, myocarditis, polyarthritis, hemolytic anemia
| | <references/> |
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| ===Disposition===
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| *Isolated parotitis or orchitis: manage as outpatient
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| *Sysemtic complications: admit
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| ==Suppurative Parotitis==
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| ===Background===
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| *Serious bacterial infection of parotid gland that occurs in pts w/ decreased salivary flow
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| **Caused by retrograde migration of oral bacteria into salivary ducts and parenchyma
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| **Usually caused by staph, strep, anerobes
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| *Risk factors:
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| **Dehydration
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| **Prematurity or advanced age
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| **Sialolithiasis
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| **Oral neoplasms
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| **Salivary duct strictures
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| **Meds (cause systemic dehydration or decrease salivary flow)
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| ***Diuretics
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| ***Antihistamines
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| ***TCAs
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| ***B-blockers
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| **Chronic illnesses
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| ***HIV
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| ***Sjogren syndrome
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| ***Anorexia/bulimia
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| ===Clinical Features===
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| *Rapid onset
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| *Skin over parotid gland is red and tender
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| *Purulent drainage from Stensen's duct
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| *Fever
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| *Trismus
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| ===Treatment===
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| #Hydrate the volume-depleted patient
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| #Massage and apply heat to the affected gland
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| #Stimulate salivation using sialagogues such as lemon drops
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| #Abx
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| ##PO abx if pts can tolerate oral liquids and have no evidence of systemic illness
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| ##Amoxicillin-clavulanate OR clindamycin OR cephalexin + metronidazole
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| ##IV abx
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| ###Indicated for trismus, inability to tolerate oral liquids, or immunocompromised
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| ###Nafcillin OR ampicillin-sulbactam OR (vancomycin + metronidazole (if MRSA suspected))
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| ==Sialolithiasis==
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| ===Background===
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| *Development of a calcium carbonate and calcium phosphate stone in a stagnant salivary duct
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| *>80% occur in the submandibular gland
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| ===Clinical Features===
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| *Pain, swelling, and tenderness may resemble parotitis
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| **Sialolithiasis is exacerbated by meals and may develop over course of minutes when eating
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| *Typically unilateral
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| *A stone may be palpated within the duct and the gland is firm
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| ===Treatment===
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| *Abx only indicated if concurrent infection
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| *Palpable stones in the distal duct may be 'milked' out
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| *Give lemon drops or other sialogogues
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| ==Source==
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| Tintinalli
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| [[Category:ENT]] | | [[Category:ENT]] |
| | [[Category:ID]] |
