Salivary gland diagnoses
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Viral Parotitis (Mumps)
Suppurative Parotitis
Background
- Serious bacterial infection of parotid gland that occurs in pts w/ decreased salivary flow
- Caused by retrograde migration of oral bacteria into salivary ducts and parenchyma
- Usually caused by staph, strep, anerobes
- Risk factors:
- Dehydration
- Prematurity or advanced age
- Sialolithiasis
- Oral neoplasms
- Salivary duct strictures
- Meds (cause systemic dehydration or decrease salivary flow)
- Diuretics
- Antihistamines
- TCAs
- B-blockers
- Chronic illnesses
- HIV
- Sjogren syndrome
- Anorexia/bulimia
Clinical Features
- Rapid onset
- Skin over parotid gland is red and tender
- Purulent drainage from Stensen's duct
- Fever
- Trismus
Treatment
- Hydrate the volume-depleted patient
- Massage and apply heat to the affected gland
- Stimulate salivation using sialagogues such as lemon drops
- Abx
- PO abx if pts can tolerate oral liquids and have no evidence of systemic illness
- Amoxicillin-clavulanate OR clindamycin OR cephalexin + metronidazole
- IV abx
- Indicated for trismus, inability to tolerate oral liquids, or immunocompromised
- Nafcillin OR ampicillin-sulbactam OR (vancomycin + metronidazole (if MRSA suspected))
Sialolithiasis
Background
- Development of a calcium carbonate and calcium phosphate stone in a stagnant salivary duct
- >80% occur in the submandibular gland
Clinical Features
- Pain, swelling, and tenderness may resemble parotitis
- Sialolithiasis is exacerbated by meals and may develop over course of minutes when eating
- Typically unilateral
- A stone may be palpated within the duct and the gland is firm
Treatment
- Abx only indicated if concurrent infection
- Palpable stones in the distal duct may be 'milked' out
- Give lemon drops or other sialogogues
Source
Tintinalli