Salivary gland diagnoses

Viral Parotitis (Mumps)

Background

• Acute infection of the parotid glands
• Most often caused by the mumps virus; less commonly by influenza, parainfluenza, coxsackie, echo, HIV
• Most common in children <15yrs
• Contagious for 9d after onset of parotid swelling

Clinical Features

• Prodrome of fever, malaise, HA, myalgias, arthralgias
• Unilateral or bilateral parotid swelling
• Unilateral orchitis (20-30% of male pts)

Treatment

• Supportive

Complications

• Mastitis, pancreatitis, aseptic meningitis, hearing loss, myocarditis, polyarthritis, hemolytic anemia

Disposition

• Isolated parotitis or orchitis: manage as outpatient
• Sysemtic complications: admit

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

1. Hydrate the volume-depleted patient
2. Massage and apply heat to the affected gland
3. Stimulate salivation using sialagogues such as lemon drops
4. Abx
   1. PO abx if pts can tolerate oral liquids and have no evidence of systemic illness
   2. Amoxicillin-clavulanate OR clindamycin OR cephalexin + metronidazole
   3. IV abx
      1. Indicated for trismus, inability to tolerate oral liquids, or immunocompromised
      2. 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