Chapter 83 Parotitis

Question 1

What is the definition of parotitis?

Answer 1

Inflammatory reaction of the parotid gland

Parotitis should not be confused with sialadenitis, which is inflammation or infection of a salivary gland.

Question 2

What are the common causes of parotitis?

Answer 2

• Bacterial invasion
• Viral invasion
• Fungal invasion
• Mycobacterial invasion

The parotid gland is most commonly affected by inflammatory processes.

Question 3

Which virus is most commonly associated with parotitis?

Answer 3

Paramyxovirus (cause of mumps)

HIV is also associated with parotitis.

Question 4

What are the acute inflammatory conditions of the parotid gland?

Answer 4

• Acute viral inflammation (mumps)
• Acute suppurative sialadenitis (Staphylococcus aureus)

Chronic conditions can be caused by Mycobacterium tuberculosis and HIV.

Question 5

In which age group is acute suppurative parotitis more likely to occur?

Answer 5

Sixth to seventh decade of life

Higher incidence in males and more frequent involvement of the right side.

Question 6

What factors increase the risk of acute suppurative parotitis?

Answer 6

• Medication-induced decrease in salivary flow
• Chronic illness (e.g., diabetes, hypothyroidism)
• Immunocompromised host
• Poor oral hygiene
• Salivary duct obstruction
• Autoimmune disease (Sjögren syndrome)

Postoperative dehydration is also a risk factor.

Question 7

What is the pathophysiology of parotitis?

Answer 7

Infection begins with retrograde migration of oral cavity flora through the Stensen duct

Contributing factors include stasis of saliva, ductal obstruction, and poor oral hygiene.

Question 8

What are the systemic symptoms associated with parotitis?

Answer 8

• Fever
• Chills
• Anorexia
• Malaise

Localized symptoms include pain, edema, and induration of the infected gland.

Question 9

What is the initial diagnostic approach for parotitis?

Answer 9

• Clinical presentation
• Physical examination
• Complete blood count (CBC) with differential

Cultures and sensitivities should be performed as needed.

Question 10

What imaging studies are indicated if sialolith obstruction is suspected?

Answer 10

• X-ray studies
• Computed tomography (CT) scan with contrast
• Ultrasound

Ultrasound is the most cost-effective and safest diagnostic tool.

Question 11

What are the priority differential diagnoses for parotitis?

Answer 11

• Sjögren syndrome
• Sarcoidosis
• Immunoglobulin G4 (IgG4)-related disease
• COVID-19

The differential should also include various infections and mechanical factors.

Question 12

What is the recommended initial antibiotic therapy for parotitis?

Answer 12

• Amoxicillin with clavulanate
• Dicloxacillin
• Clindamycin
• Cephalosporin with metronidazole

Culture results will guide further antimicrobial therapy.

Question 13

What is the role of surgery in managing parotitis?

Answer 13

Necessary if infection is refractory for more than 3 or 4 days

Surgical drainage may be required if abscess formation occurs.

Question 14

What is juvenile recurrent parotitis (JRP)?

Answer 14

Recurrent inflammation of the parotid gland in children aged 4 months to 15 years

JRP usually resolves by puberty and can progress to chronic parotitis.

Question 15

What are the complications of parotitis?

Answer 15

Abscess formation and the need for surgical drainage

Prompt management is crucial to prevent severe outcomes.

Question 16

What is induced parotitis associated with?

Answer 16

Clozapine (an atypical antipsychotic)

Patients in psychiatric care and older adults may not undergo routine head and neck examinations with parotid gland assessment.

Question 17

Older patients not on clozapine have a predisposition for which dental issues?

Answer 17

• Root caries
• Dental avulsion
• Periodontal disease

Routine dental examination should be performed for older patients.

Question 18

What are some complications of parotitis?

Answer 18

• Abscess formation
• Surgical drainage
• Hypovolemia

Discomfort may prevent the patient from eating and drinking, increasing health risks.

Question 19

What can untreated parotitis lead to?

Answer 19

• Sepsis with or without shock
• Soft tissue infection extending into the neck, face, mediastinum
• Osteomyelitis of the mandible
• Lemierre syndrome
• Airway obstruction
• Invasion of the external auditory canal
• Facial nerve palsy

These are severe complications that can arise from untreated parotitis.

Question 20

What are complications of viral parotitis?

Answer 20

• Orchitis
• Pancreatitis
• Meningoencephalitis
• Deafness

These complications can occur as a result of viral infection.

Question 21

What should be addressed preoperatively for patients not candidates for emergent surgery?

Answer 21

Hydration and overall health status

Attention to hydration is crucial for patient health.

Question 22

Post-diagnosis, what should be addressed for patients with parotitis?

Answer 22

• Hydration
• Parenteral antibiotics
• Oral hygiene
• Sialagogue use

Proper care and management are essential for recovery.

Question 23

What should patients be instructed on regarding oral hygiene?

Answer 23

• Brushing their teeth
• Flossing
• Proper care of dentures and dental appliances

Good oral hygiene is critical for preventing complications.

Question 24

Why should the side effects of medications be discussed with patients?

Answer 24

To determine if medication is causing decreased salivary secretions

Understanding medication effects can help manage parotitis symptoms.