Suppurative parotitis

Background

• Serious bacterial infection of parotid gland that occurs in patients with 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
  • beta-blockers
• Chronic illnesses
  • HIV
  • Sjogren syndrome
  • Anorexia/bulimia
  • Cystic fibrosis

Clinical Features

• Rapid onset
• Skin over parotid gland is red and tender
• Purulent drainage from Stensen's duct
• Fever
• Trismus

Differential Diagnosis

Facial Swelling

• Superior vena cava syndrome
• Buccal space infections
• Dental problems
• Masticator space infections
• Parapharyngeal space infection
• Neoplasm
• Maxillofacial trauma
• Facial cellulitis
• Canine space infection
• Salivary gland diagnoses
  • Viral parotitis
  • Suppurative parotitis
  • Sialolithiasis
  • Sialoadenitis

Evaluation

• Usually clinical

Management

Supportive Care

1. Hydrate the volume-depleted patient
2. Massage and apply heat to the affected gland
3. Stimulate salivation using sialagogues such as lemon drops

Antibiotic Options

Treatment targeted at S. aureus, gram negative bacilli, mumps, enteroviruses, and influenza virus

• Amoxicillin/Clavulanate 875mg (45mg/kg) PO BID OR
• Clindamycin 450mg PO three times daily or 10mg/kg PO four times daily
• Dicloxacillin 500mg (7.5mg/kg) PO four times daily
• Cephalexin 500mg (12.5mg/kg) PO four times daily
• Nafcillin 2g IV six times daily or 50mg/kg IV four times daily
• Vancomycin 15-20mg/kg IV BID daily

See Also

• Salivary gland diagnoses

References

Authors

Ross Donaldson, Yos Yachivev, Claire, Daniel Ostermayer, Neil Young