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Parotitis and facial nerve dysfunction.

Paralysis of the facial nerve in association with suppurative parotitis is rare, with only ten previously reported cases. In some situations, inflammation surrounding a benign neoplasm accounted for the observed paralysis. In this article, three new cases of parotitis with associated facial nerve dysfunction are described, none of which was associated with a neoplasm. In one, an occult abscess was present and in another an aggressive necrotizing process was seen. The treatment of this disease should initially be conservative management with high doses of wide-spectrum antibiotics. In the majority of cases, resolution of the facial paralysis should follow. However, persistence of a parotid mass with continued facial palsy mandates surgical exploration to exclude the presence of an underlying neoplasm.

Adult↗

Acute parotitis and hyperamylasemia following whole-brain radiation therapy.

Parotitis, an infrequent, previously unreported complication of whole-brain radiation therapy, was observed in 4 patients. The acute symptoms, which include fever, dry mouth, pain, swelling, and tenderness, are accompanied by hyperamylasemia. Among 10 patients receiving whole-brain irradiation, 8 had serum amylase elevations without symptoms. Both acute parotitis and asymptomatic hyperamylasemia result from irradiation of the parotid glands.

Adult↗

Cryptococcal parotitis presenting as a cystic parotid mass: report of a case diagnosed by fine-needle aspiration cytology.

We report the fine needle aspiration (FNA) cytology findings that allowed us to diagnose cryptococcal parotitis in a 31-year-old HIV positive patient. The patient presented with painful and enlarged right parotid gland and a CT scan showed a cystic lesion with rim enhancement. The FNA cytology revealed yeasts of variable size, some of which had bright eosinophilic capsules in Diff-Quik stained preparations. Mucicarmine and silver stain supported the diagnosis of cryptococcal parotitis, which was later confirmed by fungal culture of the aspirated material. We thus show that fungal infection can present as a cystic parotid mass in an immunosuppressed patient and that the diagnosis can be made by FNA cytology.

Adult↗

New concepts in the treatment of chronic recurrent parotitis.

The release of glandular kallikrein into the interstitium of the parotid gland appears to play an important role in the occurrence of the inflammatory interstitial edema in chronic recurrent parotitis. This provides fresh impetus for the treatment of this parotid disease with a kallikrein inhibitor. In our present study, seven patients with acute exacerbated chronic recurrent parotitis were treated with the kallikrein inhibitor aprotinin (Trasylol, Bayer AG, Leverkusen). With this therapy all patients were free of pain 12 h after the start of the therapy and most salivary gland function had returned to normal by 48 h after beginning treatment. Within this period of time, concomitant swelling of the affected parotid gland disappeared completely in five patients and resolved in the other two patients after 1 week.

Aprotinin↗

Salivary scintigraphy with vitamin C stimulation: an aid in differentiating unilateral parotitis from Warthin's tumor.

Of the nine patients included in this study, five with proven unilateral parotitis initially had diffuse high uptake of 99mTc-pertechnetate in the affected glands with adequate washout following vitamin C stimulation. Of four patients with proven Warthin's tumor, two had focal high uptake in the parotid masses and two had diffuse high uptake on baseline images. All tumors were clearly delineated after stimulation. 99mTc-pertechnetate salivary scintigraphy with vitamin C stimulation may provide a useful tool in differentiating unilateral parotitis from Warthin's tumor.

Adenolymphoma↗

Ultrasonographic features of recurrent parotitis in childhood.

Six children with recurrent parotitis were studied by ultrasound. Of the 12 parotid glands thus observed, 5 were swollen and 7 were not enlarged. Multiple round hypoechoic areas measuring 2-4 mm in diameter were seen in all 5 enlarged parotid glands and in 5 non-enlarged glands. These small hypoechoic areas were larger than the punctate pools of contrast medium shown by sialography. We consider that these hypoechoic areas represented both peripheral sialectasis and surrounding lymphocytic infiltration. We propose that ultrasonography may be useful for the diagnosis and follow-up of recurrent parotitis in childhood.

Child↗

[A rare cause of subacute parotitis. The pathogenetic role of crystals from an infarcted Whartin's tumour?].

The etiology of a subacute inflammatory swelling in the area of the right parotid gland in a 62-years old man could not be resolved clinically. The histomorphological examination of the surgical specimen showed an intraglandular area of predominantly chronic histiocytic inflammation with foreign body reaction in the intimate neighbourhood of a small, subtotally infarcted Warthin's tumour. Not birefringent spindle-shaped crystals could be demonstrated both within the parotitis or intraluminally in vital parts of the Warthin's tumour. In terms of the possible causes of the severe intraglandular inflammation, all arguments favour a primary infarction of the Warthin's tumour with the release of intraluminal preformed crystals which secondarily induce a massive inflammation with foreign body reaction, corresponding to the clinical presentation of a subacute parotitis.

Acute Disease↗

[Chronic recurrent parotitis in childhood in monozygotic twins. Magnetic resonance sialography].

Recurrent parotitis is rare in childhood. Its occurrence is characterized by recurrent episodes of swelling and pain in the parotid gland, which are usually accompanied by fever and malaise. Inflammation usually resolves spontaneously during adolescence. The disorder is a condition of unknown etiology. Sialectasis and stricturing occurs in the distal ducts, whereas inflammation of the gland and duct epithelium is probably caused by a low salivary flow rate. Which one can be considered the primary event or secondary change remains unknown. The main-stay of diagnosis is sialography, which depicts typical intraparotidal duct system lesions as strictures or ectasias and excludes sialolithiasis. We here report two 10-year-old male monovular twins who suffered from recurrent swelling and pain in only their left parotid glands. Symptoms were noted approximately every 6 weeks in both patients strictly. Characteristic sialectasis of the distal ducts was demonstrated by magnetic resonance-sialography. Our findings support the hypothesis that recurrent parotitis is caused by a congenital abnormality of the salivary gland ducts. Diagnostic imaging was performed by magnetic resonance imaging during the acute phase of the disease. This technique helps to make the diagnosis without retrograde application of a contrast agent.

Child↗

A new model of experimental parotitis in rats and its implication for trigeminal nociception.

A rat model of chronic parotitis was developed following a direct injection of Complete Freund's adjuvant (CFA) into the unilateral parotid gland via the parotid duct without skin incision. The nocifensive behavior, plasma extravasation in the parotid gland, and trigeminal Fos protein expression, a marker of neuronal activation, were analyzed in this model and compared to that of the saline-injected rats. A significant reduction of the escape threshold to mechanical stimulation of the lateral face on the ipsilateral side to the CFA injection was observed at 1-6 days after CFA injection as compared to that of the pre-CFA control ( P<0.01). The lateral face region contralateral to the CFA injection also showed mechanical hyperalgesia at 1-6 days after injection ( P<0.05). The plasma extravasation was significantly increased in the parotid gland ipsilateral to CFA injection as compared to that of the parotid gland with saline injection at 3 days after injection as shown by Evans' blue dye extravasation ( P<0.05). Bilateral expression of Fos protein-like immunoreactive cells was observed in the transition zone between the trigeminal spinal nucleus interpolaris (Vi) and caudalis (Vc) and paratrigeminal nucleus (Pa5). On the other hand, a significant unilateral expression of Fos protein-positive cells was observed on the ipsilateral side of the upper cervical (C2) dorsal horn ( P<0.05). This model of parotitis can be used to study trigeminal pain mechanisms associated with sialadenitis. A unique feature of this preparation is that the inflammation was limited to the parotid gland after intraductal injection of CFA, allowing analysis of peripheral input from a defined orofacial region. The model will be useful in developing new strategies to treat chronic orofacial pain.

Animals↗

Acute suppurative parotitis in outpatients: microbiologic and posttreatment sialographic findings.

The presenting clinical features of twenty-seven cases of acute suppurative parotitis seen in the Oral Medicine Unit, Glasgow Dental Hospital, between 1975 and 1985 are reviewed. The microbiologic findings plus the management and subsequent findings on sialography after recovery are summarized. Of the microorganisms isolated, alpha-hemolytic streptococci predominated, with many other bacteria similar in range to those reported in previous studies. Microbiologically, the drug of choice was erythromycin, closely followed by ampicillin. Sialography in the posttreatment phase demonstrated a local salivary gland abnormality in 70% of patients, and 22% of patients had a generalized salivary gland disorder. On the basis of these findings, a management regime for patients with acute suppurative parotitis is suggested.

Acute Disease↗

Quantitative bacteriology of a case of acute parotitis.

It is generally assumed that the microorganisms responsible for acute suppurative parotitis are facultative anaerobes, primarily Staphylococcus aureus and Streptococcus viridans. A quantitative microbiologic investigation of an aspirate of pus from the case we report revealed a microbial flora (5.1 X 10(6) CFU/ml) consisting entirely of strict anaerobes (Fusobacterium nucleatum and Peptostreptococcus anaerobius). The strain of F. nucleatum was sensitive to metronidazole but resistant to penicillin, amoxicillin, and erythromycin (minimum inhibitory concentration greater than 16 micrograms/ml). P. anaerobius was sensitive to the antibiotics tested. It is concluded that a high concentration of viable anaerobic bacteria may be present in acute suppurative parotitis and thus pus obtained from cases of sialadenitis should be cultured with microbiologic methods capable of isolating strict anaerobes. Additionally, antibiotic sensitivity should be determined routinely.

Acute Disease↗

Simultaneous epiglottitis and parotitis: a case report.

A patient presenting to the emergency department with simultaneous parotitis and epiglottitis is described. She underwent emergency airway intervention within 3 hours of presentation. This is the first case of simultaneous parotitis and epiglotitis. Diagnostic symptoms are discussed.

Critical Care↗

Acute parotitis as a complication of fine-needle aspiration in Warthin's tumor. A unique finding of a 3-year experience with parotid tumor aspiration.

OBJECTIVE/HYPOTHESIS: Fine needle aspiration (FNA) is an accurate, cost-effective tool for the study of salivary gland lesions. Although complications are extremely rare, salivary gland FNA can lead to hemorrhage, facial nerve injury, and cellulitis at the needle puncture site. Some studies suggest that FNA can cause infarction or metaplastic transformation of benign Warthin's tumors. We review our recent experience with FNA of the parotid gland, focusing on possible complications and pitfalls. STUDY DESIGN AND SETTING: The medical records of all patients who underwent FNA of the parotid gland from 2000 to 2002 in the Department of Otolaryngology-Head and Neck Surgery of a major tertiary-care referral center were reviewed. Cytological results were compared to the histological diagnosis and complications were recorded. RESULTS: Of the 256 lesions aspirated, 99 patients (39%), were cytologically diagnosed as benign tumors, including 31 (12%) Warthin's tumors, of which 16/17 resected and confirmed histologically. Five patients with Warthin's tumor had post-FNA parotitis and were treated accordingly. CONCLUSIONS: The combination of cystic spaces surrounded by oncocytic cells and a poor blood supply makes the tumor susceptible to infarction and inflammation. Our findings indicate that FNA is a strong and reliable tool in the investigation of the salivary glands. Nevertheless, when Warthin's tumor is clinically suspected on the basis of its location (tail of the parotid gland), cystic texture, patient sex (male) and age, one should consider parotitis as a possible complication. EBM RATING: C-4.

Acute Disease↗

Unique pattern of Epstein-Barr virus specific antibodies in recurrent parotitis.

Sera from 34 children with recurrent parotitis were measured by indirect immunofluorescence technique for antibody levels to several Epstein-Barr virus (EBV) antigens. IgG antibodies to EBV-capsid antigen (VCA) and EBV-associated nuclear antigen, often at high titres, were found in 29 of these patients, of whom 20 also had IgA antibody to VCA. Antibody level to early antigen complex (R and D) rose in 19 patients, of whom 18 had antibody to the R component alone. The abnormal patterns of EBV antibodies persisted for 3-14 months during and after the illness in 8 patients. These observations suggest that EBV infection may be important in the pathogenesis of recurrent parotitis.

Animals↗

Gland atrophy following retrograde injection of methyl violet as a treatment in chronic obstructive parotitis.

OBJECTIVE: The purpose of this study was to evaluate the clinical effectiveness of retrograde injection of 1% methyl violet as a treatment for chronic obstructive parotitis. STUDY DESIGN: Sixteen patients with chronic obstructive parotitis were treated with retrograde injection of 1% methyl violet. Pretreatment evaluation and assessment of the treatment effect were performed by clinical and imaging methods, including sialography and sonography of the treated glands. RESULTS: Clinical symptoms following treatment included initial acute swelling and then a decrease in parotid swellings; the final outcome was a clinical cure of the affected glands characterized by disappearance of all symptoms, absence of secretion, and complete obliteration of the main duct orifice. Posttreatment imaging showed total atrophy of the diseased glands. CONCLUSION: Retrograde injection of 1% methyl violet caused total atrophy of the diseased glands and brought about complete relief in all 16 patients, with no detectable side effects.

Adolescent↗

Sonographic analysis of recurrent parotitis in children: a comparative study with sialographic findings.

OBJECTIVE: The sonographic features of recurrent parotitis in children were studied to clarify a relationship between sonographic and sialographic findings in this disease. STUDY DESIGN: Twenty-one glands (7 on follow-up) were examined by 7.5 MHz ultrasonography and sialography. Echo intensity level, distribution of the internal echoes, and size of hypoechoic areas were compared with the size of punctate shadows on the sialograms. Twenty other histopathologic specimens were analyzed to investigate the entity of hypoechoic areas. RESULTS: Sonography showed hypoechoic, heterogeneous internal echoes, the level of which increased as the punctate shadows enlarged. Hypoechoic areas, all of which were larger than the sialographic punctate shadows, were observed in 62% of the glands. Histopathologic analysis suggests that these hypoechoic areas represent dilated peripheral ducts with lymphocytic infiltration. Sonography was likely to detect changes over time more sensitively than sialography. CONCLUSIONS: Sonography should be performed as the test of first choice, both in the primary and follow-up stages, in cases of recurrent parotitis in children.

Adolescent↗

[Neonatal suppurative parotitis].

This report describes the case of a 10 days old newborn of a diabetic mother with gestosis, who developed erythema and swelling of the right cheek. A diagnosis of acute suppurative parotitis due to S. aureus was made. Following this case report the most important facts of epidemiology, pathogenesis, clinical manifestation, diagnostics, and therapy of suppurative parotitis are discussed.

Administration, Oral↗

[Role of diagnostic imaging in chronic recurrent parotitis in childhood].

BACKGROUND: Chronic recurrent parotitis represents a disease of still uncertain etiology that can be divided into a childhood and an adult form. Sialography is still the imaging procedure of choice. METHOD: We report about a nine-year-old girl who had had six episodes of parotitis in the past two years. MR sialography is presented as an alternative to conventional sialography. MR was performed with a 1.5 T wholebody tomograph using a high resolution 3D-CISS sequence. RESULTS AND CONCLUSION: MR sialography does not require any contrast medium. It primarily images liquid structures, and the flow of saliva can be adequately demonstrated after stimulation with ascorbic acid. These special features of MR sialography allow its use also during acute episodes of sialadenitis, thus providing a significant improvement over conventional sialography. Furthermore, no overlapping occurs as in conventional summation images, due to the multiplanar reconstruction features.

Adult↗