Suppurative parotitis: Difference between revisions

(Created page with "==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 a...")
 
 
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==Background==
==Background==
*Serious bacterial infection of parotid gland that occurs in pts w/ decreased salivary flow
*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
**Caused by retrograde migration of oral bacteria into salivary ducts and parenchyma
**Usually caused by staph, strep, anerobes
**Usually caused by staph, strep, anaerobes
*Risk factors:
 
**Dehydration
===Risk factors===
**Prematurity or advanced age
*[[Dehydration]]
**Sialolithiasis
*Prematurity or advanced age
**Oral neoplasms
*[[Sialolithiasis]]
**Salivary duct strictures
*Oral neoplasms
**Meds (cause systemic dehydration or decrease salivary flow)
*Salivary duct strictures
***Diuretics
*Meds (cause systemic dehydration or decrease salivary flow)
***Antihistamines
**[[Diuretics]]
***TCAs
**[[Antihistamines]]
***B-blockers
**[[TCAs]]
**Chronic illnesses
**[[beta-blockers]]
***HIV
*Chronic illnesses
***Sjogren syndrome
**[[HIV]]
***Anorexia/bulimia
**[[Sjögren Syndrome]]
**[[Anorexia nervosa]]/[[bulimia nervosa]]
**[[Cystic fibrosis]]


==Clinical Features==
==Clinical Features==
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*Skin over parotid gland is red and tender
*Skin over parotid gland is red and tender
*Purulent drainage from Stensen's duct  
*Purulent drainage from Stensen's duct  
*Fever  
*[[Fever]]
*Trismus
*Trismus


==Treatment==
==Differential Diagnosis==
#Hydrate the volume-depleted patient
{{Facial swelling DDX}}
{{Lymphadenitis DDX}}
 
==Evaluation==
*Usually clinical
 
==Management==
===Supportive Care===
#[[IVF|Hydrate]] the volume-depleted patient
#Massage and apply heat to the affected gland
#Massage and apply heat to the affected gland
#Stimulate salivation using sialagogues such as lemon drops
#Stimulate salivation using sialogogues such as lemon drops
#Abx
===[[Antibiotic]] Options===
##PO abx if pts can tolerate oral liquids and have no evidence of systemic illness
{{Suppurative Parotitis Antibiotics}}
##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))


==See Also==
==See Also==
[[Salivary Gland Infetions]]
*[[Salivary gland diagnoses]]
 
==References==
==Source==
<references/>
Tintinalli
 
[[Category:ENT]]
[[Category:ENT]]
[[Category:ID]]
[[Category:ID]]

Latest revision as of 21:40, 9 September 2020

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, anaerobes

Risk factors

Clinical Features

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

Differential Diagnosis

Facial Swelling

Lymphadenitis

Infectious

Non-Infectious

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 sialogogues such as lemon drops

Antibiotic Options

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

See Also

References

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