Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Related Searches

Suppurative parotitis in adults

INTRODUCTION

Acute infection of the parotid gland can be caused by a variety of bacteria and viruses. Acute bacterial suppurative parotitis is caused most commonly by Staphylococcus aureus and mixed oral aerobes and/or anaerobes. It often occurs in the setting of debilitation, dehydration, and poor oral hygiene, particularly among elderly postoperative patients.

The epidemiology, clinical manifestations, microbiology, diagnosis, and treatment of suppurative parotitis will be reviewed here. Deep neck space infections and salivary duct stones are discussed separately. (See "Deep neck space infections" and "Salivary gland stones".)

ANATOMY AND PATHOGENESIS

The parotid glands are located on the sides of the face anterior to the external auditory canal, superior to the angle of the mandible, and inferior to the zygomatic arch. Most of the parotid gland is superficial to the masseter muscle. The salivary gland consists of 20 to 30 intraparotid and periparotid lymph nodes with lymphatic drainage from the ipsilateral side of the face and forehead, including the auricular region and the external auditory canal [1]. Stensen's duct arises from the anterior border of the parotid gland and is 4 to 7 cm long, narrows to 1.2 mm at an isthmus, and the os is 0.5 mm and is opposite the upper second molar (figure 1).

Acute bacterial suppurative parotitis may occur when salivary stasis permits retrograde seeding of the Stensen's duct by a mixed oral flora [2]. Ductal obstruction by calculi or tumor may predispose to suppuration. Abscess formation may also arise by contiguous infection or hematogenous seeding to the intraparotid or periparotid lymph nodes [1].  

EPIDEMIOLOGY AND RISK FACTORS

Suppurative parotitis typically occurs in elderly postoperative patients who are dehydrated or intubated, although it may also be seen in outpatients [2,3]. Other predisposing factors include recent intensive teeth cleaning, use of anticholinergic drugs and other drugs that reduce salivary flow, malnutrition, salivary calculi with obstruction, and neoplasm of the oral cavity [4]. Infection of embryogenic cysts, such as the first branchial cleft, may result in frequent suppuration of the parotid gland [5].  

              

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jun 2014. | This topic last updated: Sep 17, 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Tan VE, Goh BS. Parotid abscess: a five-year review--clinical presentation, diagnosis and management. J Laryngol Otol 2007; 121:872.
  2. Cohen MA, Docktor JW. Acute suppurative parotitis with spread to the deep neck spaces. Am J Emerg Med 1999; 17:46.
  3. Brook I. The swollen neck. Cervical lymphadenitis, parotitis, thyroiditis, and infected cysts. Infect Dis Clin North Am 1988; 2:221.
  4. Brook I. Acute bacterial suppurative parotitis: microbiology and management. J Craniofac Surg 2003; 14:37.
  5. Triglia JM, Nicollas R, Ducroz V, et al. First branchial cleft anomalies: a study of 39 cases and a review of the literature. Arch Otolaryngol Head Neck Surg 1998; 124:291.
  6. Raad II, Sabbagh MF, Caranasos GJ. Acute bacterial sialadenitis: a study of 29 cases and review. Rev Infect Dis 1990; 12:591.
  7. Sherman JA. Pseudomonas parotid abscess. J Oral Maxillofac Surg 2001; 59:833.
  8. Huang TT, Tseng FY, Yeh TH, et al. Factors affecting the bacteriology of deep neck infection: a retrospective study of 128 patients. Acta Otolaryngol 2006; 126:396.
  9. Al-Dajani N, Wootton SH. Cervical lymphadenitis, suppurative parotitis, thyroiditis, and infected cysts. Infect Dis Clin North Am 2007; 21:523.
  10. Varghese JC, Thornton F, Lucey BC, et al. A prospective comparative study of MR sialography and conventional sialography of salivary duct disease. AJR Am J Roentgenol 1999; 173:1497.
  11. Naragund AI, Halli VB, Mudhol RS, Sonoli SS. Parotid fistula secondary to suppurative parotitis in a 13-year-old girl: a case report. J Med Case Rep 2010; 4:249.
  12. O'Connell JE, George MK, Speculand B, Pahor AL. Mycobacterial infection of the parotid gland: an unusual cause of parotid swelling. J Laryngol Otol 1993; 107:561.
  13. Mandel L, Surattanont F. Bilateral parotid swelling: a review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 93:221.