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Suppurative parotitis in adults

Anthony W Chow, MD, FRCPC, FACP
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Allyson Bloom, MD


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".)


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].


Suppurative parotitis typically occurs in elderly postoperative patients who are dehydrated or intubated, although it may also be seen in outpatients [2-4]. 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].

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Literature review current through: Nov 2017. | This topic last updated: Sep 27, 2017.
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  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. Chi TH, Yuan CH, Chen HS. Parotid abscess: a retrospective study of 14 cases at a regional hospital in Taiwan. B-ENT 2014; 10:315.
  10. Al-Dajani N, Wootton SH. Cervical lymphadenitis, suppurative parotitis, thyroiditis, and infected cysts. Infect Dis Clin North Am 2007; 21:523.
  11. 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.
  12. Abu-Taleb NSM, Abdel-Waheb N, Amer MS. The Role of Magnetic Resonance Imaging and Magnetic Resonance Sialography in the Diagnosis of Various Salivary Gland Disorders: An Interobserver Agreement. J Med Imaging Radiation Sciences 2014; 45:299.
  13. 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.
  14. Mandel L, Surattanont F. Bilateral parotid swelling: a review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 93:221.
  15. Ogasawara N, Takano KI, Kobayashi H, et al. HIV-associated cystic lesions of the parotid gland. Auris Nasus Larynx 2017; 44:126.
  16. Cacopardo B, Pinzone MR, Gussio M, Nunnari G. High prevalence of parotideal abnormalities among HCV infected patients. Infez Med 2014; 22:31.
  17. 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.
  18. Chen S, Paul BC, Myssiorek D. An algorithm approach to diagnosing bilateral parotid enlargement. Otolaryngol Head Neck Surg 2013; 148:732.