• Nalaka de Silva

ACUTE PAROTITIS

Please note that the following is a general guideline only. For a full assessment, exclusion of any other underlying cause for your symptoms and an individualised treatment approach, you will need to be seen by a qualified specialist.



Epidemiology

50 - 60 years

male = female

parotid gland most common

associated with medically debilitated and postoperative patients





Aetiology

Systemic

-DM, hypothyroidism, renal failure, and



Local

reduced salivary flow-Medications/ Sjögren's syndrome

mechanical impairment - stenosis / sialolithiasis → more common in SMG ducts














Microbiology

most commonly -penicillin-resistant Staphylococcus aureus,

Streptococcus species,S pyogenes, S viridans, and S pneumoniae

Hemophilus influenzae

Anaerobic and gram-negative bacteria in acute suppurative sialadenitis



Pathophysiology

stasis of salivary flow secondary to dehydration

→ retrograde bacterial contamination of the salivary ducts from the oral cavity

→ suppurative infection of the gland parenchyma



Why parotid> SMG

parotid gland produces saliva that is mainly serous, as opposed to saliva from the SMG and SLGs that is primarily mucoid

serous saliva, unlike mucinous saliva, is deficient in lysosomes, IgA antibodies, and sialic acid, which have antimicrobial properties

Saliva of SMG and SLGs contains high molecular weight glycoproteins that competitively inhibit bacterial attachment to the epithelial cells of the salivary ducts


Clinical

systemic- fever, chills, and malaise

rapid onset of pain and swelling over the affected salivary gland

tenderness to palpation, with warmth and induration of the overlying skin

suppurative discharge from the duct orifice

multiple glands-bilateral involvement of up to 25% of cases




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