parotitis and parotid swellings

see also:

• mumps

• acute unilateral parotitis is usually due to an obstruction stone or acute bacterial parotitis
• acute bilateral parotitis is usually due to mumps
• alcoholism, sarcoidosis or HIV may cause chronic bilateral parotidomegaly
• tumour including lymphoma may cause parotid enlargement +/- facial nerve palsy
  • 60% of all parotid neoplasms are accounted for by the pleomorphic adenoma, while 8% are mucoepidermoid carcinoma, 7% are Warthin's tumour,
• recurrent parotitis of childhood is an uncommon syndrome
• autoimmune causes are uncommon and usually are bilateral, and mainly affects women
• rarely, a range of other conditions may involve the parotid glands

• non-obstructing stones are generally asymptomatic but partial obstruction results in increased secretions after meal resulting in post-prandial pain and swelling
• full obstruction causes acute sialadenitis
• Dx usually via CT scan
• Rx:
  • D/W ENT
  • suck on lemons to stimulation secretions to hopefully expel the calculus
  • cover with antibiotics eg. flucloxacillin
  • may require surgical removal under LA by ENT

• historically, had a high mortality if untreated
• most are Staph. aureus, other bacterial causes include:
  • Haemophilus influenzae
  • Klebsiella spp are common in patients with diabetes mellitus
  • Enterobacterales and Pseudomonas aeruginosa in hospitalized patients
  • less commonly, mycobacterial infections and Actinomyces species
• generally occurs in post-op patients, those who are dehydrated, or in the elderly who take medications with anticholinergic actions
• rare, lethal form occurs in neonates
• Rx:
  • iv antibiotics
  • oral hygiene
  • rehydration
  • surgical drainage if not responding

• mumps - may also cause orchitis
• less commonly:
  • influenza, parainfluenza, coxsackievirus, echovirus, EBV, CMV, COVID-19 coronavirus (2019-nCoV / SARS-CoV-2)
  • HIV / AIDS - may cause chronic parotitis

• chronic bacterial
• tuberculosis (TB)
• HIV / AIDS

• Chronic punctate parotitis
• Mikulicz disease - IgG4-related parotitis, aka benign lymphoepithelial lesion
  • check IgG4 levels, Rx with steroids
• Sjögren's syndrome (SS) - as a result of stones, strictures, or mucus plugs
• sarcoidosis
• rheumatoid arthritis
• systemic lupus erythematosus (SLE)

• chronic alcohol abuse
• tumours
• diabetes mellitus
• malnutrition
• liver disease
• bulimia
• medications
  • clozapine, iodinated contrast, L-asparaginase, and anticholinergics