It is a contagious disease, contracted through droplet infection and has an incubation period of 2-3 weeks. Mostly affects children below 15 years. One episode is believed to give lifelong immunity.
Clinical features : There is a brief prodrome of raised temperature and general malaise. Parotid gland, on one or both sides, becomes diffusely enlarged and painful. Opening of parotid duct becomes acutely swollen and congested. Other salivary glands may also be involved. Isolated involvement of only submandibular gland can occur, but is unusual. Temperature usually rises to 103°F (39.5° C), but is higher if CNS is also involved.
Complications : Viraemia associated with mumps can cause epididymo-orchitis, meningoencephalitis, pancreatitis or thyroiditis. Mumps is the most important cause of unilateral sensorineural hearing loss.
Diagnosis : It can be made on clinical basis. Serum amylase is raised in 95% of patients. White cell count is normal or shows leukopenia with relative lymphocytosis, but it is high in cases complicated with CNS involvement. Titres of mumps S and V antibodies may be raised and are helpful in the diagnosis of subclinical or atypical cases.
Treatment : In normal cases, treatment is only symptomatic and consists of bed rest, analgesics, soft bland diet and local heat.
ACUTE SUPPURATIVE PAROTITIS
It is most commonly seen in the elderly, debilitated and dehydrated patients. Dry mouth due to any cause is a predisposing factor. Staph aureus is the usual causative organism though other gram-positive and anaerobic organisms have also been observed. Usual route of infection is from the mouth through the Stensen’s duct.
Clinical features : The onset is sudden with severe pain and enlargement of gland. Movements of jaw aggravate the pain. Opening of the Stensen’s duct is swollen and red and may be discharging pus or the latter can also be expressed by gentle pressure over the gland. Patient is usually febrile and toxaemic.
Investigations : White cell count shows leukocytosis with increase in polymorphs. Causative organisms should be identified and their sensitivity established by culture of blood and the pus collected from the opening of the parotid duct.
Treatment : It consists of appropriate antibiotics, preferably administered through I.V. route, adequate hydration, measures to promote salivary flow and attention to oral hygiene. If temperature does not subside and there is progressive induration of the gland, in spite of adequate medical management, surgical drainage should be done.
PAROTID ABSCESS
It is an advanced stage of suppurative parotitis. Multiple small abscesses may form in the parenchyma of the parotid gland. They may coalesce to form a single large abscess. Fluctuation in parotid abscess may not be elicited due to dense fibrous capsule. An early parotid abscess can be diagnosed by ultrasound examination of the gland when considering surgical drainage. A parotid abscess may spread into parapharyngeal space or burst spontaneously on the check or into the external auditory canal.
Treatment of parotid abscess is external surgical drainage under local or general anaesthesia. A preauricular incision is made and skin flap raised to expose the surface of the gland. Abscess or abscesses are bluntly opened, working parallel to the branches of Vllth nerve. A drain is placed and the wound allowed to heal by secondary intention.
CHRONIC RECURRENT SIALADENITIS
This usually involves parotid gland which shows recurrent bacterial infection. During acute exacerbation, parotid is enlarged and tender, and pus can be expressed from its duct. Between the acute episodes, gland is firm and slightly enlarged. Culture of pus from the duct reveals staphylococci or streptococci. Sialography shows normal duct system. Treatment of acute episode is similar to that of acute bacterial sialadenitis. Between the attacks, patient is instructed to keep good oral hygiene, avoid drugs which dry oral mucosa and use sialogogues to promote salivation.
SIALECTASIS
As the name implies, there is dilatation of the ductal system, leading to stasis of secretions, which predisposes to infection. Clinically, sialectasis resembles chronic recurrent sialadenitis, but can be differentiated from it by sialography. Different degrees of dilatation of the ductal system—punctuate, globular or cavitary types—-may be seen. Sialectasis may be congenitat associated with granulomatous disease or autoimmune disease such as Sjogren’s syndrome.
GRANULOMATOUS DISEASES
Tuberculosis, sarcoidosis and actinomycosis may involve the salivary glands. Tubercular infection may involve parenchyma or lymph nodes of the parotid and present as a non-tender mass. Sometimes, overlying skin undergoes necrosis leading to a fistula formation. Surgical excision of the involved tissue and antitubercular treatment usually control the disease.
Uveo-parotid fever is due to sarcoidosis of the parotid. It is characterised by fever, enlargement of the parotid and lacrimal glands, chorioretinitis, and cranial nerve palsies.
Actinomycosis of parotid is uncommon. It may present as an acute abscess with sinus formation discharging sulphur-like granules, or as an indolent swelling in the parotid. Treatment is surgical drainage and large doses of penicillin or tetracycline.
SALIVARY CALCULI
Calculi may form in the ducts of submandibular or parotid glands. They are formed by the deposition of calcium phosphate on the organic matrix of mucin or cellular debris. About 90% of the stones are seen in submandibular and 10% in the parotid. Stones may form in the duct of parenchyma of the gland.
The presenting feature is intermittent swelling of the involved gland, and pain due to obstruction to outflow of saliva. Sometimes, stone is visible at the duct opening or can be palpated. About 80% of the stones are radioopaque and can be seen on appropriate X-rays. Sialography may be required for radiolucent stones.
Stones in peripheral part of submandibular or parotid ducts can be removed intraorally, while those at the hilum or in the parenchyma require excision of the gland.