Parotid Gland Abscess

Abscess over the left parotid gland area. (Dr. Noorali Bharwani)
Abscess over the left parotid gland area. (Dr. Noorali Bharwani)

46 year-old female presented with a two-week history of an abscess over the left parotid area. The patient reports an abscess in the same location 18 months prior which she had aspirated. She has a medical history of Sjögren’s syndrome.

The patient had finished a course of amoxicillin-clavulanic acid and then was started on a course of a cephalosporin. Incision and drainage was done under local anesthetic and a large amount of pus was drained. The patient healed well.

Culture: Streptococcus anginosus

Streptococcus anginosus is part of the human bacteria flora, but can cause diseases including brain and liver abscesses under certain circumstances.” (Wikipedia)

Pathology: Showed no parotid tissue. There was acute-on-chronic inflammation of subcutaneous tissues.


Salivary Gland

Infection: parotitis, sialandenitis

Symptoms – One-sided salivary gland swelling. Fever and pain will accompany the swelling.

Pathogens – Typically normal bacteria found in the mouth. Viral infections such as mumps often affect the salivary glands. Mumps most often involves parotid salivary gland. Mumps is a rare problem today because of the MMR vaccine.

Dehydration and malnutrition raise the risk of getting a bacterial infection.

Sjögren’s syndrome

This is a chronic autoimmune disease in which cells of a person’s immune system attack the salivary and other moisture-producing glands, leading to dry mouth and eyes. About half of people with Sjögren’s syndrome also have enlargement of the salivary glands on both sides of the mouth, which is usually painless.

Treatment

In some cases, no treatment is needed.

Antibiotics for fever or pus drainage, or if the infection is caused by bacteria. Antibiotics are not useful against viral infections.

Surgery or aspiration to drain abscess.

Self-care steps that can be done at home to help with recovery:

  • Practice good oral hygiene. Brush teeth and floss well at least twice a day. This may help with healing and prevent infection from spreading.
  • Rinse mouth with warm salt-water rinses (1/2 teaspoon of salt in 1 cup of water) to ease pain keep the mouth moist.
  • Stop smoking.
  • Drink lots of water and use sugar-free lemon drops to increase the flow of saliva and reduce swelling.

Prognosis

Most salivary gland infections go away on or are cured with treatment. Some infections will return. Complications are uncommon.

Complications

  • Abscess of salivary gland
  • Infection returns
  • Spread of infection (cellulitis, Ludwig’s angina)

Prevention

In many cases, salivary gland infections cannot be prevented. Good oral hygiene may prevent some cases of bacterial infection.

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Swollen Salivary Gland

Dear Dr. B: Left side of my face is swollen. MRI shows swelling of the parotid salivary gland. What are the causes of swelling of the parotid gland?

Answer: Saliva is produced by several salivary glands in and around our mouth. The major salivary glands are parotid glands (in front of the ears), submandibular glands (under the jaws) and sublingual glands (under the tongue).

There are several minor salivary glands located in different areas of our mouth. The function of saliva is to lubricate our mouth, initiate digestion (it has an enzyme) and help protect our teeth.

There are several reasons why the salivary gland may become enlarged.

The ducts draining the parotid or submandibular gland may get blocked by stone formation or scarring (stricture). The gland swells up and becomes painful during eating when the saliva is trying to flow through the duct. A blocked gland can easily become infected. This causes more swelling and pain. If this remains untreated then it becomes abscessed requiring surgery.

In children, the salivary gland may enlarge due to mumps.
Painless enlargement of the salivary gland usually indicates tumor. But not necessarily malignant tumor. Most common tumors of the salivary gland are benign in nature. Tumors rarely involve more than one gland.

Malignant tumors of the parotid can be painful and may cause paralysis of one side of the face. The facial nerve passes through the parotid gland and gets trapped in the malignant process. This causes weakness on one side of the face.

Salivary gland enlargement also occurs in autoimmune diseases such as HIV and Sjögren’s syndrome where the body’s immune system attacks the salivary glands causing significant inflammation. Dry mouth or dry eyes are common. This may occur with other systemic diseases such as rheumatoid arthritis, diabetes and among alcoholics.

Diagnosis of salivary gland disease depends on the careful taking of history, a physical examination, and laboratory tests, plain and dye x-rays, CT scan and/or MRI.

Not all salivary gland swellings require major surgical procedure. In some cases medical treatment is a good option. Your specialist can discuss the various options available to you once a diagnosis has been made.

Thought for the week:

“Appetite grows by eating.” – Francois Rabelais

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