Parotitis

Written by Dr Angus Cain, specialist Registrar in otolaryngology, Ninewells Hospital, Dundee

What are the parotid glands?

The parotid glands are the saliva-producing glands buried within each cheek. The saliva they produce comes out of a tiny opening (duct) within the cheek on either side, usually at the level of the upper back teeth.

What is parotitis?

Parotitis is an inflammation of one or both parotid glands. There are a number of causes, but the clinical picture remains broadly similar.

Acute bacterial parotitis

This is an acute inflammatory response to bacterial infection which causes erythema (redness), pain, swelling and tenderness over the gland on the side of the cheek along with the appearance of pus from the opening of the duct on the inside of the cheek.

It was previously common in dehydrated and debilitated patients, often in the postoperative period, but is now more commonly seen after radiotherapy or in patients with a compromised immune system.

Treatment comprises correction of the lack of fluids (rehydration), antibiotics and pain relief.

Chronic recurrent parotitis

This refers to repeated episodes of discomfort and swelling of the parotid gland often after eating. It is caused by decreased flow of saliva often secondary to either blockage of the duct by a stone or the formation of a duct stricture (narrowing).

It is treated conservatively with gland massage, methods to stimulate the flow of saliva, eg lemon juice, and antibiotics if required. Surgery to remove the gland is possible but its benefits need to be balanced against the risk of damage to the facial nerve (which allows the muscles of facial expression to function).

Damage to the facial nerve can cause paralysis of one side of the face. X-ray treatment (radiotherapy) and treatment with steroid tablets have been described but are felt generally to be ineffective.

Viral parotitis

The commonest viral cause of parotitis is mumps. It usually affects 4 to 10 year olds and causes painful swelling of both parotid glands.

Recurrent parotitis in children

This condition is thought to be due to distension or ballooning of the ducts (the medical term is 'ectasia'). It results in the same symptoms as acute bacterial parotitis. It is usually caused by bacteria called streptococci and treated using penicillin. It is usually self-limiting and therefore surgery is rarely required.

Tuberculosis

The parotid glands may become infected with the same bacteria causing tuberculosis or 'TB'. Treatment is with anti-tuberculous antibiotic therapy.

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