Parotitis
Encyclopedia
Parotitis is an inflammation
of one or both parotid gland
s, the major salivary gland
s located on either side of the face, in humans. The parotid gland is the salivary gland most commonly affected by inflammation.
is most often caused by a bacterial infection of Staphylococcus aureus
but may be caused by any commensal bacteria.http://emedicine.medscape.com/article/882461-overview Templer JW , MD, Professor of Otolaryngology, University of Missouri Medical Center at Columbia. Parotitis: Overview, Accessed 03/04/2009
Parotitis as Extrapulmonary Tuberculosis:
The mycobacterium that cause tuberculosis
can also cause parotid infection. Those infected tend to have enlarged, nontender, but moderately painful glands. The diagnosis is made by typical chest radiograph findings, cultures, or histologic diagnosis after the gland has been removed. When diagnosed and treated with antitubercular medications, the gland may return to normal in 1–3 months.
Acute viral parotitis (mumps):
The most common viral cause of parotitis is mumps
. Routine vaccinations
have dropped the incidence of mumps to a very low level. Mumps resolves on its own in about ten days.
HIV parotitis: Generalized lymphadenopathy
has long been associated with HIV
, but the localized enlargement of the parotid gland is less well known.
Sjögren's syndrome:
Chronic inflammation of the salivary glands may also be an autoimmune disease known as Sjögren's syndrome
. The disease most commonly appears in people aged 40–60 years, but it may affect small children. In Sjögren syndrome, the prevalence of parotitis in women versus men is approximately 9:1. The involved parotid gland is enlarged and tender at times. The cause is unknown. The syndrome is often characterized by excessive dryness in the eyes, mouth, nose, vagina, and skin.
Mikulicz disease:
Antiquated name for any enlargement of the parotid gland that was not tuberculosis, leukemia, or some other identifiable disease.
Lymphoepithelial lesion of Godwin:
Most frequently associated with a circumscribed tumor with the histologic features of Sjögren syndrome. This designation has also fallen out of favour.
l superinfection
. The blockage may be from a salivary stone, a mucous
plug, or, more rarely, by a tumor, usually benign. Salivary stones, also called salivary duct calculus, are mainly made of calcium
, but do not indicate any kind of calcium disorder.Salivary Gland Stones (Salivary Calculi) Accessed March 20, 2008. Stones may be diagnosed via X-ray
(with a success rate of about 80%), a computed tomography
(CT) scan or Medical ultrasonography
. Stones may be removed by manipulation in the doctor's office, or, in the worst cases, by surgery. Lithotripsy
, also known as "shock wave" treatment, is best known for its use breaking up kidney stone
s. Lithotripsy can now be used on salivary stones as well. Ultrasound waves break up the stones, and the fragments flush out of the salivary duct.
This term is generally used for patients in whom no definite etiology is found. Episodes may last for several days, paralleling the time course of a bacterial or viral illness. Others may experience episodes that last only a few hours from onset to resolution. Some episodes may last for several weeks. Quiescent periods between episodes last for hours, days, or even years.
Recurrent parotitis of childhood:
An uncommon syndrome in which recurring episodes clinically resembling mumps. Generally, episodes begin by age 5 years, and virtually all patients become asymptomatic by age 10–15 years. The duration of attacks averages 3–7 days but may last 2–3 weeks in some individuals. The spectrum varies from mild and infrequent attacks to episodes so frequent that they prevent regular school attendance.
Local heat applied to the gland, massaging the gland from back to front, and taking penicillin
usually cure individual episodes. Treatment of individual infections may prevent injury to the gland parenchyma. Severe disease may be treated by parotidectomy.
Sialadenosis (sialosis):
In this disorder, both parotid glands may be diffusely enlarged with only modest symptoms. Patients are aged 20–60 years at onset, and the sexes are equally involved. The glands are soft and non-tender. Approximately half of the patients have endocrine disorders such as diabetes, nutritional disorders such as pellagra or kwashiorkor, or have taken drugs such as guanethidine, thioridazine, or isoprenaline.
Sarcoidosis
:
The lungs, skin, and lymph nodes are most often affected, but the salivary glands are involved in approximately 10% of cases. Bilateral firm, smooth, and non-tender parotid enlargement is classic. Xerostomia
occasionally occurs. The Heerfordt-Waldenstrom syndrome consists of sarcoidosis
with parotid enlargement, fever, anterior uveitis, and facial nerve palsy.
Pneumoparotitis:
Air within the ducts of the parotid gland with or without inflammation. The duct orifice normally functions as a valve to prevent air from entering the gland from a pressurized oral cavity. Rarely, an incompetent valve allows insufflation of air into the duct system. Pneumoparotitis most commonly occurs in wind instrument players, glass blowers, and scuba divers.
Several lymph nodes reside within the parotid gland as a superficial and deep group of nodes. These nodes may be involved with any process that affects lymph nodes, including bacterial, fungal, viral, and neoplastic processes. Rarely, drugs such as iodides, phenylbutazone, thiouracil, isoproterenol, heavy metals, sulfisoxazole, and phenothiazines cause parotid swelling.
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
of one or both parotid gland
Parotid gland
The paired parotid glands are the largest of the salivary glands. They are each found wrapped around the mandibular ramus, and secrete saliva through Stensen's ducts into the oral cavity, to facilitate mastication and swallowing and to begin the digestion of starches.-Location:The parotid glands...
s, the major salivary gland
Salivary gland
The salivary glands in mammals are exocrine glands, glands with ducts, that produce saliva. They also secrete amylase, an enzyme that breaks down starch into maltose...
s located on either side of the face, in humans. The parotid gland is the salivary gland most commonly affected by inflammation.
Infectious parotitis
Acute bacterial parotitis:is most often caused by a bacterial infection of Staphylococcus aureus
Staphylococcus aureus
Staphylococcus aureus is a facultative anaerobic Gram-positive coccal bacterium. It is frequently found as part of the normal skin flora on the skin and nasal passages. It is estimated that 20% of the human population are long-term carriers of S. aureus. S. aureus is the most common species of...
but may be caused by any commensal bacteria.http://emedicine.medscape.com/article/882461-overview Templer JW , MD, Professor of Otolaryngology, University of Missouri Medical Center at Columbia. Parotitis: Overview, Accessed 03/04/2009
Parotitis as Extrapulmonary Tuberculosis:
The mycobacterium that cause tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
can also cause parotid infection. Those infected tend to have enlarged, nontender, but moderately painful glands. The diagnosis is made by typical chest radiograph findings, cultures, or histologic diagnosis after the gland has been removed. When diagnosed and treated with antitubercular medications, the gland may return to normal in 1–3 months.
Acute viral parotitis (mumps):
The most common viral cause of parotitis is mumps
Mumps
Mumps is a viral disease of the human species, caused by the mumps virus. Before the development of vaccination and the introduction of a vaccine, it was a common childhood disease worldwide...
. Routine vaccinations
Vaccine
A vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe or its toxins...
have dropped the incidence of mumps to a very low level. Mumps resolves on its own in about ten days.
HIV parotitis: Generalized lymphadenopathy
Lymphadenopathy
Lymphadenopathy is a term meaning "disease of the lymph nodes." It is, however, almost synonymously used with "swollen/enlarged lymph nodes". It could be due to infection, auto-immune disease, or malignancy....
has long been associated with HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
, but the localized enlargement of the parotid gland is less well known.
Autoimmune causes
These are also collectively known as chronic punctate parotitis or chronic autoimmune parotitis.Sjögren's syndrome:
Chronic inflammation of the salivary glands may also be an autoimmune disease known as Sjögren's syndrome
Sjögren's syndrome
Sjögren's syndrome , also known as "Mikulicz disease" and "Sicca syndrome", is a systemic autoimmune disease in which immune cells attack and destroy the exocrine glands that produce tears and saliva....
. The disease most commonly appears in people aged 40–60 years, but it may affect small children. In Sjögren syndrome, the prevalence of parotitis in women versus men is approximately 9:1. The involved parotid gland is enlarged and tender at times. The cause is unknown. The syndrome is often characterized by excessive dryness in the eyes, mouth, nose, vagina, and skin.
Mikulicz disease:
Antiquated name for any enlargement of the parotid gland that was not tuberculosis, leukemia, or some other identifiable disease.
Lymphoepithelial lesion of Godwin:
Most frequently associated with a circumscribed tumor with the histologic features of Sjögren syndrome. This designation has also fallen out of favour.
Blockage
Blockage of the main parotid duct, or one of its branches, is often a primary cause of acute parotitis, with further inflammation secondary to bacteriaBacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
l superinfection
Superinfection
In virology, superinfection is the process by which a cell, that has previously been infected by one virus, gets coinfected with a different strain of the virus, or another virus at a later point in time. Viral superinfections of serious conditions can lead to resistant strains of the virus, which...
. The blockage may be from a salivary stone, a mucous
Mucus
In vertebrates, mucus is a slippery secretion produced by, and covering, mucous membranes. Mucous fluid is typically produced from mucous cells found in mucous glands. Mucous cells secrete products that are rich in glycoproteins and water. Mucous fluid may also originate from mixed glands, which...
plug, or, more rarely, by a tumor, usually benign. Salivary stones, also called salivary duct calculus, are mainly made of calcium
Calcium
Calcium is the chemical element with the symbol Ca and atomic number 20. It has an atomic mass of 40.078 amu. Calcium is a soft gray alkaline earth metal, and is the fifth-most-abundant element by mass in the Earth's crust...
, but do not indicate any kind of calcium disorder.Salivary Gland Stones (Salivary Calculi) Accessed March 20, 2008. Stones may be diagnosed via X-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
(with a success rate of about 80%), a computed tomography
Computed tomography
X-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...
(CT) scan or Medical ultrasonography
Medical ultrasonography
Diagnostic sonography is an ultrasound-based diagnostic imaging technique used for visualizing subcutaneous body structures including tendons, muscles, joints, vessels and internal organs for possible pathology or lesions...
. Stones may be removed by manipulation in the doctor's office, or, in the worst cases, by surgery. Lithotripsy
Lithotripsy
Lithotripsy refers to the physical destruction of gallstones or kidney stones. The term is derived from the Greek words meaning "breaking stones" .Forms include:* Extracorporeal shock wave lithotripsy...
, also known as "shock wave" treatment, is best known for its use breaking up kidney stone
Kidney stone
A kidney stone, also known as a renal calculus is a solid concretion or crystal aggregation formed in the kidneys from dietary minerals in the urine...
s. Lithotripsy can now be used on salivary stones as well. Ultrasound waves break up the stones, and the fragments flush out of the salivary duct.
Diseases of uncertain etiology
Chronic nonspecific parotitis:This term is generally used for patients in whom no definite etiology is found. Episodes may last for several days, paralleling the time course of a bacterial or viral illness. Others may experience episodes that last only a few hours from onset to resolution. Some episodes may last for several weeks. Quiescent periods between episodes last for hours, days, or even years.
Recurrent parotitis of childhood:
An uncommon syndrome in which recurring episodes clinically resembling mumps. Generally, episodes begin by age 5 years, and virtually all patients become asymptomatic by age 10–15 years. The duration of attacks averages 3–7 days but may last 2–3 weeks in some individuals. The spectrum varies from mild and infrequent attacks to episodes so frequent that they prevent regular school attendance.
Local heat applied to the gland, massaging the gland from back to front, and taking penicillin
Penicillin
Penicillin is a group of antibiotics derived from Penicillium fungi. They include penicillin G, procaine penicillin, benzathine penicillin, and penicillin V....
usually cure individual episodes. Treatment of individual infections may prevent injury to the gland parenchyma. Severe disease may be treated by parotidectomy.
Sialadenosis (sialosis):
In this disorder, both parotid glands may be diffusely enlarged with only modest symptoms. Patients are aged 20–60 years at onset, and the sexes are equally involved. The glands are soft and non-tender. Approximately half of the patients have endocrine disorders such as diabetes, nutritional disorders such as pellagra or kwashiorkor, or have taken drugs such as guanethidine, thioridazine, or isoprenaline.
Sarcoidosis
Sarcoidosis
Sarcoidosis , also called sarcoid, Besnier-Boeck disease or Besnier-Boeck-Schaumann disease, is a disease in which abnormal collections of chronic inflammatory cells form as nodules in multiple organs. The cause of sarcoidosis is unknown...
:
The lungs, skin, and lymph nodes are most often affected, but the salivary glands are involved in approximately 10% of cases. Bilateral firm, smooth, and non-tender parotid enlargement is classic. Xerostomia
Xerostomia
Xerostomia is the medical term for the subjective complaint of dry mouth due to a lack of saliva. Xerostomia is sometimes colloquially called pasties, cottonmouth, drooth, or doughmouth. Several diseases, treatments, and medications can cause xerostomia. It can also be exacerbated by smoking or...
occasionally occurs. The Heerfordt-Waldenstrom syndrome consists of sarcoidosis
Sarcoidosis
Sarcoidosis , also called sarcoid, Besnier-Boeck disease or Besnier-Boeck-Schaumann disease, is a disease in which abnormal collections of chronic inflammatory cells form as nodules in multiple organs. The cause of sarcoidosis is unknown...
with parotid enlargement, fever, anterior uveitis, and facial nerve palsy.
Pneumoparotitis:
Air within the ducts of the parotid gland with or without inflammation. The duct orifice normally functions as a valve to prevent air from entering the gland from a pressurized oral cavity. Rarely, an incompetent valve allows insufflation of air into the duct system. Pneumoparotitis most commonly occurs in wind instrument players, glass blowers, and scuba divers.
Several lymph nodes reside within the parotid gland as a superficial and deep group of nodes. These nodes may be involved with any process that affects lymph nodes, including bacterial, fungal, viral, and neoplastic processes. Rarely, drugs such as iodides, phenylbutazone, thiouracil, isoproterenol, heavy metals, sulfisoxazole, and phenothiazines cause parotid swelling.