DISORDERS OF SALIVARY GLAND:- Reference Andrews Controversies in the Management of Salivary Gland Disease. Edited by Mark McGurk and Andrew Renehan. Salivary Gland Disorders Editors: Myers, Eugene N., Ferris, Robert L. (Eds.) Classification is given below in picture slide INFLAMMATORY DISORDERS Sialadenitis Sialadenitis represents inflammation mainly involving the acinoparenchyma of the gland. Awareness of salivary gland infections was increased in 1881 when President Garfield died from acute parotitis following abdominal surgery and associated systemic dehydration. Acute Sialadenitis Etiopathogenesis Acute inflammation of the salivary glands is usually of viral or bacterial origin. 1) Viral infection- mumps is the most common. RNA virus from the paramyxovirus group and typically involves the parotid glands bilaterally. Children are most often affected with peak incidence at approximately 4 to 6 years of age. Transmission is via infected respiratory droplets . Treatment mainly- supportive and symptomatic treatment with early detection and management of complications like (rare)- meningoencephalitis, orchitis, pneumonia. 2) Bacterial infections- a) Acute Sialadenitis- Common clinical settings in which this entity may occur include the elderly postoperative patient after cardiothoracic or gastrointestinal surgery. Onset is typically heralded by unilateral abrupt diffuse swelling of the parotid perhaps with accompanying induration and tenderness. Mucopurulent material may be expressed from the opening of Stensen's duct with massage of the gland, and a sample should be obtained for Gram stain and culture. Fluctuance is often not present due to the multiple fascial investments with the substance of the parotid gland. Clinical features: Sudden onset painful swelling in the preauricular region. Parotid gland involved either unilaterally/bilaterally. Fever, malaise, headache and redness of the skin overlying the parotid. Trismus and difficulty in swallowing. Intraorally parotid papilla may be inflamed and often pus/exudates may be expressed from the duct opening. b) Chronic Bacterial Sialadenitis:- It is a nonspecific inflammatory disease of the salivary gland secondary to duct obstruction or low grade sustained ascending infection. Clinical features : Occurs in adults and children Commonly affects parotid gland Usually unilateral Recurrent tender swelling of the affected gland is a common feature Duct orifice will be inflamed and in case of acute exacerbation, there can be purulent Discharge from it Decreased salivary flow Investigations : USG Sialoscopy Sialography Bacterial culture from saliva / secretion of the gland FNAC/Biopsy. Histopathology : Acinar atrophy of the salivary gland with subsequent fibrosis. Dilatations of the ductal system Hyperplasia of ductal epithelium Chronic inflammatory cell infiltration. c) Recurrent parotitis: Rare condition Affects children and adults. Predisposing factors: salivary gland calculi structure of the duct. Abnormal low secretion of saliva due to any cause. Congenital absence of duct system Immunosupression Clinical features: unilateral / bilateral. Recurrent painful swelling of affected gland Discharge of pus from the duct orifice Lab investigations: Elevated ESR and leucocyte Bacterial culture from saliva/parotid secretions. Treatment Goal : Eliminate causative organism Rehydration of patient Drainage of purulence Empirical antibiotic therapy pencillianse resistant antibiotic such as semisynthetic penicillin/ Clindamycin ( preferred) Analgesics Bed rest Therapy is initially conservative with adequate hydration, sialogogues, heat, massage of the affected gland, and the administration of an appropriate intravenous antibiotic, usually a penicillinase-resistant antistaphylococcal antibiotic. Improvement is expected within the first 24 to 48 hours. If this does not occur, operative intervention may be indicated. This usually consists of a standard parotidectomy skin incision and flap followed by creation of several openings within the substance of the gland parallel to the course of the facial nerve. A drain is then placed over the gland and the wound closed. Complications include possible septicemia or deep space neck infection. Mortality has been reported as high as 20% and is likely related to the severity patient's underlying medical condition.

5 year old male. Starting December 2018, he has a history of swelling in right parotid / infra auricular reigion which was painful and erythematous then. Mantoux neg. CXR normal. FNAC - necrotizing inflammation with no granuloma. He presents to me now in March 2019 with 2-3 fluctuant, non tender, non erythematous, cold swelling ~1.5*1.5 cm each. Outside diagnosed necrotizing parotitis. No significant oral, nose, ear findings. Please suggest next step. CBNAAT negative.

A child was brought to E/D with complaint of sudden onset swelling over right side neck region. His parents told that he had an episode of fever yesterday night, but no medications taken as of now. Is it Mumps?

14yr female B/L neck swelling since 2-3days pain+ poor appetite lethargic fever moderate grade plz dx and rx

Girl 6yrs.fever with a soft to firm swelling comes on and off .no pain or any finding in the ear and throat.guide me regarding the diagnosis and treatment ...