Parotitis

Introduction

Parotitis is an inflammation of the parotid glands that can be caused by various things such as, a
viral infection like mumps, blockage of salvia flow and bacterial infections (1). The parotid glands
are the largest of the salivary glands and can be found below the ears. Parotid glands play a
significant role in lubrication of the mouth, digestion and immunity of the human body (2). The
glands are boarded anteriorly and medially by the masseter, superiorly by the zygomatic arch and
posteriorly by the sternocleidomastoid (3). Parotitis can either be acute, meaning the swelling gets
better in a short period, or it can be chronic, meaning the inflammation gets worse before it gets
better (4)

Epidemiology & Causes

Parotitis affects people and ages differently according to what caused the inflammation of the
parotid gland. Acute bacterial parotitis is commonly caused by a bacterium known as
staphylococcus aureus and mix of oral aerobes and/or anaerobes (6). Acute bacterial parotitis often
occurs due to poor oral hygiene, dehydration and debilitation (5,6) and is, therefore mainly seen in
postoperative elderly patient. It is also common in newborns and chronically ill patients (6). The
second type is only seen in kids and is known as juvenile recurrent parotitis (JRP), and it is a
recurrent inflammatory of the parotid glands in children (5). It is characterized by several multiple
episodes of the swelling of the parotid glands or pain in the glands coupled with fever on kids over
the years. The first JRP episode occurs between the ages of 3 -6 years old (5). The third type is
known as chronic parotitis and affects adults, mainly females (5). The average of patients presenting
with chronic parotitis is between 40-60 years old (5). The cause is unknown; however, most cases
recorded over the past years did record that patients with chronic parotitis often had an autoimmune
disease (5). However, we cannot conclude that it is the only cause or that having an autoimmune
disease is the leading cause as there are cases where patients suffer from chronic parotitis and not
have an autoimmune disease. The fourth type is known as acute viral parotitis, and it can be caused
by various things such as mumps, coxsackievirus and Epstein-Barr virus, (5). It mostly occurs
between the ages of 20 - 60 years old in both males and females (5).
Clinical Presentation & Symptoms

Clinical presentation of parotitis can vary according to the past medical history and age of the
patient. However, some symptoms are common among all patients. In general, patients suffering
from both chronic and acute parotitis, their parotid gland is visibly swollen and tender to touch
when palpating around the gland (1) Patients will also have symptoms such as sudden pain when
chewing, they will also show redness over the side of the face, and upper neck, fever and a dry
mouth (1). Patients suffering from acute parotitis will often have pus that may drain into the mouth
while patients suffering from chronic parotitis will have a milky discharge in their mouth (4).

Effect on Local Anatomy

The parotid gland is one of the major salivary glands. It produces serous salvia, which is rich in
enzymes. The salvia is secreted into the oral cavity, where it lubricates the mouth and helps the
breakdown of food (3). The parotid gland can be found anterior and below the ear. The gland
extends down to the lower border of the mandible and up to the zygomatic arch (3). They cover the
anterior section of the sternocleidomastoid muscle and continue anteriorly halfway across the
masseter muscle (3). Many neurovascular structures pass through the gland; one of them is the
facial nerve, also known as the cranial nerve VII, which gives five different terminal branches
within the parotid gland (2). The parotid duct leaves the parotid gland between the zygomatic arch
and the corner of the mouth (7). The normal flow of salvia through the duct prevents oral bacteria
from ascending the duct to cause infection (7). If the parotid duct becomes blocked, salvia ascends
the duct causing an infection which leads to parotitis. Due to the blockage, the parotid gland
becomes inflamed; this causes the labia of the ear to elevate, which can cause ear pain. The
inflamed gland also leads to pain in the mandible, as the muscle around the parotid gland becomes
inflamed and as a result, stiffen and are constricted in movement. As infections mostly cause
parotitis, the body sends signals to the hypothalamus to increase body temperature as a way to fight
the infection; this causes the patient fever (3). The cranial nerve also might be affected by the
inflammation and can cause bell’s palsy, although this is very rare (8).
Treatment and Prevention

Treatment for parotitis varies according to the severity of the illness. Treatment for parotitis can be
little as apply heat and messaging the are affected to have a surgical procedure (1,4). Parotitis that
is caused by infection, antibiotics are prescribed (1). If complications arise, such as abscess, surgical
drainage is required to treat the infected area (1). Prevention of parotitis can be as easy as staying
hydrated and making sure to have good oral health. MMR vaccines against mumps are also a
preventive measure, as mumps can lead to parotitis. There is not a specific vaccine or treatment
that can prevent or stop parotitis. Patients suffering from parotitis can face complication such as
respiratory obstruction, absences and discharge in the mouth (1,4). Males can develop orchitis,
which is an inflammation of one or both testicles, during the first week of parotitis (9).

Conclusion

Parotitis is not a common illness, and it very rare as society is more aware of oral hygiene and the
vaccine against mumps where developed. However, there are some cases that still arise today, but
are mostly seen in elderly postoperative patients and chronically ill patients. Although there is not a
specific treatment for parotitis, there are treatments that can cure it.
References
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Otolaryngologic Clinics of North America. 2016;49(2):273-284.
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4. Parotitis | Winchester Hospital [Internet]. Winchesterhospital.org. 2020 [cited 16 May
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id=100273
5. Parotitis, Acute and Chronic | 5-Minute Clinical Consult [Internet].
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and Neck Surgery. 1992;118(5):469-471.
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https://www.kenhub.com/en/library/anatomy/the-parotid-gland
8. Bell's Palsy Fact Sheet | National Institute of Neurological Disorders and Stroke
[Internet]. Ninds.nih.gov. 2020 [cited 17 May 2020]. Available from:
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-
Sheets/Bells-Palsy-Fact-Sheet
9. Orchitis - an overview | ScienceDirect Topics [Internet]. Sciencedirect.com. 2020
[cited 17 May 2020]. Available from:
https://www.sciencedirect.com/topics/medicine-and-dentistry/orchitis