Parotid Gland Anatomy

Parotid duct over maxillary second molar

The extratemporal facial nerve and its branches pass through the parotid gland and supply motor innervation to the muscles of facial expression, as well as to the postauricular muscles, the posterior belly of the digastric muscle, and the stylohyoid muscles.

Pathophysiology• decreased salivary production or an

impedance of its delivery.

• failure of sufficient ductal lavage by saliva facilitates an ascending duct infection from the oral cavity.

• infection results in immune/inflammatory response

Causes• Viral infection from: HIV, Mumps

• Bacterial infection from:• medications that cause dry mouth. When your flow of saliva is reduced,

bacteria can collect and grow in the Parotid duct.

• Dehydration

• poor oral hygiene• Sialoliths

• Sjögren's syndrome

• tumor - can block the flow of saliva (usually not cancerous)• Pneumoparotitis - air gets into the ducts of the parotid gland, most commonly

occurs in wind instrument players, glass blowers, and scuba divers.

Findings• Subjective:

• oral or facial pain, especially when eating

• abnormal, foul tastes

• dry mouth

• fever may be present

• Objective:

• facial asymmetry caused by unilateral parotid gland swelling

• Palpation reveals that the swelling is tender and indurated and follows the anatomical contour of the parotid gland.

• erythema over skin overlying the glands

• Intraorally, a flow of saliva mixed with pus will be seen exiting from the involved parotid duct orifice when the gland is forcefully massaged.

Diagnosis

• Med Hx (medications, Sjögren's, HIV)

• Physical exam (pain, swelling, purulence, dry mouth)

• Radiographs: PA, Pano, or CT

The panoramic radiograph shows a patient with a pseudo-bilateral tonsillolith. The white arrow shows a unilateral calcification that overlapped the middle portion of the ascending ramus. The white and black arrow indicates a ghost image of the radiopacity on the right side appearing higher and more blurred than its source on the left side. B. The CBCT images reveal what appeared on panoramic radiographs as bilateral images were in fact unilateral lesions. The 3D, axial, and coronal CBCT images show a unilateral mass of the right side.

Imaging Sci Dent. 2013 Sep;43(3):163-169. English.Published online Sep 23, 2013. http://dx.doi.org/10.5624/isd.2013.43.3.163

Figure 1 Chronic parotitis in the left parotid gland. The computerized tomographic scan demonstrates increased parenchymal density of the left parotid gland (arrow) compared with the right parotid gland.

LOUIS MANDEL , ERIN LEIGH WITEK

Chronic parotitis : Diagnosis and treatment

The Journal of the American Dental Association, Volume 132, Issue 12, 2001, 1707 - 1711

http://dx.doi.org/10.14219/jada.archive.2001.0125

An oropharyngeal examination reveals dry oral mucosa and swelling adjacent to the right parotid papilla, with no saliva expressed from the orifice (Panel A, arrow).

Maxillofacial computed tomography showed changes consistent with inflammation in the parotid gland and surrounding tissues, with marked dilatation of the parotid duct (Panel B, red arrow) and a small calcified mass (Panel B, white arrow) proximal to the

duct orifice.

Susarla, Peacock, M.D., D.M.D. Obstructive Parotitis. N Engl J Med 2012; 366:2305. June 14, 2012 DOI: 10.1056/NEJMicm1113977

Treatment• In some cases, no treatment is needed.

• Conservative/Palliative treatment:

• good oral hygiene (can add Peridex if needed)

• stimulate glands by chewing sugarless chewing gum or sour candy (sugarless lemon drops)

• massage the gland with heat

• increased fluid intake

• Antibiotics may be helpful.

• Avoid tobacco

• Analgesics if needed

• In severe cases: superficial parotid lobectomy

Complications• Prognosis: good! Treatments for most salivary

gland infections will go away on their own or are cured with treatment. Complications are not common.

• Possible Complications:

• Infection recurs

• Abscess of salivary gland

• spread of infection (cellulitis, Ludwig's angina)

Conclusion• Dentists are in the unique position to

diagnose a patient with Chronic Parotitis.

• The ability to perform a thorough clinical examination, salivary examination and imaging procedure facilitates the differentiation of Parotitis from other pathology.

• Accurate diagnosis is necessary for an appropriate therapeutic approach.

Robbie Schaack

Doctor of Dental Surgery