Parotid Gland Enlargement
Parotid Gland Enlargement: Excerpt from The Diagnostic Approach to Symptoms and Signs in Pediatrics
The parotid gland lies between the externalauditory canal and cheek and extends from the lower zygomatic archto the mandible. It is palpable only when it is enlarged.
Principal Causes of Parotid Gland Enlargement
- Infection/inflammation
- Viralinfection
- Bacterial infection
- Recurrent parotitis of childhood
- Parotid gland obstruction
- Allergic reaction
- Trauma
- Masses
- Cysts
- Neoplasm
- Sjögren syndrome
- Sarcoidosis
- Drugs
Clinical Features and Diagnosis
Infection/Inflammation
Viral Infection
Most commoncause of parotid gland enlargement is viral infection, usually with mumpsvirus.In mumps parotitis, 1 or both parotidglands are enlarged, tender, and painful. Fever is variable finding.Inflamed ductal punctum with clear saliva suggests viral infection.Other viruses that may be associatedwith parotitis include enteroviruses, parainfluenza viruses, influenzaviruses, Epstein-Barr virus, cytomegalovirus, lymphocytic choriomeningitisvirus, and HIV.Positive viral culture of oropharynxis diagnostic. Bacterial Infection
Bacterialinfection of parotid gland is more unusual than viral infection.Common pathogens are S. aureus and viridans streptococci. Infectionswith S. pneumoniae, E. coli, P. aeruginosa, M. catarrhalis, andanaerobes are less common.Usual clinical findings are fever andpainful, tender, swollen gland. If purulent material oozes fromparotid duct, Gram stain and bacterial culture should be performed.U/S or CT can detect parotidabscess, and needle aspiration may yield culture-positive material.Parotid duct stones and stricturespredispose to bacterial infection. Recurrent Parotitis of Childhood
Characterizedby recurrent swelling of parotid gland occurring every few monthsand sometimes associated with fever. Pathogenesis is unknown, butillness does respond to antibiotics.Between episodes, the child is asymptomatic.Diagnosis is confirmed by history,physical exam, clinical course, response to antimicrobials, andtests to determine presence of any stone or mass. Parotid Gland Obstruction
Calculus,food particle, or stricture may cause obstruction of parotid ductwith subsequent enlargement of the gland.Increased pain and gland enlargementwith eating suggest a lesion obstructing salivary flow. Palpationmay reveal duct stone.If a stone is not visible on plainradiograph, CT may be useful in diagnosis. Allergic Reaction
Rare cause of parotid enlargement that usuallyproduces acute, nonpainful, bilateral swelling, which lasts hoursto several days. Presence of other allergic manifestations (e.g.,urticaria or wheezing) and predominance of eosinophils in parotidduct secretions supports diagnosis.
Trauma
Direct traumato the face may injure parotid gland or duct.Dental appliances or chronic cheekchewing may produce chronic irritation and inflammation of punctumwith resulting stricture formation and infection.History and physical exam are usuallydiagnostic. Masses
Cysts
Parotidcysts are usually nontender unless they are infected.Some cysts are congenital, whereasothers occur secondary to parotid duct obstruction caused by trauma,infection, stricture, or calculi.U/S can distinguish cysticfrom solid masses. Neoplasm
Most tumorsof parotid gland in pediatric population are benign. They includehemangioma (most common), lymphangioma, and pleomorphic adenoma.Tumors are usually single, mobile, firm, and slow growing.Malignant tumors include various carcinomasand sarcomas but are rare. Malignancy should be suspected if massis hard, fixed, and rapidly enlarging. Parotid gland is also commonsite for metastases from tumors of scalp, face, cheek, orbit, andexternal nose.CT and MRI are useful in defining extentof mass and in surgical planning. Histologic diagnosis is definitive. Sjögren Syndrome
In thischronic autoimmune disorder, parotid gland enlargement may be unilateralor bilateral. Other findings are dry eyes (keratoconjunctivitissicca), dry mouth (xerostomia), and arthritis.Lab findings include increased serumimmunoglobulin G, positive rheumatoid factor, and antibodies toRo (SS-A) and La (SS-B).Biopsy of minor salivary glands oflower lip that shows lymphocytic infiltration confirms diagnosis. Sarcoidosis
One manifestation of sarcoidosis is uveoparotidfever, in which there is bilateral, tender enlargement of parotidgland, uveitis, and fever. See Chap.38, Lymphadenopathy, for further discussion ofsarcoidosis.
Drugs
Iodide-containing compounds may produce parotidenlargement, but mechanism is unknown.
Diagnostic Approach
In manycases of parotid enlargement, history and physical exam are diagnostic.Most common cause of parotid enlargementin children is viral infection.Presence of fever, gland fluctuance,and pus from parotid duct indicates presence of bacterial infection,and positive bacterial culture is diagnostic.History usually provides clues to trauma,allergic reaction, and use of iodine-containing compounds.U/S can distinguish cysticand solid masses. Although CT and MRI locate and define extent ofneoplastic lesions, histologic diagnosis is definitive. References
- Behrman RE, et al., eds. Nelson textbookof pediatrics, 16th ed. Philadelphia: WB Saunders, 2000.
- Feigin RD, Cherry JD, eds. Textbook of pediatric infectiousdiseases, 4th ed. Philadelphia: WB Saunders, 1998.
- Long SS, et al., eds. Principles and practice of pediatricinfectious diseases. New York: Churchill Livingstone, 1997.
- Seibert RW. Diseases of the salivary glands. In: BluestoneCD, Stool SE, Kenna MA, eds. Pediatric otolaryngology, 3rd ed. Philadelphia:WB Saunders, 1996:1093–1107.
- Shott SR. Salivary disease in children. In: CottonRT, Myer CM III, eds. Practical pediatric otolaryngology. Philadelphia:Lippincott-Raven, 1999:693–710.
Book Source Details
- Book Title: The Diagnostic Approach to Symptoms and Signs in Pediatrics
- Author(s): Paul S. Bellet
- Year of Publication: 2006
- Copyright Details: The Diagnostic Approach to Symptoms and Signs in Pediatrics, Copyright © 2006 Lippincott Williams & Wilkins.
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