Streptococcus pneumoniae acute suppurative parotitis in a patient with Sjögren's syndrome

A case of suppurative parotitis due to Streptococcus pneumoniae is reported in a patient with Sjögren's syndrome. The rarity of this condition is noted by a review of the literature.

Accidental full thickness burn of the ear lobe following division of the great auricular nerve at parotidectomy

Division of the great auricular nerve is commonly performed during superficial parotidectomy and leads to anaesthesia of the ear lobe. In the case presented here, this gave rise to an accidental self-inflicted thermal burn of the ear lobe. This might have been avoided had the posterior branch of the nerve been preserved.

Simultaneous epiglottitis and parotitis: a case report

A patient presenting to the emergency department with simultaneous parotitis and epiglottitis is described. She underwent emergency airway intervention within 3 hours of presentation. This is the first case of simultaneous parotitis and epiglotitis. Diagnostic symptoms are discussed.

[Revision of the parotid--assessing the risk and indications status for re-parotidectomy]

Recurrences of benign and malignant tumors and inflammatory complications are the main indications for revision parotidectomy. Many of these operations could be avoided if the primary surgical procedure had been adequate. Revision parotidectomy is difficult to perform when the facial nerve is embedded in scar tissue. Indications for and risks of revision parotidectomy are demonstrated for typical situations such as recurrent pleomorphic adenomas and malignancies, postoperative fistulas, and recurrences of previously operated chronic parotitis.

[Surgically treated diseases of the parotid gland in childhood and adolescence]

Between 1969 and 1986 parotid gland surgery was performed on 86 children and adolescents in the ENT clinic of the University of Tübingen. Chronic recurrent parotitis was found to be the most common chronic inflammatory disease in our young patients. Total parotidectomy was done on 24 children. Because of the high incidence of potential complications the indication for a total parotidectomy in chronic parotitis should be carefully considered. A more hopeful attitude applies to the cystic tumours (haemangioma, lymphangioma and branchiogenic cysts). A solid tumour of the parotid gland in children and adolescents, however, necessitates surgical extirpation without delay because one-third of these tumours are malignant.

Difficult decisions in parotid surgery

Six atypical case presentations of parotid tumors are presented along with solutions proposed by two experts on the topic. The differences and similarities of the opinions expressed are summarized and discussed by the editor.

Actinobacillus actinomycetemcomitans: a new cause for granuloma of the parotid gland and buccal space

A case of chronic granuloma of the buccal space and parotid gland is described which was caused by the unusual organism Actinobacillus actinomycetemcomitans. A review of the literature describing its pathogenesis and other clinical presentations is offered.

Salivary glands

A review of the more common inflammatory and neoplastic conditions affecting salivary glands has been presented. The use of hydration, massage, antibiotics, and steroids is effective initial treatment for suppurative sialadenitis and usually negates the need for surgical drainage. Total excision of the salivary gland and its duct is necessary in procedures for recurrent infection. Our technique for closure of the floor of the mouth after excision of the submandibular gland and Wharton's duct is described. Salivary neoplasms involving the parotid gland, the submandibular gland, and the minor salivary glands are treated on the basis of their histologic and local findings. Stepwise illustrations of our technique of parotidectomy and surgical considerations, including the counseling of a patient with a parotid mass, are presented to assist surgeons who care for patients with salivary disorders.

Long-term follow-up of the effect of tympanic neurectomy on sialadenosis and recurrent parotitis

We examined the effect of tympanic neurectomy on the clinical symptoms and secretory function of the parotids in 13 patients with chronic parotitis or sialadenosis for 3 years. Each patient had significantly fewer complaints immediately after the surgery. In quite a few patients the improvement was transient only. Three years after neurectomy 3 of the 10 examined patients were free from complaints and 4 further patients had less severe complaints than before the surgery. Neurectomy was followed by a significant decrease in parotid flow rate and an increase in the sodium concentration of parotid saliva, while potassium concentration showed a slight decrease. Three years after the surgery the flow rate and the sodium concentration were moderately higher than before that. There was a significant, long-lasting change in the amylase activity of parotid saliva; 3 years after neurectomy it attained one-third of the preoperative value. A pharmacological test, carried out 3 years after neurectomy in 2 patients, suggested parasympathetic reinnervation of the parotid.

Benign parotid diseases of childhood

A 25-year retrospective study of 63 pediatric surgical cases of benign parotid disease was done. Inflammatory disorders accounted for 34 of the cases. The remaining 29 non-inflammatory conditions included vasoformative, solid, and cystic lesions and were nearly always asymptomatic.

[Surgical therapy of chronic parotitis]

A short survey of the therapeutical possibilities available in cases of chronic parotitis is followed by a discussion of the results achieved after surgical treatment. This discussion is based on the findings obtained in follow-up checks. The - very strict - indication for surgery was not made until all conservative measures had been exhausted and thus it involved only 2.4% of 380 surgical patients suffering from various diseases of the parotis gland. It was possible to achieve a sustained total absence of complaints in all cases, with partial or subtotal resection being sufficient in most instances. Although postoperatively partial loss of the N. facialis function occurred relatively frequently, permanent damage was not observed in any single case.

[Surgical treatment of chronic parotitis (author's transl)]

Of 58 patients whose parotid glands were extirpated because of a chronic parotitis, 90% could be cured. The rate of success of this operation is reduced to 70-80% if its is based on those 31 patients alone who showed the typical symptoms of a chronic-recurrent parotitis. The incidence of persisting facial pareses is about twice as high as after removal of non-inflamed parotid glands. This figure is based on seven patients suffering, with one exception, from only slight disorders of innervation in the region of the angle of the mouth. In our opinion total parotidectomy is the method of choice for the treatment of chronic parotitis, if all attempts at conservative treatment have failed. We attribute our failures to remaining glandular parenchyma that was both inflamed and still secretory-active. To further improve the rate of success of parotidectomy, its combination with procedures suitable for occlusion of the duct system is proposed. In this way one should succeed in completely eliminating any secretory-active gland tissue.

Non-neoplastic disorders of the parotid gland

The parotid glands are subject to many pathological disorders other than neoplastic diseases. This large group of disorders is classified for the parotid glands into infectious, metabolic and endocrine, traumatic, congenital, and acquired cystic diseases. The other major salivary glands also can be affected by many of these conditions. In recent years more and more patients have been examined and treated who have had diseases classified according to our concepts. Surgical procedures are now commonly recommended for these groups of patients not only for diagnosis but for treatment as well. The microscopic examination of permanently prepared, stained excised tissues still remains the final diagnostic procedure in most patients in spite of more recently developed diagnostic techniques. Further, the well trained surgeon of today is in a position to assure the patient that permanent injury to the facial nerve trunk or to its branches is only a remote possibility. Lastly, our medical and surgical experiences are discussed in the following groups of patients: those with acute suppurative sialadenitis, those with acute abscess, those with chronic obstructive and non-obstructive sialadenitis, those with traumatic lesions, those with congenital lesions, and those with acquired cystic lesions.

Tympanic neurectomy and chorda tympani section

Tympanic neurectomy with or without chorda tympani section is a surgical procedure which can play a role in the treatment of diseases for which more extensive procedures have in the past been performed. The surgical approach is familiar to most ear, nose and throat surgeons, and the operation, which can be satisfactorily performed under local anaesthesia, is associated with very little, if any, discomfort to the patient.

Facial nerve function in 100 consecutive parotidectomies

The risk of facial nerve paresis after parotidectomy is thought to be within acceptable limits, although it is difficult to find published data regarding the specific magnitude of this risk. This study reviews the subject and reports postoperative facial function in 100 consecutive patients who had parotidectomies at the Henry Ford Hospital during a 9-year period. Permanent weakness of a major branch was identified in 2 of 77 patients having lateral lobectomy for parotid disease. Both patients demonstrated marginal mandibular paresis after surgery for adenolymphoma. No weakness was noted in 16 patients undergoing total parotidectomy. No unanticipated nerve disability was noted in 4 patients having partial nerve sacrifice in extended procedures; 3 patients had complete sacrifice of the nerve.