[Effects of neurectomy of the tympanic plexus on secretion of the parotid gland in man. Histopathological, histochemical and clinical study (author's transl)]

This study involved five patients suffering from bilateral chronic parotiditis and then with a persistent unilateral fistula of the parotid gland. Two types of parotid biopsy were examined: the first taken during surgery and the second six months later. All of the specimens underwent histopathological and histochemical investigations. Definitive degeneration and atrophic type changes were seen in all the parotid fragments removed six months after selective neurectomy of the tympanic plexus. Six months after surgery, all of the patients were cured.

[Clinical aspects and treatment of postoperative parotitis]

The clinical picture and treatment of postoperative parotitis in 31 patients are described. An early operation is recommended in case of the failure of conservative therapy. 22 patients were operated upon, 11 out of them recovered, and 11 died. Postoperative parotitis is directly responsible for the death of three out of them.

The surgical management of recurrent parotitis

Twenty-eight parotidectomies were carried out upon 26 patients with chronic parotitis. The lesion considered is chronic inflammation of the parotid gland associated with such intraglandular defects as sialadenitis secondary to ductal obstruction by calculi, cellular debris, stenosis or infiltrating lesions, that is, Mikulicz's or Sjögren's syndromes and sialoangiectasis, either primary or secondary to obstruction of the duct. Seventeen near total parotidectomies were done without significant complications or a recurrence of symptoms. Eleven superficial parotidectomies were performed in which symptoms recurred on the 12th postoperative day in one patient. No permanent weakness of the facial nerve occurred in any of the 28 parotidectomies. Based upon this experience, near total parotidectomy with removal of the parotid duct can be performed safely and should be the procedure of choice in patients with chronic, relapsing parotid sialadenitis.

Effect of tympanic neurectomy on human parotid salivary gland. Histopathologic, Histochemical, and Clinical Study

Five patients with bilateral chronic recurrent parotiditis and ten patients with unilateral persistent paratoid gland fistulas underwent tympanic neurectomies. Two biopsy specimens from the diseased gland were examined. The first biopsy specimen was taken at the time of operation, while the second one was taken six months later. All specimens were subjected to both histopathologic and histochemical investigations. Definite degenerative and atrophic changes occured in all parotid gland specimens taken six months after selective tympanic neurectomy. All patients were completely cured at about that time. This supported the practical indication of the selective tympanic neurectomy for treating certain benign disorders or diseases of the parotid gland that require persistent arrest of the function of its secretory units.

Scanning evaluation of parotid gland after tympanic neurectomy

Summary--Nine patients suffering from chronic parotitis, gustato sweating syndrome, and gustato lacrymation syndrome underwent tympanic neurectomy. Follow-up showed discrepancies between the good clinical results and the unchanged parotid scans in eight out of nine patients. Parasympathetic bypasses to the parotid gland are discussed.

Acute septic parotitis: incidence, aetiology and management

The clinical details, management and bacteriology of acute septic parotitis in 36 patients occurring during the period 1956–67 are reviewed.

The incidence of acute septic parotitis increased from 0.009 per cent of hospital admissions during 1956–61 to 0.016 per cent in the period 1962–67.

In the period 1956–61, the organism most commonly isolated was Streptococcus viridans; during the period 1962–67 it was Staphylococcus aureus and more than 50 per cent of the latter were penicillin-resistant. During the period 1962–67, 4 patients with acute septic parotitis died during the course of their hospitalisation. All had acute renal failure as well as the clinical features of bacteraemic shock.

The factors influencing the incidence and mortality of acute septic parotitis during the 20th century are considered.

A regime for the future management of this condition, based upon an analysis of the present survey is suggested.

Infected adenolymphoma: a new parotid syndrome

Two cases are presented of acute inflammatory swellings developing in a parotid gland in elderly men and going on to abscess formation. Both proved to be due to secondary infection of adenolymphomas. In the first case the rupture of the abscess led to a salivary fistula; in the second an associated septicaemia threatened the life of the patient. Both patients were successfully treated by a conservative parotidectomy. From a consideration of the clinical and pathological features, it is suggested that the most likely route of infection of the tumours is the blood-stream.