Recurrent parotitis and sialectasis in childhood. Clinical, radiologic, immunologic, bacteriologic, and histologic study

Utility of sialendoscopy in the management of juvenile recurrent parotitis. Retrospective study

INTRODUCTION

Juvenile recurrent parotitis is a rare disease characterized by repeated episodes of inflammation affecting, unilaterally or bilaterally, the parotid glands during childhood.

MATERIAL AND METHODS

Retrospective study including patients diagnosed with juvenile recurrent parotitis between January 2010 and September 2020 at a tertiary level hospital, with the aim of evaluating the results of medical treatment and sialendoscopy.

RESULTS

A total of 48 patients met the inclusion criteria and had a mean follow-up of 4 years (SD = 3; Min: 2/Max: 12). Regarding treatment, 34 (70.8%) patients received conservative treatment and had a mean of 5 episodes (SD = 3; Min: 2/Max: 13) until symptom resolution. Meanwhile, 14 (29.2%) patients underwent sialendoscopy, of which two (12%) required reintervention. In 100% (14) of the patients treated with sialendoscopy, the findings were consistent with JRP and, after sialendoscopy, a statistically significant reduction in episodes was observed, with a mean of 1 post-intervention episode (SD = 1.5; Min:0/Max: 6) (P < .001).

CONCLUSIONS

The results obtained in this study suggest that sialendoscopy is a useful tool in the treatment of juvenile recurrent parotitis. However, new studies comparing the results of sialendoscopy with other therapeutic alternatives are necessary.

Non-neoplastic salivary gland diseases in children: a 10-year review at a tertiary center

OBJECTIVES

Non-neoplastic salivary gland diseases are rare in children. This paper aims to present the spectrum of encountered non-neoplastic salivary gland diseases at a tertiary center by describing the demographics, clinical characteristics, and outcomes in this patient population.

METHODS

A review of electronic medical records was performed from 2010 until 2020. Relevant data were retrieved and charted according to the type of salivary gland disease. A comparison between diseases was made for demographics, presenting symptoms, treatment, and outcomes.

RESULTS

Fifty patients with 11 different non-neoplastic salivary gland diseases were identified. Sialolithiasis was the most prevalent condition (12/50), with 83% localized in the submandibular gland. In contrast to gender, age, and symptoms, the location of pathology was significantly associated with the diagnosis (p < 0.001). In patients with sialolithiasis, a hybrid procedure (combined endoscopy and lithotomy) resulted in 100% resolution of symptoms. For (plunging) ranula, marsupialisation had a relative risk of recurrence of 9.6 compared to (partial) extirpation of the sublingual gland.

CONCLUSIONS

Children with salivary gland diseases present with overlapping symptoms, making clinical diagnosis challenging. The present study may aid physicians and specialists in diagnosing the most prevalent conditions in children. Although no gold standards exist for their treatment, hybrid procedures (sialolithiasis) and subglingual gland extirpation (ranula) showed superior results over alternatives.

Sialendoscopy approach in treating juvenile recurrent parotitis: a systematic review

BACKGROUND

Juvenile recurrent parotitis (JRP) is characterized by recurrent episodes of painful parotid swelling in children. The purpose of this systematic review was to determine the diagnostic and therapeutic effectiveness of sialendoscopy in children affected by JRP.

METHODS

A systematic literature search was performed in PubMed, EMBASE, Scopus and the Cochrane Library until April 2022, without language restrictions or specified start date. Quality assessment was performed using the Newcastle-Ottawa Scale (NOS).

RESULTS

Our review included 524 patients and 646 sialendoscopies. The sample sizes of the different studies ranged from 3 to 77 subjects. Most authors performed sialendoscopy under general anesthesia. The mean percentage of recurrences observed was 25.1% (95% confidence intervals) (CI 23.6-26.6). There was a statistically significant relationship between the number of attacks/year and recurrences (p < 0.05). The percentage of recurrences according to the type of irrigation/flushing used ranged from 22.2% to 25.2%, with no significant differences between the use of corticosteroids alone (25.2% of recurrences), corticosteroids plus antibiotics (25% of recurrences) or saline alone (22.2% of recurrences). Sialoendoscopy has proved in all cases to be a valid method for the diagnosis of JRP, but it does not allow a reliable differential diagnosis with other autoimmune parotitis such as Sjögren's syndrome.

CONCLUSION

According to our results, parotid sialoendoscopy was 74.9% effective as a primary treatment in the prevention of recurrent symptoms in JRP. The type of ductal irrigation used did not significantly influence the prognostic outcome.

Common Characteristics and Clinical Management Recommendations for Juvenile Recurrent Parotitis: A 10-Year Tertiary Center Experience

Objective

Juvenile recurrent parotitis (JRP) is a rare disease that may adversely affect normal development and quality of life. The objective of this study was to report on the demographics, characteristics, and treatment outcomes of JRP and to offer evidence-based management recommendations.

Study Design

Retrospective review.

Setting

A single tertiary care pediatric teaching hospital.

Methods

Medical records, imaging studies, and laboratory findings over a 10-year period were retrospectively collected and reviewed, resulting in 41 patients with JRP between the ages of 8 months and 16 years.

Results

Black males aged 2 to 8 years were most commonly affected by JRP. Overall, 18 (44%) patients received ≥3 antibiotics, and 17 (42%) underwent sialendoscopy for treatment. Over 75% of patients had no JRP recurrences after 3 sialendoscopies. The most common imaging approach was computed tomography (42%), and the most frequent laboratory results were elevated amylase (83%) and C-reactive protein (82%). Atopy (61%) and excess weight (42%) were routinely associated with JRP, especially in severe cases.

Conclusion

JRP workup and treatment plans should begin with the least burdening modalities, including over-the-counter analgesics, minimal laboratory studies in the acute phase, and ultrasonography over computed tomography. Clindamycin is an effective initial antibiotic of choice, and severe recurrences may be controlled with sialendoscopy. Optimizing the health of patients with JRP includes managing comorbidities, especially of atopic and overweight origins, which are associated with more severe cases.

Juvenile recurrent parotitis: Review and proposed management algorithm

INTRODUCTION

Despite being the second most common salivary disease in childhood, the aetiology and appropriate management of juvenile recurrent parotitis (JRP) remains uncertain. Consequently patients may be misdiagnosed, or even undergo indeterminate or potentially invasive procedures without benefit. This article reviews the current understanding of the epidemiology and pathophysiology of JRP, and to appraise the management options available.

METHODS AND RESULTS

Medline and Google Scholar databases were searched and peer reviewed journal articles assessed. The epidemiology of JRP remains uncertain, and the clinical presentation of JRP can vary widely in frequency and severity. Diagnosis is still largely based on clinical signs and symptoms including parotid swelling, pain and fever. Investigation typically focuses on the exclusion of other diseases and immunodeficiencies, however there are noted typical radiological findings on both ultrasound and magnetic resonance imaging. The ideal management of this condition still remains unclear, however symptoms typically resolve by puberty. Treatment focuses on minimally invasive procedures such as sialography and sialendoscopy to reduce the frequency and severity of acute episodes.

CONCLUSIONS

Acute episodes of JRP can occur up to 30 times per year and have a significant impact on the quality of life of an affected child. Consequently a management algorithm is proposed based on the exclusion of other pathology. There is increasing evidence for non-ablative, minimally invasive approaches such as sialography and sialendoscopy to reduce the impact of this disease.

Juvenile recurrent parotitis: Diagnostic and therapeutic effectiveness of sialography. Retrospective study on 110 children

INTRODUCTION

Juvenile recurrent parotitis (JRP) is characterized by recurrent episodes of painful parotid swelling, generally associated with non-obstructive sialectasia of the parotid gland. The aim of this study was to evaluate the diagnostic and therapeutic effectiveness of sialography in children affected by JRP.

METHODS

Clinical records of 110 outpatients with a diagnosis of JRP followed up from 2008 to 2017 at the Unit of Paediatric Otorhinolaryngology, Surgery Department of the Bambino Gesù Children's Hospital of Rome, were retrospectively reviewed. Data on demographics, number of acute episodes/year, course of disease, site of symptoms and duration of follow up were collected. The inclusion criteria were: at least two or more episodes of intermittent swelling of the parotid glands on one side or both sides during the last 6 months, age <16 years. Exclusion criteria were: obstructive lesions, dental malocclusion, Sjogren syndrome, congenital IgA immunodeficiency, and relevant systemic diseases. Outcome of the procedure was measured by evaluating number and degree of episodes of parotid swelling before and after sialography.

RESULTS

Sialography has been shown in all cases to be a valid method in the diagnosis of JRP. Following the execution of the sialography, in 98 patients (89% of cases) there was a statistically significant improvement of disease with a mean reduction of 67.4% of episodes of parotid swelling (p < 0.05). In 75 patients there was marked improvement of the symptomatology (p < 0.05). In 23 patients partial resolution occurred (p < 0.05); in 12 patients there was no resolution or a reduction less than 30% of episodes (p > 0.05). There was a statistically significant relationship between the number of attacks/year and the degree of glandular function, pre and post-sialography in 2-way ANOVA test (p < 0.05).

CONCLUSION

Sialography is effective method not only as a diagnostic procedure but also as a therapeutic procedure in treatment of JRP. It is a method that can be carried out in ambulatory setting, without anaesthesia, with a minimum cost and with a very low rate of complications. In a disease with tendency to spontaneous resolution like JRP, sialography represent a therapeutic option alternative to more invasive treatment.

Viral mumps: Increasing occurrences in the vaccinated population

Before the introduction of the vaccine, mumps was the most common salivary gland disease and was one of the most common infectious diseases in children globally. Following the introduction of the mumps vaccine in 1967, the disease was almost nonexistent in the United States and was only found to occur in nonvaccinated patients, and even then, it did not present in epidemic portions because of the extent of vaccination in the population at large. Beginning in the early 2000s, viral mumps began to present itself in vaccinated populations, and currently, outbreaks are continuing to increase in number. This article presents information on the various outbreaks, a review of the virus and the disease, including symptoms and comorbidities, and new recommendations for management. Dental practitioners should be aware of the increasing incidence and prevalence of this disease, be able to recognize it, and make appropriate referrals for management.

Pediatric Sialendoscopy for Recurrent Salivary Gland Swelling: Workup, Findings, and Outcomes

Introduction:

Recurrent salivary gland swelling of the parotid and submandibular glands results in painful swelling in the pediatric population. There is no defined algorithm for workup and treatment of these disorders, resulting in wide heterogeneity and in some cases overuse of computed tomography (CT) imaging. Sialendoscopy (SE) is an interventional option for recurrent swelling of both glands; however, its effectiveness in the pediatric population is still being determined.

Objectives:

To assess preoperative imaging utilization and benefit in the workup of recurrent pediatric sialadenitis, intraoperative SE findings, and postoperative outcomes after intervention with SE.

Methods:

Case-series with a 5-year retrospective chart review on children undergoing SE for recurrent sialadenitis.

Results:

Forty-nine SE procedures were performed on 38 parotid glands (PG) and 11 submandibular glands (SMGs) in 29 children. CT imaging findings were useful for identifying a stone or stricture and guiding surgical management in 45.5% of SMGs versus 2.6% of PGs ( P < .001). A stone was found in 45.5% of SMGs and none in PG ( P < .001). SE intervention such as balloon dilation or stone removal was performed in 54.6% of SMGs and 5.3% of PGs ( P < .001). 74% of parotid patients undergoing SE responded to 1 intervention with a cessation of recurrent gland swelling, while 26% required additional interventions. One hundred percent of SMG patients responded to first intervention. There was no improvement in the beneficial effect of SE with steroid injection ( P = .897) regardless of steroid used ( P = .082).

Conclusion:

CT findings were found to be low yield for recurrent parotid swelling, and ultrasound is a recommended first-line step for PG pathology. SE is a recommended first-line intervention for SMG and parotid sialadenitis as demonstrated by 100% and 74% response rate to initial SE, respectively.

Ultrasound elastography in diagnosis and follow-up for patients with chronic recurrent parotitis

PURPOSE

Chronic recurrent parotitis (CRP) is a non-obstructive disease with episodes characterized by painful swelling of the parotid gland. It presents in both a juvenile and an adult form, with no clear information on its actual origin. Diagnosis is based on patient medical history and ultrasound examination but is frequently not correctly identified. Acoustic Radiation Force Impulse Imaging (ARFI) is a novel ultrasound elastography technology that has recently been implemented in the diagnostic work-up of patients with malignancies. This study aimed to answer whether ARFI can reasonably be employed in the initial examination and follow-up during therapy in patients with CRP.

MATERIAL AND METHODS

Mechanical tissue properties of the salivary glands were analyzed by ARFI in 37 parotid glands of patients with CRP.

RESULTS

Having integrated ARFI into our diagnostic protocol for CRP, affected parotid glands were found to exhibit lower tissue elasticity compared to both healthy contralateral glands in the same individuals as well as those of healthy individuals. Most importantly, this method enabled us to quantitatively assess the patient benefit of therapy regarding the recovery of the glands' diseased parenchyma.

CONCLUSIONS

ARFI provides a quick, easy, and reliable diagnostic tool for the assessment of disease severity and progression in patients with CRP that can be seamlessly implemented into preexisting ultrasound protocols.

Role of sialendoscopy in juvenile recurrent parotitis (JRP)

Juvenile recurrent parotitis (JRP) is a rare disease of childhood occurring between the ages of 3 and 5 years, characterized by recurrent non-suppurative parotitis, spontaneously evolving towards parotid gland dysfunction. Clinically, JRP presents in the form of unilateral or bilateral, usually asynchronous, swelling of the parotid gland. The diagnosis is based on ultrasound characteristics. Widespread use of sialendoscopy has opened up new prospects for the management of this disease. This review of the literature evaluates the role of sialendoscopy in the management of JRP. A Medline search retrieved 68 articles, 18 of which concerned JRP. Standard treatment consists of antibiotics for at least 10 days at the acute phase of the disease. All studies demonstrated the diagnostic value of sialendoscopy by visualizing strictures, hypovascularization and whitish intraductal debris. Sialendoscopy is also useful for treatment, by allowing intraductal lavage and, when possible, dilatation of strictures. Lavage is performed with saline solution, hydrocortisone, antibiotics or a combination of these solutions, with no significant differences in terms of efficacy. The mode of administration with or without sialendoscopy also appears to provide similar results. Sialendoscopy appears to be a diagnostic and therapeutic option, although it has not been shown to be more effective than simple lavage. All lavage solutions appear to be effective.

[Swelling of the submandibular and parotid glands : A description of possible differential diagnoses]

Swelling of single or multiple major salivary glands can be caused by various local or systemic diseases. In differential diagnosis, congenital cystic or vascular malformations should be considered, as well as infectious or tumorous alterations. Salivary duct obstructions due to sialolithiasis or stenosis can cause salivary gland enlargement. Multiple systemic diseases can have manifestations in the parotid or submandibular glands. As therapy varies from cause to cause, knowledge of the different potential diagnoses is crucial.

Eosinophilic sialodochitis: redefinition of 'allergic parotitis' and 'sialodochitis fibrinosa'

Sialodochitis fibrinosa and allergic parotitis have described rare patients with recurrent salivary gland swelling and mucus plugs, often with atopy. We have evaluated three patients with atopic disease, recurrent salivary gland swelling, and an eosinophilic sialodochitis. Two had eosinophil-rich mucus plugs. Fifty-six additional cases were identified in a medical literature database search, each defined by recurrent salivary gland swelling associated with eosinophil-rich mucus plugs or sialodochitis with periductal eosinophilic infiltration. The majority (78%) were reported from Japan. Females were predominantly affected (F:M = 2.3) with a median age of 47 years at evaluation. The parotid and submandibular glands were involved, respectively, in 71% and 46%. Allergic symptoms were present in 66%, atopic disease in 63% of those with reported allergy testing, and blood eosinophilia in 71%. Contrast sialography and other imaging modalities documented ductal dilatation in 82%. Treatments included anti-allergic medications (58%), systemic glucocorticoids (25%), duct cannulation with irrigation, steroid injection, and/or duct dilatation (36%), and glandular resection (19%). We recommend the diagnosis 'eosinophilic sialodochitis' be applied to patients who meet this case definition. The disease is a unique cause of chronic recurrent salivary gland swelling. Its likely allergic etiology may be amenable to current or future biologic therapies.

Function of the parotid gland in juvenile recurrent parotitis: a case series

Our aim was to find out how the parotid gland functions in 44 patients with juvenile recurrent parotitis, and to assess the value of measuring the serum amylase activity. Clinical and personal details were recorded, and all patients had their serum amylase activity measured together with sialography during the chronic phase. The function of the gland was classified by sialographic images. The chi square test and Spearman's rank correlation coefficient were used in the statistical analyses. There was a significant association between the degree of glandular function and serum amylase activity (p=0.014). The patients with unilateral and bilateral disease differed significantly in their degree of glandular function (p=0.020), those with bilateral disease having poorer function. There were no significant correlations between other clinical variables and glandular function. Serum amylase activity is an important diagnostic variable in juvenile recurrent parotitis, and poor parotid function reflects the severity of the disease.

Salivary gland diseases in children

Salivary gland diseases in children are rare, apart from viral-induced diseases. Nevertheless, it is essential for the otolaryngologist to recognize these uncommon findings in children and adolescents and to diagnose and initiate the proper treatment.

The present work provides an overview of the entire spectrum of congenital and acquired diseases of the salivary glands in childhood and adolescence. The current literature was reviewed and the results discussed and summarized.

Besides congenital diseases of the salivary glands in children, the main etiologies of viral and bacterial infections, autoimmune diseases and tumors of the salivary glands were considered. In addition to the known facts, new developments in diagnostics, imaging and therapy, including sialendoscopy in obstructive diseases and chronic recurrent juvenile sialadenitis were taken into account. In addition, systemic causes of salivary gland swelling and the treatment of sialorrhoea were discussed. Although salivary gland diseases in children are usually included in the pathology of the adult, they differ in their incidence and some­times in their symptoms. Clinical diagnostics and especially the surgical treatment are influenced by a stringent indications and a less invasive strategy. Due to the rarity of tumors of the salivary glands in children, it is recommended to treat them in a specialized center with greater surgical experience.

Altogether the knowledge of the differential diagnoses in salivary gland diseases in children is important for otolaryngologists, to indicate the proper therapeutic approach.

Treatment of chronic recurrent juvenile parotitis using sialendoscopy

CONCLUSION

The combination of sialendoscopy and an intraductal application of corticosteroids can be recommended for children with chronic recurrent juvenile parotitis (CRJP) as there is growing evidence for a positive effect in the absence of side effects.

OBJECTIVE

CRJP is a disorder with painful, episodic swelling of the parotid gland in children. The majority of cases have a self-limiting character within 5-10 years, but the disease may also continue into adulthood. CRJP can occur on one or both sides and up to now the etiology has been unclear. The aim of this study was to analyze the therapeutic effect of a sialendoscopic application of corticosteroids on the clinical course of patients with CRJP.

METHODS

We retrospectively analyzed the clinical course of 9 children with 10 parotid glands affected by CRJP, who all underwent sialendoscopy and intraductal application of corticosteroids. In all cases the procedure was conducted under general anesthesia. The average follow-up period was 15 months.

RESULTS

There were no side effects associated with the sialendoscopy. All duct systems showed signs of chronic inflammation with an atrophic or thickened epithelium. At the follow-up visit, CRJP symptoms had completely resolved in eight children. One child still showed slight parotid swellings without the need for antibiotics. None of the parents reported that symptoms had continued at an equal level or worsened after sialendoscopy.

Recurrent parotitis of childhood or juvenile recurrent parotitis--a review and report of two cases

Recurrent parotitis of childhood is an uncommon condition which affects children of variable age. The condition may be misdiagnosed so delaying treatment. These two case reports highlight the variable signs and symptoms of this unusual condition and the value of ultrasound as an aid to diagnosis.

CLINICAL RELEVANCE

This is to improve awareness of recurrent parotitis of childhood and aid early diagnosis.

The clinical picture of juvenile parotitis in a prospective setup

AIM

To characterize the features of juvenile parotitis in a prospective setup and epidemiology.

METHODS

All children with parotitis admitted to Helsinki University Central Hospital 2005-2010 were recruited. Clinical characteristics, given treatment, outcome, blood leukocyte count, C-reactive protein, serum amylase and trypsinogen, SPINK-1 genotype and mumps antibodies were recorded. To map the epidemiology, a questionnaire was sent to 1000 randomly selected 13-year-old children.

RESULTS

The prospective study included 41 children (aged ≤ 17) with acute parotitis, all in good general condition. Serum amylase, but not trypsinogen, was elevated in majority of the cases (79%) and C-reactive protein in 68%. Eleven (27%) children had an elevated blood leukocyte count. None had acute mumps. Most children recovered well, 51% being treated symptomatically only. Seven children were treated on ward. Seventeen (46%) children had recurrent symptoms. One child (2.4%) had SPINK P55S mutation. According to the epidemiological questionnaire, 1.1% of the respondents (8/728, response rate 73%) reported a verified episode(s) of parotitis.

CONCLUSION

Juvenile parotitis has a frequency close to 1%. In the majority, the general condition is good during the episode. Serum amylase serves as an additional marker for the disease. Parotitis has a tendency to recur in almost half of the cases.

Modern management of juvenile recurrent parotitis

Aims:

To evaluate modern diagnostic and therapeutic management of juvenile recurrent parotitis, and to show the benefits of operative sialoendoscopy on the basis of our experience in 14 patients and the results of others.

Results:

Ultrasonography is sensitive in detecting the pathological features of juvenile recurrent parotitis. Interventional sialoendoscopy is a safe and effective method of treating the disease. In our case series, after a mean follow-up time of 30 months only 5 patients experienced recurrence of symptoms, with a mean symptom-free period of 20 months.

Conclusion:

The use of modern, minimally invasive diagnostic tools such as colour Doppler ultrasonography, magnetic resonance sialography and sialoendoscopy represents a new frontier in the management of juvenile recurrent parotitis. Operative sialoendoscopy also has the important therapeutic benefit of reducing the number of recurrences of acute episodes of parotitis, thus giving patients a better quality of life until puberty.

MRI and MR sialography of juvenile recurrent parotitis

BACKGROUND

Juvenile recurrent parotitis (JRP) is the second most common inflammatory salivary gland disease of childhood, after mumps. Diagnosis of JRP is usually based on clinical history of recurrent unilateral or bilateral parotid swelling and demonstration of sialectasis. Conventional sialography, digital sialography, US, MRI and sialoendoscopy have been used as investigative tools for the diagnosis of JRP. MR sialography is increasingly recognized as a useful supplement to sialography in salivary duct disorders.

OBJECTIVE

To describe the MRI and MR sialographic findings in children with JRP.

MATERIALS AND METHODS

MR Sialography was performed using T2-weighted three-dimensional constructive interference in steady-state (CISS) and half fourier acquisition single-shot turbo spin-echo (HASTE) sequences in 62 children with inflammatory salivary gland disease. Out of these 62 children, 6 had JRP. Axial T1- and T2-W images were also performed.

RESULTS

The main parotid duct was normal in all six children with JRP. High signal intensity focal lesions suggestive of sialectasis were seen involving both parotid glands in all six children. CISS sequence demonstrated the intraglandular ducts and sialectasis better than HASTE images.

CONCLUSION

MRI and MR sialography can non-invasively delineate the parenchymal and ductal system abnormalities of the parotid glands in children with JRP. Although MR and MR sialography cannot substitute US, they can accurately depict findings such as sialectasis and signal intensity changes in the parotid gland depending upon the phase of the disease (acute vs. chronic inflammation). The radiologist should be familiar with MR findings of JRP.

[Chronic recurrent parotitis]

Chronic recurrent parotitis is a non-obstructive disease with episodes of mostly painful swelling of the gland. It is categorized into a juvenile and an adult form, even without clear information on its actual origin. As to the etiology of the juvenile form, genetic factors and duct malformations as well as bacterial infections are discussed. Very rarely a complete lymphatic transformation of the gland might take place. Juvenile chronic recurrent parotitis is self-limiting in about 90% of all cases, as patients grow up. The diagnosis is based on patient history and clinical findings. Sonography is the imaging method of choice. Sialendoscopy shows a typical whitish pattern of the ducts in juvenile disease. Strictures or stenoses are typical for the adult form. The therapy of choice is gland massage and sialagogues, in addition to the administration of antibiotics. In more severe cases sialendoscopy together with rinsing of the ducts and instillation of cortisone are indicated. Total parotidectomy remains the last choice and is rarely necessary.

Is recurrent parotitis in childhood still an enigma? A pilot experience

AIM

To test the hypothesis that dental malocclusion with mandibular misplacement may be a causative factor for recurrent parotitis (RP) through unbalancing of masticatory muscles.

METHODS

Thirteen patients (age 4-14 years) who were referred to a dental clinic for RP and malocclusion were treated by oral appliance positioning for a 6-month period. Monthly visits were scheduled regularly.

RESULTS

Symptoms were clearly improved in nine children. No effect was obtained in three patients. One patient was lost at follow-up.

CONCLUSION

Occlusal intervention is effective in patients with RP and associated malocclusion. It should be considered an important option for the treatment of such intriguing disorder.

Cervical Lymphadenitis, Suppurative Parotitis, Thyroiditis, and Infected Cysts

Neck masses are common and have a variety of infectious agents and noninfectious causes. This article reviews the more common infectious causes of neck masses-cervical lymphadenitis, suppurative parotitis, thyroiditis, and infected cysts. Important clinical pearls, diagnostic evaluation including laboratory studies, and imaging are summarized. Methods for prevention are highlighted.

Juvenile recurrent parotitis: clinical, sialographic and ultrasonographic features

OBJECTIVE

Juvenile recurrent parotitis (JRP) is a rare salivary gland disease of obscure aetiology that affects children. The aim of this study was to investigate the patterns of clinical presentation, and the sialographic and ultrasonographic features of JRP in Sri Lankan children.

METHODS

The authors analysed the hospital records of 26 subjects who had been diagnosed with JRP between January 2003 and April 2006.

RESULTS

The subjects consisted of 15 males and 11 females (male:female ratio=1.4:1). The age range of the sample was 2.5-16 years (mean=8.4 years). The age of onset was biphasic, with two major peaks at 6 years (n=6) and 10 years (n=5) (mean=6.73 years). Unilateral involvement was seen in 69.2% of patients. The commonest clinical features were swelling (100%), pain (80.8%) and fever (50.0%). The average frequency of recurrences of JRP in 18 patients was 7.1 times per year. The average duration of an individual episode, also in 18 patients, was 5.44 days. Sialography in 17 patients had revealed punctate sialectasis, whereas ultrasonography in 16 patients had demonstrated multiple hypoechoic areas and heterogeneous echoes

CONCLUSIONS

This study documents the clinical features of JRP in Sri Lankan children. It has established the usefulness of sialography and ultrasonography in the diagnosis of JRP.

Infantile recurrent parotitis: follow up study of five cases and literature review

Recurrent parotitis (RP) is defined as recurrent parotid inflammation, generally associated with non-obstructive sialectasis of the parotid gland. It is a rare condition, and its etiology remains an enigma. Aim: The purposes of the present study were (1) to relate the follow up of five RP cases; (2) to examine the role of sialography and ultrasound in diagnosis and follow up; and (3) to make a literature review. Study design: series review. Material and Method: We reviewed all recurrent parotitis cases from the files of the Otolaryngology Division at University of Sao Paulo, Brazil. The criteria for inclusion were at least two years of evolution and more than one year and a half follow-up in our service. We included five children in the study. Sialograhpy was performed in the first evaluation and sonography was executed annually. Recurrent parotitis showed male predominance, and affected mainly children between the ages of 3 and 6. Frequency of crisis improved with time in all cases. Sialography showed sialectasis aspect in the affected glands and sonographic exams demonstrated hipoechoic and heterogeneous internal echoes. One case showed regression of ultrasound changes after clinical improvement.

Lesions of the accessory parotid gland in children

The accessory parotid gland, a little-known and seldom-mentioned anatomical variant, is a nodule of normal salivary tissue separate from the main parotid gland, located on the masseter muscle and connected to the Stensen duct at that level. It can be the site of both congenital and acquired lesions.

Recurrent parotitis of childhood

BACKGROUND

Recurrent parotitis (RP) of childhood is a rare condition of unknown aetiology, probably immunologically mediated.

OBJECTIVE

To review the clinical presentation, diagnosis and management of RP of childhood.

METHODS

Retrospective study from 1983 to 2004 of children diagnosed with RP of childhood at a tertiary children's hospital.

RESULTS

We identified 53 children, 37 (70%) male and 16 (30%) female. The age of onset was biphasic, with peaks at 2-5 years of age and at 10 years. The commonest symptoms were swelling (100%), pain (92.5%) and fever (41.5%). Symptoms usually lasted 2-7 days with a median of 3 days. The mean frequency was 8 episodes per year. The diagnosis was often delayed, >1 year in 70% of patients, maximum 8 years. The most common diagnoses, before the definitive diagnosis of RP, were mumps (21%), 'infection' (15%) and stones (11%). Sialogram (57%) and/or ultrasound (41%) showed sialectasis in 81% of patients. Over half the patients (54%) were given antibiotics at least once to treat the parotitis. Two children had hypogammablobulinaemia, one child had human immunodeficiency virus infection, and one child had Sjogren's syndrome. Two children had high titre antinuclear antibodies.

CONCLUSIONS

Recurrent parotitis had a biphasic age distribution. The major clinical features that distinguish it from other causes of parotid swelling are the lack of pus and recurrent episodes. A clinical diagnosis can often be confirmed by ultrasound. Antibiotics do not have a role in treatment. Affected children should be screened for Sjogren's syndrome and immune deficiency.

New insights into juvenile parotitis

AIM

We inquired about the possibility of a familial trend in juvenile parotitis and evaluated the role of SPINK1 mutations in juvenile parotitis.

METHODS

The clinical records of all children admitted to the Helsinki University Hospital during 1995 to May 2003 because of swelling in the parotid gland were reviewed. A questionnaire on possible recurrences and on familial cases was mailed. As disturbances in trypsin inhibition might be involved in the pathogenesis, we assessed the SPINK1 gene encoding for Kazal-type trypsin inhibitor in voluntary patients. The study group comprised 133 children (boys 82 girls 51) with juvenile parotitis. The median age at presentation of first symptoms was 6.0 y (range 1-19 y).

RESULTS

Recurrent symptoms in the parotid gland were common (57%), and 29% of the children (38/133) had suffered from four or more episodes. A young age at the first episode of symptoms increased the likelihood of recurrences (p<0.0001). Familial cases of parotid swelling were common (22%; response rate 67%). A total of 47 patients (35%) agreed to testing for SPINK1 status. Four children had a major mutation (N34S or P55S), corresponding to an 8.5% (4/47) prevalence, but this was not different from the controls (5%).

CONCLUSION

It is likely that inherited factors are involved in the manifestation of juvenile parotitis in a subset of patients. It is tempting to speculate that disturbed proteolytic balance may play a role in the development of symptoms.

Pediatric soft tissue lesions

Soft tissue oral and perioral lesions in the pediatric population are numerous and occur in various clinical presentations. Some conditions observed in children share characteristics with adult-onset disease. Other oral lesions are limited to the pediatric population. This article focuses on the more common soft tissue manifestations in children. Rather than a comprehensive review of pediatric oral pathology, the article offers an overview of selected clinical conditions often encountered in young patients.

Juvenile recurrent parotitis: a new method of diagnosis and treatment

OBJECTIVE

Juvenile recurrent parotitis (JRP) is a nonobstructive, nonsuppurative parotid inflammation in young children. Causative factors, such as local autoimmune manifestation, allergy, infection, and genetic inheritance, have been suggested, but none of them has been proved to date. Until now, treatment of JRP was divided into conservative observation and antibiotic treatment, and no preventive therapy was available.

METHODS

Twenty-six cases symptomatic JRP in children were diagnosed and treated with a combined endoscopic approach. Sialography and sialoendoscopy were performed bilaterally in all children. The treatment modality was composed of lavage, ductal dilation, and hydrocortisone injection.

RESULTS

Sialography showed multiple sialectasis in the affected gland and in the contralateral one as well. Dilations and strictures were noticed in the main duct, and kinks could be identified in 31% of the glands. The main endoscopic finding was a white appearance of the ductal layer without the healthy blood vessel coverage. Recurrence of the symptoms occurred in only 2 (8%) children.

CONCLUSIONS

The endoscopic technique provides the possibility of a correct diagnosis and treatment. In this article, we present a new treatment modality of irrigation and dilation under direct vision by endoscopically guided miniature surgical instruments.

Virology of infantile chronic recurrent parotitis in Santiago de Chile

Infantile chronic recurrent parotitis (ICRP) has been attributed to multiple causes, including viral infections, and therefore its treatment remains empirical. Our aim was to evaluate the involvement of respiratory and oropharyngeal viruses in acute episodes of ICRP. Seventy children were studied, 50 patients and 20 age-matched controls, in a 2-year follow-up study. Saliva samples were taken from the parotid duct and analyzed by viral isolation and immunofluorescence for adenovirus (Ad), respiratory sincitial virus (RSV), parainfluenza virus (PI), influenza virus (Flu), Cytomegalovirus (CMV), and herpes simplex virus (HSV). Paired sera samples were tested by ELISA for anti-Epstein-Barr virus (EBV) IgG and anti-mumps IgM and IgG. Viral infections were detected in 7/50 (14%) cases of the ICRP group: one CMV; 2 Enteroviruses isolated in human embryonic lung fibroblast cells; 1 Flu A; and 3 mumps virus. No EBV seroconversions were detected. In the control group, 2 out of the 20 children had an asymptomatic mumps positive IgM titer. Our data indicate that the main respiratory and oropharyngeal viruses are not the cause of acute episodes of ICRP in Chilean children.

Microbiology and Management of Sialadenitis

Acute and chronic inflammatory diseases of the major and minor salivary glands constitute the most common clinical syndrome of salivary glands. During the past decade, the use of antibiotics along with fluid hydration and electrolyte management has almost eliminated the development of fulminating acute suppurative parotitis in hospital surgical patients. Although acute bacterial and viral sialadenitis persists, the clinical challenge has changed, with more focus on the chronic inflammatory group of diseases. The pathogenesis of the chronic salivary inflammatory disease spectrum has also changed, with the interplay between sialadenitis, sialectasia, and sialolithiasis. There also exists a heterogeneous group of disorders in chronic inflammatory sialadenitis, which include the group of specific and nonspecific granulomatous diseases.

Possibility of sialographic sonography: a Doppler phantom study

OBJECTIVES

The purpose of this study was to develop a new diagnostic method that has the merits of both sialography and sonography.

STUDY DESIGN

Saline solution and various contrast media (Urografin 76%; 100%, 90%, and 67% Lipiodol Ultra-Fluide; 5% and 1% barium sulfate; and Levovist) were injected into thin tubes at a rate of approximately 0.001 to 0.1 mL/s. The relationship between the Doppler signal intensity and the kind, concentration, and velocity of the fluid was analyzed.

RESULTS

Levovist, 90% and 67% Lipiodol Ultra-Fluide, and the barium sulfate solutions produced Doppler signals. The mixture of Lipiodol Ultra-Fluide and saline solution produced high signals at any concentration, in contrast with the barium sulfate solutions. Signals could be observed at any speed, from the speed of normal sialography down to 0.001 mL/s, and there was a proportional relationship between signal intensity and velocity for all fluids producing signals.

CONCLUSION

The fact that we could obtain high signals with several fluids indicates potential clinical diagnostic usefulness of sialographic sonography.

MRI of chronic recurrent parotitis in childhood

PURPOSE

Chronic recurrent parotitis (CRP) is a rare inflammatory disease characterized by multiple episodes of unilateral or bilateral parotid inflammation over a period of years. The objective of this study was to evaluate the parotid glands using MRI during acute inflammation as well as during symptom-free intervals.

METHOD

Twelve children with a history of CRP were included. Four patients were examined during the acute phase and eight children during symptom-free intervals. MR findings were correlated with the clinical status.

RESULTS

Two different patterns were identified by MRI: acute inflammation versus chronic inflammation. Contrast enhancement of the parotid gland indicated acute inflammation. Cysts due to chronic inflammation were encountered in children who suffered multiple episodes of inflammation.

CONCLUSION

Our findings suggest that CRP is characterized by recurrent, acute exacerbations of inflammation, resulting in a slowly progressive destruction of the parotid gland.