Role of the Accessory Parotid Gland in the Etiology of Parotitis: Statistical Analysis of Sialographic Features

This retrospective study aimed to identify if the existence of the accessory parotid gland correlated with the etiology of parotitis. This may aid the development of better treatment strategies in the future. Sialographic features of cases with parotitis and healthy subjects were reviewed. The chi-square test was used to compare the incidence of accessory parotid gland between the groups. The Student's t test was used to compare the length of Stensen's duct, the length from the orifice to the confluence of the accessory duct, and the angle between the accessory duct and Stensen's duct between the groups. The incidence of accessory parotid gland in patients with parotitis was 71.8% (28/39), which was significantly higher than that in healthy subjects (P = 0.005). Patients with parotitis had a longer Stensen's duct than healthy subjects (P = 0.003). There was no significant difference in the length from the orifice to the confluence of the accessory duct or the angle between the accessory duct and Stensen's duct (P = 0.136 and 0.511, respectively) between the groups. The accessory parotid gland might play a role in the pathogenesis of parotitis. The existence of an accessory parotid gland is likely to interfere with salivary flow. Computational fluid dynamics analysis of salivary flow in the ductal system would be useful in future etiologic studies on parotitis.

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.

Differential responses of rostral subnucleus caudalis and upper cervical dorsal horn neurons to mechanical and chemical stimulation of the parotid gland in rats

Blockage of the salivary duct can produce pain and inflammation from the build up of saliva in the parotid gland. The processing of parotid inflammation-induced pain, however, is poorly understood. The purpose of this study was to clarify the functional involvement of the trigeminal subnucleus interpolaris/caudalis transition region (Vi/Vc) and upper cervical spinal cord (C1/C2) in processing nociceptive input relevant to parotitis. The effect of capsaicin-induced parotitis was examined on a total of 37 nociceptive neurons isolated from the Vi/Vc (n = 23) and C1/C2 (n = 14) regions. Eight of 23 Vi/Vc neurons responded to mechanical distention of the parotid gland, whereas no C1/C2 neurons responded to the parotid distention. Receptive field characteristics in all neurons were examined following capsaicin injections into the parotid gland. Mechanical and cold responses increased significantly in C1/C2 but not Vi/Vc neurons following capsaicin. Receptive field sizes also increased in C1/C2 but not Vi/Vc neurons. At the Vi/Vc transition region, pinch-evoked activity increased in neurons receiving convergent inputs from the parotid gland and facial skin when compared to non-convergent neurons. The present data indicate that the hyperalgesia and referred pain associated with parotitis may result from sensitization of C1/C2, but not Vi/Vc nociceptive neurons.

Parotitis due to organophosphate intoxication

Acute pancreatitis due to pancreatic exocrine over-secretion induced by organophosphate poisoning has been previously reported but parotid gland involvement has not. This paper describes a case of acute organophosphate-induced parotitis in a patient with pre-existing sialolithiasis. The patient developed bilateral facial swelling in the pre-auricular area extending to the angle of the jaw and also developed elevated serum amylase on the second day of the poisoning. Serum lipase remained normal. Autopsy confirmed parotid gland inflammation and pre-existing ductal lithiasis. This case illustrates that organophosphate-induced parotitis can occur and should be considered in patients with organophosphate poisoning who have hyperamylasemia without elevation in serum lipase.

Chronic parotitis: diagnosis and treatment

BACKGROUND

Chronic parotitis, or CP, is a nonspecific sialadenitis that often is seen first in the dental office. The cause, although not definitively determined, is most likely multifactorial and includes decreased salivation, stasis and an ascending retrograde duct infection. The authors present a case report to illustrate the symptomatology of CP to facilitate its differentiation from other entities that mimic CP.

CASE DESCRIPTION

A 60-year-old woman with a 30-year history of recurrent swellings of her left parotid gland was diagnosed with CP. The diagnosis was based on history, clinical examination, salivary volume and chemistry, computerized tomographic scan and sialography. Treatment was palliative in nature.

CLINICAL IMPLICATION

As a member of the health care team, the dentist must be familiar with the various causes of recurrent parotid infections. Early clinical recognition of CP leads to appropriate and successful care.

[Recurrent parotitis in children and HIV infection. Apropos of 4 cases]

We report four cases of recurrent infectious parotiditis in children and recall the clinical radiographic and pathogenic features. Particular attention was paid to the possible relationship between sialadenitis and HIV infection in two cases. This would open a large etiological field when HIV contamination is suspected. Treatment if all four cases (spiramycine, diclofenac, soframycin washing, lipiodol instillation and local bucco-dental treatment) was successful leading to longer intervals between relapses.

Gland atrophy following retrograde injection of methyl violet as a treatment in chronic obstructive parotitis

OBJECTIVE

The purpose of this study was to evaluate the clinical effectiveness of retrograde injection of 1% methyl violet as a treatment for chronic obstructive parotitis.

STUDY DESIGN

Sixteen patients with chronic obstructive parotitis were treated with retrograde injection of 1% methyl violet. Pretreatment evaluation and assessment of the treatment effect were performed by clinical and imaging methods, including sialography and sonography of the treated glands.

RESULTS

Clinical symptoms following treatment included initial acute swelling and then a decrease in parotid swellings; the final outcome was a clinical cure of the affected glands characterized by disappearance of all symptoms, absence of secretion, and complete obliteration of the main duct orifice. Posttreatment imaging showed total atrophy of the diseased glands.

CONCLUSION

Retrograde injection of 1% methyl violet caused total atrophy of the diseased glands and brought about complete relief in all 16 patients, with no detectable side effects.

[Recurrent parotiditis in adults: review and new therapeutic options]

Our experience in the management of 20 patients with recurrent parotitis (RP) as an isolated symptom is reported. The clinical manifestations in all patients were pain, infection and swelling of the parotid gland on at least three separate occasions. The presence of obvious tumor or specific inflammation were exclusion criteria. Three patients benefited from radiological interventional treatment: two stones were removed from the main duct with a Dormia basket and one parotid duct stricture was dilated with a balloon catheter. The role of conventional or digital sialography and interventional radiology procedures in the diagnosis and management of RP is discussed. We proposed this approach as a therapeutic alternative to surgery, which is more aggressive and carries a risk of facial nerve damage.

[The physicochemical properties of the mixed saliva and parotid secretion of patients with chronic parenchymatous parotitis and of persons who have a history of earlier acute parotitis]

Eighty-five patients with chronic parenchymatous parotitis and 73 convalescents after epidemic or acute nonepidemic parotitis were examined for their secretory function and some physicochemical characteristics of mixed saliva and parotid secretion (secretion rate, pH, viscosity, transparency, electrokinetic properties). A significant reduction of salivary secretion volume and rate were detected, as were pH shift to the acid direction and increased viscosity of both saliva and parotid secretion, reduced transparency and increased electric conductivity in the patients with chronic parenchymatous parotitis, more marked in those with an active course of the disease. Such changes were absent in convalescents after epidemic or acute nonepidemic parotitis. This permits a conclusion that none of these two conditions may be responsible for the development of a chronic inflammation of the parotid gland. The detected changes in physicochemical parameters of the saliva in chronic parenchymatous parotitis supplement the known data on the pathogenesis of this condition and may be used in the diagnosis and prediction of the course and outcome of sialadenitis. The authors emphasize the desirability of therapeutic and prophylactic measures during remissions of chronic parenchymatous parotitis.

[A treatment method for chronic parenchymatous parotitis]

A method for therapy of chronic parenchymatous parotitis is suggested supplementing dimethyl sulfoxide. As reported, the parotid glands produce parotin, an insulin-like substance, whose production is reduced in chronic parotitis; hence, short-acting insulin administered in microdoses was chosen for therapy. To potentiate local insulin effect and increase the sensitivity of oral mucosa peripheral receptors to it a 5% calcium pantothenate solution was used. This method was used in the treatment of 42 patients with chronic parenchymatous parotitis aged 23 to 62. The method is effective, it can be easily used by the patients themselves, and there are virtually no contraindications against such therapy. The authors have applied for inventors' certificate, the priority certificate is No. 4836436/14 as of June 27, 1990.

[The prevention and treatment of patients with suppurative-inflammatory diseases of the maxillofacial area by using vibromassage at autoresonance frequencies]

Autoresonance frequency vibromassage sessions were administered to patients with pyoinflammatory processes in maxillofacial soft tissues. Comprehensive examinations of these patients were carried out to assess the efficacy of this treatment modality; the examinations included rheographic and ultrasonic examinations of blood flow intensity, analysis of neutrophilic activity by chemiluminescence amplitude, measurements of trypsin inhibitor levels and cholinesterase activity, assessment of wound exudate pH values and of resorption capacity of purulent wound tissues. Microbiologic, histologic, cytologic, clinical and biochemical studies were carried out. The findings permit a conclusion that autoresonance vibromassage enhanced biologic purification of the wound from pyonecrotic mass and accelerated reparative regeneration.

Sialographic changes related to clinical and pathologic findings in chronic obstructive parotitis

This paper presents the results from a study of 23 patients with chronic obstructive parotitis (COP) in whom the sialographic changes were related to the clinical and histopathologic features. The sialographic changes were divided into four types. The stimulated parotid flow rate (SPFR) was normal in sialography Type I patients, while SPFR was significantly reduced in Types II, III, and IV patients, as compared with healthy persons. The changes observed by light microscopy were irregular dilation and chronic inflammation of main and branching ducts with saliva deposits in the enlarged luminal system. Ultrastructural changes included degeneration of ductal epithelial cells, marked proliferation of periductal fibrous tissue, and moderately electron-dense deposits in the lumen of the dilated peripheral ducts. The extent of the histopathologic changes largely paralleled the severity of the sialographic changes. These findings indicate that COP is a relatively common inflammatory disease and that the sialographic classification reflects the severity of the disease.

Sequential quantitative scintigraphy of parotid glands with chronic inflammatory diseases

A practical, time-saving procedure for sequential quantitative scintigraphy is introduced and 4 parameters chosen from 12 parameters by discriminant analysis are used to evaluate the function of the parotid gland. The examination was performed in 120 cases, including 16 cases with recurrent parotitis in childhood, 33 with chronic obstructive parotitis (COP), 37 with Sjögren's syndrome (SS), 4 with sialadenosis, and 30 normal controls. The scintigraphic findings were analyzed and compared with the histologic findings. The diagnostic value of this method was investigated and scaling for differential diagnosis of COP and SS was established. Scintigraphy is considered to be a useful method for evaluation of parotid function and as a diagnostic aid for SS and COP, especially in patients in whom sialography cannot be performed.

Chronic obstructive parotitis. Report of ninety-two cases

Clinical, sialographic, and sequential quantitative scintigraphic characteristics of 92 cases of chronic obstructive parotitis (in 117 diseased parotid glands) are reported, and the treatment investigated. The cardinal feature of this disease is obstruction or retarded salivary flow resulting in recurrent swellings and retrograde infection. The main characteristic seen in sialograms is irregular dilation of the main and branching ducts. On the basis of sialographic findings, the ducts are classified into four types. This classification reflects the severity of the disease and can also be used as a guide to treatment.

[The clinico-morphological characteristics of the regional blood circulation of the parotid glands in patients with chronic parenchymatous parotitis]

Regional circulation in the parotid glands was studied in 34 patients with chronic parenchymatous parotitis (CPP) with the use of clinical (rheography and coagulography) and morphologic methods. A relationship has been revealed between regional circulation changes and the inflammation severity, CPP stage, type of concomitant diseases.

[The regional blood circulation of the parotid gland and the correction of its disorders in chronic interstitial parotitis]

Elevated vascular tone, lengthened time of intraglandular arterial bed filling, fibrinogenemia, elevated plasma tolerance to heparin were detected in 32 patients with chronic interstitial parotitis (CIP) during exacerbation and in a number of CIP patients with the remission of the disease. Correction of microcirculation disturbances is advisable during CIP exacerbation; in remission it may be effective in patients with the late stage of parotitis, in those with parotitis coursing along with diabetes mellitus, essential hypertension, or against the background of prolonged oral drug therapy (e. g. clofelin). Drugs correcting the microcirculatory disorders are conducive to a sooner alleviation of the inflammation and better and longer preservation of the function of the parotid glands.

[Chronic recurrent parotitis in children. Apropos of 25 cases]

The clinical, analytical and radiological findings of 25 cases of recurrent parotitis aging 2 to 12 years are reviewed. The greater incidence in males, the preferentially unilateral localization and the absence of an associated pathology or immunological defect is pointed out, considering the chronic recurrent parotitis and independent pathology. The value of sialography as a diagnostic method is confirmed, finding alterations in 90% of cases. The alterations of the acinar system represented as sialectasias were the most commonly found (86.9%), following in order of frequency the alterations of the ductal system (70%). Spontaneous recuperation with less frequent episodes in adolescence is common, and complications are rare, so that we consider symptomatic treatment appropriate, reserving surgical treatment for complicated cases.

Juvenile recurrent parotitis: clinicoradiologic follow-up study and the beneficial effect of sialography

In twenty-two children juvenile recurrent parotitis (JRP) was diagnosed on the basis of age at onset, duration of parotid swelling episodes, frequency of attacks, lack of pus formation, and typical sialograms. Age at onset and severity of the disease varied widely. There was a high incidence of upper respiratory tract infection, and in some cases a familial history of JRP was noted. The sialograms revealed acinar and ductal atrophy and severe sialectasis. A dominant feature was impaired glandular function. The follow-up period was notable for a striking decrease in the number of incidents of glandular swelling regardless of the patient's age at the time of his or her first visit to our clinic. Since drug treatment was administered prior to our first examination and no medicaments were prescribed by us, the improvement in the clinical status of the patients is attributed to the sialographic procedures.

Spontaneous regeneration of the parotid salivary gland following juvenile recurrent parotitis

Sialograms of an 18-year-old female patient known to suffer from juvenile recurrent parotitis (JRP) disclosed the destructive glandular changes typical of the disease. During the 10 years subsequent to the sialographic examination, the patient did not experience any further attacks of JRP. Sialograms carried out when the patient was 28 years of age demonstrated a normal gland. This case illustrates that a damaged parotid gland is capable of regeneration following JRP.

[Pathogenesis of chronic recurrent parotitis (author's transl)]

A combination of several factors is of importance in the pathogenesis of sialectatic parotitis. Stenson's duct is relatively long and its orifice is narrow. The flow of the saliva may be impaired, especially when mastication is abnormal or when the ductal lumen is scarred because of infection or trauma. Dental or oral mucosal disease may increase the number of pathogenic organisms which might then lead to a retrograde ascending infection. This is followed by epithelial desquamation and subsequent ductal obstruction. Allergic, genetic an racial factors in sialectatic parotitis are also discussed. The four characteristic progressive histologic stages of sialectatic parotitis are: a periductal inflammatory reaction, a diffuse lymphocytic sialadenitis with dilated ducts, fully developed sialectatic parotitis and, finally, fibrosis of the parotid gland. Conservative treatment will lead to an improvement of the clinical symptoms as well as the histopathological features in the first two stages, but in the two final stages total parotidectomy, with preservation of the facial nerve, is the treatment of choice.

[Acrylamid- and immunelectrophoretic separations of human parotid secretions from individuals with parotid tumors, chronic parotitis and sialadenosis (author's transl)]

After previous examinations in normal parotid glands in this paper secretion of proteins in parotid glands with pleomorphic adenomas, Whartin tumors, parotid carcinomas, chronic parotitis and sialadenosis should be studied. Different discelectrophoretic and immunelectrophoretic runs were done. Thereby we got the following changes in electrophoreses: Pleomorphic adenomas generally show a more palid pattern in band-structure, caused by the diminished proteinconcentration in the secretions. Most remarkable are thereby the c1 and d1-4-bands. Immunelectrophoretic separations are normal. Whartin tumors show a different bandpattern in the anodal near gel region, which is enpowered by immunelectrophoretic runs. Secretions from parotid carcinomas show a characteristic change in bandstructure. There are found added bands which result from serumproteins as immunelectrophoretic examinations proof. The same is found in glands with parotitis in contrary to glands with sialadenosis.

[Quantitative functional exploration of the salivary glands. Measurement of salivary elimination of technetium 99]

The authors propose a method for the quantitative functional exploration of the salivary glands using two objective criteria, on the one hand the level of fixation in the parotid of technetium 99m injected in the form of its pertechnate and on the other hand by the fraction of radioactivity found in different specimens of saliva collected in the course of a test carried out using a pharmacological agent free of toxic effects--lemon juice. The quantitative results obtained and its simplicity render the method particularly useful in evaluating the course of salivary function in all forms of disorder, pathological or iatrogenic.