JOURNAL READING

MANAGEMENT OF ACUTE SUPPURATIVE

PAROTITIS
Tirbod T. Fattahi, DDS, MD,* Peter E. Lyu, DDS,†
and Joseph E. Van Sickels, DDS‡

PEMBIMBING :
drg. Metaria Susan H. Sp.Perio

OLEH :
NORITA APRILYA S (21704101027)

KEPANITERAAN KLINIK MADYA

LABORATORIUM PENYAKIT GIGI & MULUT
RSUD SYARIFAH AMBAMI RATO EBU BANGKALAN
FAKULTAS KEDOKTERAN UNIVERSITAS ISLAM MALANG
2019
ABSTRACK
• Acute Suupurative Parotitis (ASP)  an inflamatory and
infectious process of parotid gland.
 well-recognized complication of abdominal surgery before the
advent of antibiotics

• Incidence  0,01% to 0,02% (all hospitals), 0,02%-0,04% (post

operative patient)

ASP has been traditionally regarded as an ascending bacterial

sialoadenitis via retrograde transductal flow of bacteria from
Stenson’s duct into the gland parenchyma
 PREDISPOSISING FACTORS

Conditions may increase the odds of the development of ASP

• Immunosuppression
 Diabetes and alcoholism, autoimmune disorders such Majority of the
as Sjo¨gren’s disease. patients are elderly
• Poor oral hygiene
• Decrease in salivary flow
• Secondary to medications (antidepressants,
anticholinergics, diuretics) Also been seen in
• Postsurgical dehydration neonatal and premature
• Ductal obstructions due to sialolithiasis, tumor, or infant groups
foreign bodies

Etiologic causes in
children
include dehydration,
allergy and heredity
 CLINICAL MANIFESTATIONS

• An indurated,warm, erythematous swelling of the cheek.

• Most patients  fever, along withcomplaints of pain.
• Pain ASP  Glandular parenchyma inflamed & swollen , subsequent
stretching of the sensory nerves close to the parotid capsule
 CONT...

• Intraorally
Stenson’s duct orifice appears red, and
pus may be expressed with palpation of
the gland

Facial nerve dysfunction associated with

parotitis is exceedingly rare, with only
10 cases reported in the literature
 DIFFERENTIAL DIAGNOSIS
• Viral parotitis (mumps)
• Cystic fibrosis
• Collagen vascular diseases
• Alcoholism
• Sarcoidosis,
• Sialolithiasis
• Chronic recurrent parotitis
• Neoplasms.
An acute bacterial infectious
origin can be distinguished :
• Purulent discharge
Stenson’s duct
• Pain
• Radiographic evidence of
a suppurative process in
the gland parenchyma
observed on a computed
tomography (CT) scan with
intravenous contrast
medium.
DIAGNOSIS AND EVALUATION
• Laboratory
 Complete blood cell count, chemistry panel, culture
• Radiology
 CT scanning with intravenous contrast medium
 Ultrasonography of the gland  evidence of abscess
formation
 Sialography
MICROBIOLOGY
• More than 80% of all cases of ASP have been caused
by Staphylococcus aureus

• Strict anaerobes (Peptostreptococcus and

Bacteriodes) in 43% of the patient population, with
the other 57% composed of mixed aerobic and
anaerobic organisms
TREATMENT
• Treatment modalities  both medical and surgical interventions
 The key in the treatment of ASP is rehydration
 Initial medical therapy should include intravenous fluids, nutritional support,
warm compress, sialogogues, good oral hygiene and antibiotic therapy.
• The first drug of choice should be an antistaphlylococcal penicillin (nafcillin,
oxacillin, Unasyn, Augmentin), first-generation cephalosporin (cephazolin), or
clindamycin.
• A review of the literature supports antibiotic therapy for 10 to 14 days.

Quinn and Graham  reported good success with intraductal injections of

antibiotics, although the patient population had recurring episodes of suppurative
parotitis.
 CONT ...

If medical management fail  surgery

• Surgical intervention, including incision and drainage of the gland in the
direction of the facial nerve via a standard parotidectomy incision,
• Is indicated for the following :
 Lack of improvement after 3 to 5 days of antibiotic therapy
 Facial nerve involvement
 Involvement of adjacent vital structures (lateral pharyngeal space, deep fascial
spaces)
 Frank abscess formation within the gland parenchyma.
• Superficial parotidectomy
FOLLOW UP
• Proper follow-up is recommended for all patients with ASP.
 Repeat CT scan or sialogram should be performed to identify the
status of the remaining gland parenchyma.
• Glandular abnormalities such as calculi, mucous plugs, or benign
strictures  surgical intervention to avoid the future
development of recurrent parotitis.
• Presence tumor
 Repeat clinical examination, fine-needle biopsy, and imaging