Re-cognition of chronic obstructive diseases of the parotid gland / 口腔疾病防治

@#Chronic obstructive diseases of the parotid gland are common clinically, with repeated swelling and a prolonged course and poor treatment outcomes. Based on the summarization of clinical practice and related literature, from the viewpoint of etiology, parotid obstructive diseases can be classified as mechanical obstructions, specific obstructions and non-specific obstructions. The principles of fluid mechanics are introduced to explain the formation of parotid obstructions. According to the different causes, the methods of changing the flow pattern of saliva in the parotid to reduce the resistance and relieve the obstruction, are proposed, such as mechanical factors removals, application of drugs that promote saliva secretion and lower saliva viscosity, ductal expansion under endoscopy and stent placement, and embolization of collateral ducts. These managements can effectively increase the salivary flow rate, reduce the occurrence of the saliva stranded and parotid gland obstructions.

Aspectos clínicos y evolución de la parotiditis recurrente infantil / Clinical aspects and progression of recurrent parotitis of childhood

INTRODUCCIÓN: la parotiditis recurrente infantil es una enfermedad inflamatoria de las glándulas parótidas que se presenta con frecuencia en la práctica pediátrica. OBJETIVO: describir algunos aspectos clínicos y la evolución de la parotiditis recurrente infantil en un grupo de niños atendidos en el Hospital "Hermanos Cordové" de Manzanillo, Granma, Cuba. MÉTODOS: estudio descriptivo y longitudinal. La población quedó constituida por 86 pacientes afectados por la enfermedad que fueron vistos de primera instancia entre los años 1990 y 2005. La información se obtuvo mediante la observación y la entrevista; se consideraron las variables siguientes: sexo, edad en la primera consulta, localización, edad al momento de remisión de la enfermedad, número de crisis, y estado funcional glandular al final del seguimiento. Se utilizaron métodos estadísticos descriptivos que incluyeron medidas de tendencia central y de dispersión. Se determinaron diferencias de medias y sus intervalos de confianza del 95 %. RESULTADOS: predominaron el sexo masculino (66,3 %), las edades entre 5 y 9 años (53,5 %) y la localización derecha (47,6 %). El tiempo promedio general entre la primera consulta y la remisión de las crisis fue de 3 años y medio, mientras que el promedio de crisis fue de 6,36. CONCLUSIONES: la evolución fue buena; al final del seguimiento todos los pacientes tuvieron una función glandular salival adecuada.

INTRODUCTION: recurrent parotitis of childhood is an inflammatory disease of the parotid glands that frequently occurs in pediatric patients. OBJECTIVE: to describe some clinical aspects and the progression of recurrent parotitis of childhood in a group of children seen at ¨Hermanos Cordové¨ hospital, Manzanillo, Gramma province, Cuba. METHODS: longitudinal and descriptive study was conducted. The population was made up of 86 patients with the disease, who were seen from 1990 to 2005. The information was collected through observation and interview and the study variables were sex, age at the first medical appointment, location, age at the time of remission, number of crises and functional status of the glands at the end of the follow-up period. Summary statistic methods included central tendency and dispersion measures. Mean differences and their 95% confidence intervals were then determined. RESULTS: males (66.3 %), five to nine years of age patients (53.5 %) and right location (47.6 %). The average time elapsed from the first medical appointment to remission of crises was 3 and a half years whereas the average number of crises was 6.36 CONCLUSIONS: recovery was good. At the end of the follow-up period, all the patients showed adequate salivary gland function.

Recurrent parotitis as a first manifestation in a child with primary sjogren's syndrome / Parotitis recurrente como primera manifestación en un niño con el síndrome de sjögren primario

Recurrent parotitis is an acute, severe inflammation of one or both parotid glands, the major salivary glands in young children. We report the case of a seven-year old boy with Primary Sjogrens syndrome (PSS) who presented with 15 episodes of painful recurrent bilateral swellings of the parotid glands over a four-year period.

La parotitis recurrente es una inflamación aguda, severa y reiterada de una o ambas glándulas parótidas - la mayor de las glándulas salivares - en los niños pequeños. Se reporta el caso de un niño de siete años de edad con el síndrome de Sjögren primario (SSP). El niño presentó 15 episodios de dolorosas inflamaciones bilaterales recurrentes de las glándulas parótidas por un período de cuatro años.

Caracterización clínica de la parotiditis recurrente en niños. Hospital Pediátrico William Soler / Clinical features of recurrent parotitis in children. William Soler Pediatric Hospital

La Parotiditis Recurrente es el segundo cuadro inflamatorio más frecuente que afecta a la glándula parótida y se define como una inflamación parotídea, generalmente asociada a una sialectasia no obstructiva glandular. Se caracteriza por episodios recurrentes de aumento de volumen inflamatorio de una o ambas glándulas parótidas, acompañados ocasionalmente de fiebre y malestar general. Estos episodios se alternan con intervalos de remisión de semanas o meses, en los que la glándula se observa clínicamente asintomática. Se realizó un estudio en 74 niños menores de 15 años, con diagnóstico de parotiditis recurrente del 2000 a 2007 con el objetivo de realizar una caracterización clínica de esta enfermedad. A cada paciente se le realizó: interrogatorio y examen físico; se confirmó el diagnóstico con ultrasonografía. La enfermedad no presentó diferencias importantes entre los sexos. La edad de presentación de la primera crisis fue alrededor de los 3 años, con un promedio de 7 crisis por niño, con una duración de 6 días. En la mayoría de los casos se presentó como un aumento de volumen bilateral, acompañado de dolor.

The recurrent parotitis is in order of frequency the second inflammatory disease that affects the parotid gland; it is defined like an inflammatory process generally associated to a glandular non obstructive sialectasis. It is characterized by recurrent inflammatory episodes and volume increase of one or both parotids glands, occasionally accompanied by fever and general uneasiness. These episodes are alternated with remission intervals of weeks or months, in which the gland is observed clinically asymptomatic. It was carried out a study in 74 children smaller than 15 years, with diagnose of recurrent parotitis from 2000 to 2007 in order to perform a clinical characterization of this disease. To each patient it was carried out: interrogation and physical exam, diagnose was confirmed with ultrasound. There were not found remarkable differences among sexes. The presentation age of the first crisis was around 3 years, with an average of 7 crises per patient and 6 days of duration. In most of the cases it occurred as a bilateral volume increase, accompanied by pain.

Enfoque y tratamiento actual de laparotiditis recurrente: revisión sistemática de la literatura / The current approach to recurring parotitis and its treatment: a systematic review of the literature

Objetivos: realizar una revisión de la literatura actual en cuanto a etiología, enfoque médico,diagnóstico y tratamiento de la parotiditis recurrente. Metodología: búsqueda en Pubmed desde 2000 hasta enero 2010, con revisión de artículos relevantes por su casuística, opciones terapéuticas o diagnósticas innovadoras y diseño metodológico adecuado. Resultados: se hallaron 69 artículos, de los cuales se seleccionaron 35. Se aclaran mecanismos etiopatogénicos de la enfermedad como inflamación, infección, deshidratacióny eventos que promueven la recurrencia. El diagnóstico de la enfermedad se basa en la recurrencia del cuadro. Se describe el diagnóstico diferencial y priorización en los paraclínicos de apoyo. Las imágenes recomendadas son en primer lugar la ecografía de alta resolución, seguida de la siolografía, que provee diagnóstico y según algunos autores tratamiento. Las últimas tendencias involucran la sialografía por RMN y por TAC. El tratamiento de la etapa aguda continúa siendo el uso de antibióticos contra gram positivos, antiinflamatorios esteroideos y no esteroideos, hidratación y alimentos con capacidad sialogoga. Para el manejo de las recurrencias se plantea manejo conservador discutiendo el uso de antibióticos, sialografía, y diversas estrategias de ablación no quirúrgica y la sialo endoscopia. El tratamiento quirúrgico queda reservado para casos de alta recurrencia, planteándosela parotidectomía y la denervación parasimpática mediante neuronectomía del nervio de Jacobson. Conclusiones: la parotiditis recurrente presenta nuevas estrategias diagnósticas y terapéuticas, que deben ser seguidas para construir en poco tiempo un manejo ideal de esta patología. Palabras clave: parotiditis crónica, parotiditis recurrente, diagnóstico, tratamiento.

Objectives: To conduct a review of the current literature as far as the etiology, medical approach, diagnoses and treatment for the recurrent parotitis is concerned. Methodology: a search in Pubmed from 2000 to 2009 was performed. All articles that were relevant due to the causes, therapeutic or innovative diagnose options and the appropriate methodologicaldesign, were revised. Results: 69 articles were found, 33 of which were selected. Some etiopathogenic mechanisms of the disease such as inflammation, infection, dehydration and those events promoting recurrence wereclarified. Diagnosing the disease is done based on the recurrence rate of the chart. The differential diagnose as well as the prioritization are described in the supporting paraclinical procedures. Therecommended images are a high resolution ultrasound scan, followed by a sialography, which diagnosesand treats according to some authors. The latest trends involve a sialography by RMN and TAC. The treatment continues to be using antibiotics against great positive, non- steroidal and steroidal anti inflammatory drugs, hydration and foods that have great sialogogue ability during the acute phase. In order to handle recurrences a conservative management is suggested by discussing using antibiotics,a sialography, as well as several other non- surgical ablations and the endoscopic sialography. Surgical treatment is then reserved for those cases that have a great recurrence rate. A parotidectomy surgery as well as the parasympathetic denervation by means of the neuronectomy of the Jacobsonnerve has been suggested treatments.Conclusions: recurrent parotitis has exhibited new diagnosing and therapeutic strategies that need tobe followed in order to construct, in a short period of time, an ideal management for this pathology.

Sialography: Report of 3 cases.

Salivary gland examination is an important part of oral examination, especially because of it's involvement in most of the systemic diseases. Patients most commonly seek medical attention when the major salivary glands like parotid and submandibular gland become enlarged or painful. The various imaging modalities practiced to check the salivary gland disorders include conventional radiography, sialography, ultrasonography, computerized tomography, radionuclide imaging and magnetic resonance imaging. Sialography is one of the oldest imaging procedures and still most commonly practiced, as it is a chair side procedure, simple to perform, and cost effective. We report the role of sialography as an adjuvant in the diagnosis of bacterial sialadenitis and sialadenosis and as a diagnostic and therapeutic aid in a case of juvenile recurrent parotitis.

Parotiditis crónica recurrente o síndrome de Sjõgren primario juvenil?: reporte de un caso / Chronic recurrent parotiditis or juvenile primary Sjõgren?: a case report

Introduction: Chronic Recurrent Parotiditis is a recurrent swelling of the parotid gland, of multiple etiology. In some cases it may be an early manifestation of Sjõgren's syndrome. Objective: A comparison of both diseases, in light of the clinical, radiological, histological and laboratory findings in a patient suffering from a chronic recurrent parotiditis suggestive of Sjõgren's syndrome. Case Report: A 14 years old girl, seen in Oral Maxillary Medicine consultation at "Hospital Universitario de Maracaibo", for a year's history of multiple episodes of parotid swelling. Glandular involvement was confirmed clinically. While dental cavities and thick saliva were observed, the absence of oral dryness and ocular manifestations resulted in a diagnosis of Chronic Recurrent Parotitis at the time. Due to multiple recurrent dental cavities, high recurrence of the swelling episodes, and poor response to treatment, Sjõgren's syndrome was suspected. Lower lip minor salivary gland biopsy, specific antibodies, sialometry and Schirmer's test were requested, finding enough positive criteria for the diagnosis of Sjõgren's syndrome. Conclusions: Among children and teenagers with CRT with treatment failure, the presence of Sjõgren's syndrome must be evaluated, even in the absence of oral and ocular symptoms.

Introducción: La parotiditis crónica recurrente es una inflamación recidivante de la glándula, producida por diversos factores, sin embargo, ésta en algunos casos puede presentarse como primera manifestación del síndrome de Sjõgren. Objetivo: Describir la relación existente entre los signos y síntomas de ambas patologías, evaluando los hallazgos clínicos, radiográficos, histológicos y de laboratorio encontrados en un paciente con antecedentes de parotiditis crónica recurrente y criterios positivos para Síndrome de Sjõgren. Presentación del caso: Paciente femenino de 14 años de edad, atendida en la consulta de Medicina Bucal del Hospital Universitario de Maracaibo por presentar múltiples aumentos de volumen parotídeo de 1 año de evolución. Clínicamente se confirmó los cambios glandulares, observándose además caries y salivación espesa, sin sequedad bucal ni molestias oculares, llegando al diagnóstico de Parotiditis Crónica Recurrente. Ante las múltiples caries avanzadas, la marcada recurrencia de los episodios inflamatorios y respuesta inadecuada al tratamiento, se solicitó biopsia de glándula salival menor de labio inferior, anticuerpos específicos para el síndrome de Sjõgren, sialometría y test de Schirmer, encontrando criterios positivos suficientes para diagnosticar este Síndrome. Conclusión: En pacientes niños y adolescentes con PCR en los cuales a pesar del tratamiento indicado no se logre prolongar el tiempo entre las recurrencias ni disminuir el aumento de tamaño de la glándula satisfactoriamente, debe ser evaluada la presencia del Síndrome de Sjõgren, aún en ausencia de síntomas oculares y bucales.

Clinical Experience of Chronic Recurrent Parotitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic recurrent parotitis has been considered as an ascending infection from the oral cavity, but its causes remain unknown. Although conservative mechanical and medical measures are usually effective in controlling the acute exacerbations of this disease, surgical treatment may become necessary when the infection become too frequent or severe for episodic treatment. This study was designed to evaluate the etiology and pathology, and to analyse the outcome of surgery. MATERIALS AND METHODS: A retrospective study was conducted on nine patients who were managed by surgery(seven patients: superficial parotidectomy, two patients: total parotidectomy) after failure with all conservative measures. The age distribution was from 25 to 72 years, with the mean of 44 years. RESULTS: Of nine patients, the numbers of recurrence were 1-5 times (with the average of three times). Duration of illness ranged from one to 42 years, with a mean of 12 years. Conservative treatments preceding surgery included parotid gland massage, sialogogues, repeated use of antibiotics, and Stensens duct probing in all patients. The disease persisted in all the patients despite these measures, but following parotidectomy (superficial: 7 patients, total: 2 patients), all had complete resolution of the disease. Two patients developed transient facial weakness (House-Brackmann grade II) postoperatively without permanent sequelae. Other complications included seroma in two patients, facial deformity in two patients, Freys' syndrome in one patient, and salivary fistula in one patient. CONCLUSION: Chronic recurrent parotitis, when deeply severe, causes significant. When all the conservative medical management fail, parotidectomy can be offered as the last resolution.

Clinical Study of Recurrent Parotitis in Children

PURPOSE: Recurrent parotitis is defined as a recurrent parotid inflammation, generally associated with sialectasis of the parotid gland. It can often be misdiagnosed as recurrent mumps. We studied the clinical and laboratory features of recurrent parotitis. METHODS: Outpatient clinical records of 23 cases were analyzed retrospectively between April 1993 and March 1999. Follow-up after the last outpatient clinic visit was carried out by telephone interview. RESULTS: Mean age of onset was 3.7+/-2.1 yr with 16 cases (69.6%) of 2-4 yr being predominant. Males (56.5%) were affected more than females. Mean number of recurrence per year for patients who recurred more than 3 times was 1.8/yr. Most parotid swellings subsided within 3-7 days. Laboratory findings at first visits were as follows:WBC 14,100+/-7,660/mm3 (neutrophil 56.6+/-18.9%, lymphocyte 35.5+/-17.6%), ESR 19.3+/-7.6mm/hr in males and 24.7+/-6.8 mm/hr in females and amylase 407.4+/-391.8IU/L. An eosinophil count over 250/mm3 was found in 6 out of 23 cases and IgE levels over 150IU/ml was found in 3 out of 14 cases. Anti-mumps IgG was positive in 10 out of 16 cases but anti-mumps IgM was all negative. CONCLUSION: Recurrent parotitis is not uncommon in childhood. Careful history taking and follow-up observation are important for the diagnosis of recurrent parotitis. The clinicians should reassure patients and their parents of the benign disease process.

A Case of Recurrent Parotitis with Sialolithiasis in a 14-year-old Boy

Recurrent parotitis, which is also known as juvenile recurrent parotitis, is characterized by a cyclic swelling of parotid glands associated with discomfort and/or pain in the absence of external inflammatory changes or progression to frank suppuration. It is usually accompanied by fever and malaise. Recurrent parotitis, following mumps, is the most common inflammatory salivary gland disease during childhood. Its etiology remains an enigma, but various etiologies have been suggested as causes, including infection, allergy, localized manifestations of systemic immunologic disorders, autoimmune diseases and hereditary or congenital abnormalities of salivary duct. Sialolithiasis may occur at any age. Its higher frequency is found between the 4th and 6th decade, but it is rare in the first decade. We currently experienced a 14-year-old boy with recurrent parotitis associated with sialolithiasis. One and a half year earlier this boy experienced right-sided parotid swelling, which subsided spontaneously over a few days. During the following year and a half period, he experienced three more short bouts of parotid swelling with mild pain, fever and malaise. The symptoms including swelling lasted from several days to 2 weeks and resolved spontaneously, independent of any treatment. Forty days ago diffuse swelling of his right parotid gland developed with pain and fever, which were more exacerbated during or after meals. Meanwhile, his left parotid gland also became swollen. Diagnosis for sialolithiasis was confirmed by sialographic findings showing the filling defect in the right parotid duct. We present a case of parotid parotitis with sialolithiasis in a child with a brief review of related literatures.