return to: Salivary Swelling

see: Juvenile Recurrent Parotitis Sialogram

Patient Population

• Juvenile type and adult type (10 x more common)
• Juvenile type
  • Age range – infancy to teenage years
  • Male = female
  • Typically resolves in puberty
  • Predisposing factors
    • Punctate sialectasis – bilateral
    • Progresses to globular sialectasis (see Foggia 2020 for description of sialography findings)

Disease Characteristics 

• Sudden onset of parotid swelling
• Unilateral; can involve both sides
• No relationship to meals or seasons
• Symptoms
  • Low grade fever
  • Inflammation
  • Swelling 1-2 days to 1-2 weeks; may have residual swelling
  • Reduction of salivary flow – viscous, rarely if ever muco-purulent, microcalcifications

Diagnosis

• Sialograms
• Ultrasound – micro-calcifications
  • Sensitivity – 75%, specificity – 95%, PPV – 94%, NPV – 75%
• MR sialography
  • Sensitivity – 91%, specificity – 97%, PPV – 97%, NPV – 91%
• Sialendoscopy

Treatment

• Two-fold approach
  • Treat inflammation
    • Antibiotics – role questionable
    • Steroids
• Treat thickened secretions
  • Massage
  • Hydration
  • Foods: Lemon, lemon drops, pickles, sauerkraut

Treatment

• Surgery – as a last resort
• Gland irrigation under local anesthesia (Geisthoff 2022)
• Sialendoscopy
  • Diagnostic
  • Therapeutic
    • Solu-Medrol 40 (methylprednisolone), 1 cc
    • Antibiotic (Amoxil – 1 cc)

CRP - Conclusions

• Most common cause of parotid swelling in children
• Associated with inflammation and thickened secretions
• Related to sialectasis
• Treatment should address inflammation and stasis of secretions
  • Sialendoscopy is both diagnostic and therapeutic

Sialendoscopy – Getting Started

• Chronic Recurrent Parotitis
  • Diagnostic sialendoscopy
  • Therapeutic sialendoscopy
  • Inject
    • Solu-Medrol 40 (methylprednisolone), 1 cc
    • Antibiotic (Amoxil – 1 cc)
  • Balloon dilation

Sialography as primary management (without sialendoscopy)

Tucci et al identified 110 children evaluated for JRP (juvenile recurrent parotitis) from 2008 to 2017 in a Children's Hospital in Rome (Tucci 2019).

• Inclusion criteria: age <16 years and at leasdt two or more episodes of parotid swelling (uni- or bi-lateral) over preceding 6 months
• Exclusion criteria: obstructive lesions, dental malocclusion, Sjogren syndrome, IgA immunodeficiency and 'relevant systemic disease'
• Outcome: evaluate number and degree of episodes ofp arotid swelling before and after sialography
  • 98 patients (89% of cases) significant improvement with mean reduction in episodes of parotid swelling
  • 75 patients improved symptomatology; additional 23 pateints with partial resolution
  • 12 patients no resolutionor a reduction less than 30% of episodes
• Conclusion: "Sialography is effective method not only as a diagnostic procedure but also as a therapeutic procedure in treatment of JRP"

References

Foggia MJ, Peterson J, Maley J, Policeni B, Hoffman HT:  Analysis of Parotid Ductal Abnormalities Associated with Sjogren's Syndrome. Oral Dis. 2020 Feb 7. doi: 10.1111/odi.13298. [Epub ahead of print]PMID:32031309

Tucci FM, Roma R, Bianchi A, and De Vincentiis GC: Juvenile recurrent parotitis: Diagnostic and therapeutic effectiveness of sialography. Retrospective study on 110 children.   International Journal of Pediatric otorhinolaryngology  124(2019) 179-184

Geisthoff UW, Droege F, Schulze C, Birk R, Rudhart S, Maune S, Stuck BA, Hoch S. Treatment of juvenile recurrent parotitis with irrigation therapy without anesthesia. Eur Arch Otorhinolaryngol. 2022 Jan;279(1):493-499. doi: 10.1007/s00405-021-06928-w. Epub 2021 Jun 12. PMID: 34117898; PMCID: PMC8739303.

Soriano-Martín D, García-Consuegra L, Junquera L, Reda S, Junquera S. Juvenile Recurrent Parotitis: Video-Documented Sialendoscopy. J Clin Med. 2023 Oct 30;12(21):6842. doi: 10.3390/jcm12216842. PMID: 37959307; PMCID: PMC10649241.