Parotitis pathophysiology: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
Parotitis is a disease that occurs in debilitated patients. [[Dehydration]] and decreased salivary flow/stasis are the main risk factors for ascending infection through [[Stenson’s duct]] to the gland. Postoperative patients who are dehydrated and NPO with little salivary stimulation are at particular risk with an incidence estimated at 1 in 1000. Debilitating medical conditions such as [[Diabetes mellitus]], [[renal failure]], [[HIV]] and [[Sjögrens’s syndrome]] are risk factors. | Parotitis is a disease that occurs in debilitated patients. [[Dehydration]] and decreased salivary flow/stasis are the main risk factors for ascending infection through [[Stenson’s duct]] to the gland. Postoperative patients who are dehydrated and NPO with little salivary stimulation are at particular risk with an incidence estimated at 1 in 1000. Debilitating medical conditions such as [[Diabetes mellitus]], [[renal failure]], [[HIV]] and [[Sjögrens’s syndrome]] are risk factors. | ||
Acute infection can occur in any [[salivary gland]] but the most commonly affected one is the parotid. This is thought to be due to a combination of anatomic and physiologic factors. The saliva from the parotid is less [[mucoid]] than that from the other salivary glands. [[IgA]], [[lysozyme]] and [[sialic acid]] are all found in smaller amounts in the more viscous parotid secretions. These substances are thought to help fight off ascending bacterial infection. Bacterial parotitis is generally unilateral in adults (75-90%), while viral is generally bilateral. | |||
Though 80-90% of salivary [[calculi]] occur in the [[Wharton’s duct]] of the [[submandibular gland]], the parotid remains the most common site of acute [[suppurative]] salivary infection. The secretions from the submandibular gland are more alkaline, thought to result in a higher concentration of insoluble calcium phosphate. | |||
Patients with [[Anorexia]], [[Bulimia]], [[CF]] or those with salivary ductal dilation are also at risk. Ductal dilation is found in those with high intraoral pressure such as trumpet players and glass blowers and medications with [[anticholinergic]] properties or diuretic effects. | Patients with [[Anorexia]], [[Bulimia]], [[CF]] or those with salivary ductal dilation are also at risk. Ductal dilation is found in those with high intraoral pressure such as trumpet players and glass blowers and medications with [[anticholinergic]] properties or diuretic effects. | ||
Revision as of 15:04, 5 November 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pathophysiology
Parotitis is a disease that occurs in debilitated patients. Dehydration and decreased salivary flow/stasis are the main risk factors for ascending infection through Stenson’s duct to the gland. Postoperative patients who are dehydrated and NPO with little salivary stimulation are at particular risk with an incidence estimated at 1 in 1000. Debilitating medical conditions such as Diabetes mellitus, renal failure, HIV and Sjögrens’s syndrome are risk factors.
Acute infection can occur in any salivary gland but the most commonly affected one is the parotid. This is thought to be due to a combination of anatomic and physiologic factors. The saliva from the parotid is less mucoid than that from the other salivary glands. IgA, lysozyme and sialic acid are all found in smaller amounts in the more viscous parotid secretions. These substances are thought to help fight off ascending bacterial infection. Bacterial parotitis is generally unilateral in adults (75-90%), while viral is generally bilateral.
Though 80-90% of salivary calculi occur in the Wharton’s duct of the submandibular gland, the parotid remains the most common site of acute suppurative salivary infection. The secretions from the submandibular gland are more alkaline, thought to result in a higher concentration of insoluble calcium phosphate.
Patients with Anorexia, Bulimia, CF or those with salivary ductal dilation are also at risk. Ductal dilation is found in those with high intraoral pressure such as trumpet players and glass blowers and medications with anticholinergic properties or diuretic effects.
The most common bacterial cause is S. aureus. S. pneumonia, S. pyogenes and H. influenza are also common. Less commonly gram negative rods (GNR) as well as anaerobes are found. M. tuberculosis and T. pallidum have also been reported but are usually associated with chronic, painless infection.
Viral etiologies include paramyxovirus (particularly Mumps), influenza, parainfluenza, echovirus and coxsackie. Cytomegalovirus (CMV) and adenovirus have been implicated in HIV patients.
Nonbacterial causes include Wegener’s granulomatosis and lymphoma. Cat-scratch and actinomycosis should be considered if the patient fails to respond to standard therapy. This predispose to parotitis. [1]
References
- ↑ McQuone SJ. Acute Viral and Bacterial Infections of the Salivary Glands. Otolaryngologic Clinics of North America. 1999, 32:793-811. PMID 10477787