Acute suppurative sialadenitis was first reported in 1828. The disease gained attention in 1881, when President Garfield died of acute parotitis following abdominal surgery. Most cases involve the parotid gland, but some also occur in the submandibular gland.
Parotid increased vulnerability due to reduced bacteriostatic activity of parotid saliva when compared with submandibular saliva. content and high molecular weight glycoprotein sialic acid in saliva mucinous aggregation ability of bacteria greater than serous saliva. In addition, mucoid saliva IgA concentrations of lysozymes and higher.
The classic presentation of acute suppurative sialadenitis is a sudden there is an enlargement of the gland involved spreading associated induration and tenderness. Purulent saliva bias can be seen in the duct orifice, especially with a massage in the gland. saliva should be in culture for aerobic and anaerobic bacteria and specimens for Gram staining.
Organisms are usually involved include coagulase-positive Staphylococcus aureus, with other aerobic organisms are sometimes involved, especially Streptococcus pneumoniae, Escherichia coli, and Haemophilus influenzae. The most common anaerobic organisms were Bacteroides melaninogenicus and Streptococcus micros. Twenty percent are bilateral.
Histological examination showed damage to the gland with abscess formation. There is erosion of the channels with exudate penetration into the parenchyma.
Initial treatment should include adequate hydration, good oral hygiene, repeated massage of the glands, and intravenous antibiotics. Empirical administration of an antibiotic-resistant antistaphylococcal penicillinase-be started while awaiting culture results. Quoted mortality rate approaching 20%.
Incision and drainage is best accomplished by lifting the cover and then use a standard parotidectomy hemostat to make a few openings to the glands, scattered in the general direction of the facial nerve. A channel is then placed on top of the gland and the wound closed.
In some cases, it is possible to perform CT-guided needle aspiration or ultrasound-on parotid abscess, which can help avoid an open surgical procedure. It is also to be remembered that the fluctuations in the parotid gland does not occur until very late phase because some investment in the gland fascia. Thus, it is impossible to determine the presence of early abscess formation by physical examination alone.
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