Parotid abscess is the formation of an inflammatory purulent focus in the tissues of the maxillofacial zone of the face. It is manifested by local swelling, redness and fluctuation of the skin over the focus of inflammation, facial asymmetry, difficulty and pain of swallowing, intoxication phenomena. It can develop into a diffuse inflammation – phlegmon, with involvement in the process of the near-pharyngeal and under-ocular areas, neck. Treatment is always surgical – opening and drainage of the abscess cavity.
ICD 10
K12.2 Phlegmon and abscess of the oral cavity
Meaning
Parotid abscess is a limited focus of purulent inflammation of the tissues of the maxillofacial zone. In the absence of treatment of abscess, purulent decay and purulent melting of neighboring tissues begins.
Causes
The abscess is caused by streptococcal and staphylococcal microflora, the most common cause is dental diseases and inflammatory processes in the maxillofacial zone. Furunculosis, angina, tonsillitis in chronic course are complicated by parotid abscess. Damage to the skin and mucous membrane in the mouth area, infection during dental procedures can provoke an abscess of the parotid area.
Common infectious diseases that occur by the type of sepsis, as a result of the spread of microorganisms by blood and lymph, cause multiple abscess in various organs and tissues, including abscess of the parotid zone. An abscess of the mandibular zone may occur due to facial injuries. During military operations and natural disasters, due to the lack of first aid, dislocations and fractures of the jaws are often complicated by abscess. Pericoroneal and pericoronary foci of inflammation and periodontal pockets during exacerbations can provoke an abscess of the jaw due to bone resorption.
Symptoms of parotid abscess
The formation of an abscess is preceded by toothache as in periodontitis. Biting in the affected area increases pain. Next, dense edema joins with the formation of a painful seal. An abscess developing under the mucous membrane is characterized by bright hyperemia and protrusion of the affected focus. Sometimes there is an asymmetry of the face.
In the absence of therapy, the general condition of the patient worsens: the body temperature rises, there is a refusal of food. After spontaneous opening of the abscess, the pain subsides, the contours of the face take normal outlines, the general state of health stabilizes. But due to favorable conditions for microorganisms in the oral cavity, the process is chronicled, so its spontaneous autopsy does not indicate a cure.
With short-term weakening of the immune system, parotid abscess worsen. Chronic suppuration from fistula passages is possible, it is accompanied by an unpleasant odor from the mouth and the ingestion of purulent masses. There is a sensitization of the body by decay products, allergic diseases worsen.
Abscess of the bottom of the oral cavity are characterized by hyperemia in the sublingual area with rapid formation of infiltrate. Conversation and eating become sharply painful, hypersalivation is noted. The mobility of the tongue decreases, it rises slightly upwards so as not to come into contact with the forming abscess. As the swelling increases, the general condition worsens. With spontaneous autopsy, pus spreads to the near-pharyngeal region and neck, which leads to the appearance of secondary purulent foci.
Abscess of the palate often occurs as a complication of periodontitis of the upper second incisor, canine and second premolar. During the formation of the abscess, hyperemia and soreness of the hard palate are observed, after swelling, the pain becomes more intense, eating becomes difficult. With spontaneous autopsy, purulent contents spread to the entire area of the hard palate with the development of osteomyelitis of the palatine plate.
If an abscess of the cheek occurs, then depending on the localization and depth, swelling and redness may be more pronounced from the outside or from the oral mucosa. The soreness of the focus is moderate, with the work of the facial muscles, the pain increases. The general condition practically does not suffer, but the abscess of the cheek is dangerous to spread to neighboring parts of the face even before the opening of the abscess.
Abscess of the tongue begins with soreness in the thickness of the tongue, the tongue increases in volume, becomes sedentary. Speech, chewing and swallowing food are sharply difficult and painful. Sometimes with an abscess, a feeling of suffocation may occur.
Diagnostics
The diagnosis is made on the basis of a visual examination of the dentist and patient complaints. Sometimes during the survey it turns out that there were boils of the facial area, there are chronic infectious diseases. Before visiting a doctor, it is recommended to take analgesics, rinse the mouth with antiseptic solutions, self-administration of antibiotics is unacceptable. The ultimate goal of treatment is the complete elimination of the infectious process and the restoration of impaired functions in the shortest possible time.
Treatment of parotid abscess
The treatment regimen depends on the stage of the disease, on the virulence of the microorganism and on the characteristics of the response from the macroorganism. Localization of abscess of the parotid zone, the age of the patient and the presence of concomitant diseases significantly affect the principles of treatment. The more complicating factors, the more intensive the therapy should be.
During the treatment of abscess of the mandibular zone, it is recommended to follow a diet with a predominance of pureed soups and purees. If there is a persistent refusal of food, they resort to intravenous administration of protein solutions. In the presence of a formed abscess, its opening is shown with subsequent drainage of the cavity. In other cases, antibiotic therapy is resorted to, and only if it is inexpedient, the question of surgical treatment is raised.
Antibiotics are prescribed in the form of injections or in tablet forms, additionally a course of vitamin therapy is carried out. Immunostimulants and detoxification therapy are indicated. Rinsing the mouth with warm solutions of furacilin and soda relieves puffiness and prevents the spread of infection. In the presence of a pronounced pain syndrome, analgesics are used. When complex therapy is started on time, the prognosis is usually favorable, recovery occurs within 6-14 days.
Literature
- Cases presenting as parotid abscess in children / Saarinen RT, Kolho KL, Pitkäranta A. / Int J Pediatr Otorhinolaryngol. 2007 Jun;71(6):897-901. doi: 10.1016/j.ijporl.2007.02.011. Epub 2007 Mar 28. link
- Treatment for parotid abscess: a systematic review. / Saibene AM, Allevi F, Ayad T, Lechien JR, Mayo-Yáñez M, Piersiala K, Chiesa-Estomba CM./ Acta Otorhinolaryngol Ital. 2022 Apr;42(2):106-115. link
- Salmonella Typhi: a rare cause of parotid abscess. / Anandan Y, Antony T, Kumari S, Alexander N. / BMJ Case Rep. 2020 Nov 9;13(11) link
- Deep Parotid Lobe Abscess Presenting with Dysphagia and Trismus. / Grinnell M, Logeman A, Knudsen T, Sayed Z. / Case Rep Otolaryngol. 2019 Feb 24 link
