It's all mumps

What are the clinical manifestations of chronic recurrent parotitis?

Chronic recurrent parotitis, also known as chronic suppurative parotitis, mostly involves both sides and is common in clinic. Patients generally have no systemic symptoms, often do not know the onset time, and often see a doctor because of repeated swelling and pain of parotid gland. Patients may have persistent slight pain and discomfort in parotid gland, dry mouth, bad breath and other symptoms. When I get up in the morning, I feel swollen and painful glands, and sometimes I feel sticky and salty liquid suddenly flowing out of the catheter mouth, and I feel lighter locally. The common symptom of chronic recurrent parotitis is obstruction. When eating or seeing food, especially acidic food, the amount of saliva secretion increases, and the parotid gland is swollen and painful due to the obstruction of saliva discharge; After stopping eating, the swelling gradually disappeared because of the gradual discharge of saliva. Inspection shows that the mouth of the catheter is slightly red, and the gland can flow out of the nozzle with turbid "snow-like" saliva, or sticky egg white saliva, or even mucus embolus. The parotid gland is slightly swollen or normal. If the course of the disease is long, the glands feel hard and tough, and the parotid duct is thick and hard. It is worth noting that children's recurrent mumps often heal themselves, and many people think that this disease is caused by congenital hypoplasia.

How to treat chronic recurrent parotitis?

It is difficult to treat chronic recurrent parotitis, and comprehensive therapy is often used. The prognosis of chronic recurrent parotitis in adults and children is obviously different, so the treatment methods are different. After the child has compound parotitis, he should drink plenty of water and massage his glands every day to help discharge saliva and maintain oral hygiene. You can gargle with chlorhexidine solution, strong tea or scutellaria baicalensis every day. If there is acute inflammation, antibiotics such as penicillin and sulfamethoxazole can be used. The basic treatment principles of adult chronic recurrent parotitis are the same, but the treatment effect is not ideal. If the pathogenic factors can be found, then symptomatic treatment. If it is caused by sialolith, sialolithotomy can be performed first; If it is caused by the stenosis of the duct opening, parotid duct opening enlargement is feasible. Traditional Chinese medicine has a certain effect on chronic recurrent parotitis. Commonly used prescriptions are: Fuyuan Huoxue Decoction, Xianfang Huoxue Drink, Ganlu Xiaodu Dan, Wuwei Xiaodu Drink, etc. In addition, the use of ultrashort waves, infrared rays and other physical therapy methods also has a certain effect on chronic recurrent parotitis. If all the above methods have no effect, drugs such as iodized oil, Hypericum japonicum and various antibiotics can be injected into the catheter. Before using antibiotics, it is best to do a drug sensitivity test, select the most sensitive drugs to keep, and infusion directly from the catheter. If conservative treatment fails, surgical ligation of parotid duct can be considered. Antibiotics can be used to rinse the parotid duct system repeatedly before operation, so that the mucus purulent secretion can be obviously reduced or stopped. After catheter ligation, atropine can be taken orally to reduce saliva secretion, and the parotid gland area can be compressed to shrink.

When all methods fail, parotidectomy with facial nerve preservation is feasible. All glandular tissues should be removed as much as possible during the operation, and the parotid duct should be completely removed, otherwise the duct section will be preserved, and a retention abscess may be formed after the operation.

How does acute suppurative parotitis occur and how to prevent it?

The basic factor of acute suppurative parotitis is the severe dehydration of the body, which leads to the reduction or cessation of saliva secretion. In this way, the duct system of salivary gland lacks mechanical flushing of saliva, and the anti-infection ability of salivary gland itself decreases. Staphylococcus aureus is the main pathogen in the oral cavity when the patient's systemic resistance is low, and it is retrograde infected through parotid duct, causing acute suppurative parotitis. Saliva reduction can be seen after abdominal gastrointestinal surgery, and it can also be caused by long-term or excessive use of diuretics, anticholinergic drugs and other drugs, which can not be taken orally and insufficient fluid replacement. In addition, trauma in parotid region and acute inflammation spread by adjacent tissues can also lead to acute suppurative parotitis, such as suppurative lymphadenitis in parotid region, spreading to parotid gland.

Because acute suppurative parotitis is mainly caused by retrograde infection, keeping oral hygiene is an important link to prevent its onset. Brush your teeth every morning and evening, rinse your mouth after meals, and clean your teeth when necessary. Some patients with weak constitution, long-term bed rest, high fever or fasting are often accompanied by dehydration, so it is necessary to strengthen oral care (such as brushing your teeth carefully and gargling with chlorhexidine solution). ), maintain body fluid balance, strengthen nutrition and anti-infection treatment. After major surgery, especially after abdominal surgery, the reflex function of salivary glands may decrease or stop. Doctors should think of the possibility of patients with acute suppurative parotitis, and strengthen the treatment before and after the operation, maintain the normal eating and fluid balance of patients, correct the body's water shortage and electrolyte disorder, and inject a small amount of fresh blood when necessary to enhance the body's resistance. Taking the above preventive measures can effectively avoid the occurrence of acute suppurative parotitis.

What disease should acute suppurative parotitis be differentiated from?

The diagnosis of acute suppurative parotitis is mainly based on medical history and clinical examination. The parotid gland is often unilaterally involved, the catheter mouth is red and swollen, and pus overflows when massaging the parotid gland. The swelling is centered on the earlobe and accompanied by spontaneous jumping pain. It is not difficult to diagnose acute suppurative parotitis due to general failure or abdominal surgery. In general, acute suppurative parotitis should be differentiated from masseter space infection, parotid lymphadenitis and parotitis.

Infection of masseter space is a common complication of pericoronitis of mandibular wisdom teeth, with a history of gingival swelling. In some cases, masseter space infection began to appear without toothache, which is very similar to acute suppurative parotitis. However, the swelling center and tender point of masseter space infection are in the mandibular angle, which is often accompanied by limited mouth opening, no redness and swelling of parotid duct opening, and clear saliva secretion.

Lymphadenitis in parotid region is more common in children and adolescents. The lesion was localized and developed slowly, and the abscess broke out from the lymph nodes and involved the parotid gland. Patients can often recall the history of intraglandular nodules first, and then gradually aggravate the development. There is no redness and swelling at the mouth of parotid duct, and there is no abnormality in saliva secretion.

Mumps mostly occurs in children and has a history of contact infection. Although there are parotid gland swelling, pain, fever and other manifestations, but the catheter mouth is not red and swollen, no pus overflow. The total number of white blood cells is not high, but the proportion of lymphocytes in classification increases, and both parotids can be involved at the same time or successively. In acute phase, the amylase in blood and urine increased slightly or moderately.

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