CT Case 073

There is diffuse swelling and enlargement of the right parotid gland, compared to the normal left parotid gland.

No calculus is seen in the right parotid duct

No abscess or mass.

This a case of right sided parotid swelling due to bacterial infection (sialadenitis).

Anatomical reminder of the location of the parotid gland

The parotid gland is bound be the following;

• Superiorly – Zygomatic arch
• Inferiorly – Inferior border of the mandible
• Anteriorly – Masseter muscle
• Posteriorly – External ear and sternocleidomastoid

The secretions are then transported to the oral cavity via the Stensen duct which arises from the anterior surface of the gland. It opens into the oral cavity near the second upper molar. It is important to examine the oral cavity for a stone which may be sitting at the duct opening.

Swelling of a parotid, submandibular or sublingual salivary gland can be divided into obstructive, inflammatory, metabolic and neoplastic;

Obstructive

• Stones (sialolithiasis)
• Trauma
• Mucous retention

Inflammatory

• Bacterial infection (acute suppurative sialadenitis)
• Viral infection (mumps, coxsackievirus, EBV)
• Chronic infections (tuberculosis)
• Auto-immune (Sjögren syndrome)

Metabolic

• Obesity, hypothyroidism, alcoholic liver disease, malnutrition

Neoplastic

• Benign (adenoma)
• Malignant (eg mucoepidermoid carcinoma, adenoid cystic carcinoma, adenocarcinoma, lymphoma)

This patient was diagnosed with sialadenitis, treatment included;

• Rehydration
• Antibiotics (treated empirically with flucloxacillin – as usually the organism is staph aureus)
• Sialagogues (salivary stimulants such as sucking on lemon or sour candy)
• Local measures; massage of the involved gland and applying a heat pack

• Jones O. The Parotid Gland. Teach me anatomy
• Ugga L, Ravanelli M, Pallottino AA, Farina D, Maroldi R. Diagnostic work-up in obstructive and inflammatory salivary gland disorders. Acta Otorhinolaryngol Ital. 2017 Apr;37(2):83-93.