CT Case 074

There is oedema and swelling of the epiglottis, right vestibular fold (false cord) and the right vocal cord.

There is moderate narrowing of the supraglottis.

No discrete collection is seen.

Adult acute supraglottitis used to be called epiglottitis in the past.

Supraglottitis is the more appropriate terminology in adults as the infection and inflammation involve the epiglottis AND surrounding structures, namely arytenoid, uvula, aryepiglottic folds, the false vocal cords and the laryngeal ventricles.

It is an upper airway infection that is potentially life threatening.

Adult acute supraglottitis is on the rise, whereas epiglottitis in children is decreasing thanks to the HiB vaccine.

The infection can spread to surrounding structures, resulting in parapharyngeal abscess, epiglottis abscess or Lemierre syndrome (thrombus of the IJV).

Management principles include early administration of antibiotics, steroid administration and close airway monitoring.

As we can see from this case, you must have a high index of suspicion for supraglottitis in patients with sore throat, odynophagia and fever, but with a normal oropharyngeal examination.

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

• Navaratnam AV, Smith ME, Majeed A, McFerran DJ. Adult supraglottitis: a potential airway emergency that can present in primary care. Br J Gen Pract. 2015 Feb;65(631):99-100.
• El Hitti DE. Acute epiglottitis. InnovAiT. 2020;13(10):608-612.
• ENT Equivocation 002 – Just a Sore Throat