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THE SALIVARY GLANDS - RECURRENT PAROTITIS IN CHILDREN
The Salivary Gland Center (SGC) wishes to call attention to recurrent parotitis in children (RPC), an unusual childhood inflammatory disease of the parotid salivary glands. RPC is characterized by intermittent episodes of parotid swelling, unilateral or bilateral, over a period of years and is associated with a sialographic pattern of sialectasis. Although congenital or autoimmune duct defects are suspected, the etiology is yet to be determined.
RPC is usually evident by the age of 6 years, predominantly in male children. Progression into adult life has been observed but remission normally occurs with puberty. The parotid swellings are sudden in onset, may be accompanied by fever and discomfort, and spontaneously subside within 2 weeks. The parotid sialogram, as performed in the SGC, is a major factor in diagnosis. Bilaterally, the interlobular ducts are cystically dilated. Consequently, instead of a normal branching linear duct configuration, sialography reveals an abnormal droplet pattern- sialectasis (see illustration). Sonograms and CT scans confirm the presence of these duct dilatations.
Infection may develop with mucopus plugs readily observed in saliva
milked from the involved gland. The infection probably represents
a secondary manifestation of an ascending ductal infection originating
from The therapeutic approach is conservative since subsidence with puberty is to be expected. Exacerbations are readily managed with sialogogic agents (sugarless sour candy, chewing gum), aggressive glandular massage, and duct probing in order to promote ductal lavage and break up mucus logjams. Antibiotics and steroids are limited in value while surgery is rarely necessary.
Since SjogrenÌs syndrome (SS) can occur in the young, it must be included in differential diagnosis. Confusion arises from the similarity of clinical symptoms, the presence of sialectasis in both RPC and SS, and reports of the occasional progression of RPC into SS. The absence of serum autoantibodies rules out SS. The Salivary Gland Center (SGC) was developed because a void existed in the diagnostic and comprehensive care of patients with salivary gland problems and/or secretory dysfunction. Since the diversity of these salivary conditions presents challenges to the clinician, the SGC is available for referrals. Louis Mandel, DDS Director, Salivary Gland Center (212) 305-9982
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the
oral flora. The defective ducts have been shown to pre-exist the
glandular swellings and as such they are susceptible to the exercise
by oral bacteria of their right to eminent domain.