MEET THE DOCTORS IN LONDON & BELGRADE: NOVEMBER 2017

Dr. Hamilton and Dr. Osborne will be in London, UK, and Belgrade, Serbia in November 2017.

PAROTITIS

parotitis
Figure: Patient before and after treatment for bilateral parotid gland hypertrophy.

Parotitis is a common medical issue that affects millions of people worldwide. The parotid glands are partially responsible for the production of saliva and can become inflamed or infected leading to a constellation of vague and often non-specific symptoms. These symptoms can include pain, tenderness, and/or inflammation of one or both of the parotid glands. Because of their location on either side of the face and the nonspecific symptoms, parotid gland issues such as parotitis are classically mistaken for other ailments.

Misdiagnosis of parotitis is a reality for most people suffering from this condition. Classically, the parotitis patient will seek consultation and evaluation from a variety of physicians and specialists before arriving at a correct diagnosis. Parotitis is oftentimes misdiagnosed as the following conditions by many providers:

  • Temporomandibular Joint Disease (TMJ)
  • Dental Disease
  • Sinus Disease
  • Atypical Facial Pain
  • Trigeminal Neuralgia
  • Lymphadenopathy
  • Neoplasm/Cancer

The treatment of persistent or recurrent parotitis has traditionally included invasive and oftentimes suboptimal procedures. Many chronic or recurrent parotitis patients have chosen to forego traditional surgical options to avoid the complications associated with these procedures. The salivary gland specialists at the Osborne Head and Neck Institute have pioneered non-invasive techniques as well as cutting edge surgical options for the treatment of parotitis that preserve gland function and avoid the associated complications of traditional surgery.

Conditions Causing Parotitis

Parotitis is a relatively common condition that can affect anyone. The term “parotitis” is used to refer to inflammation or infection of the parotid gland. Episodes of parotitis can be single or even recur over time. The parotid gland can become infected or inflamed through a variety of different processes, including:

  • Mechanical/Obstructive
    • Mechanical or obstructive issues within the salivary gland can lead to fluid drainage issues. When stasis occurs and saliva cannot properly drain through the gland’s ductwork, microorganisms begin to thrive and infect the surrounding tissue.
  • Neoplastic/Tumors
    • Tumors of the parotid gland can often times invade or compress the gland’s ducts. Dysfunctional drainage within the gland again leads to parotitis when proper drainage of saliva is affected.
  • Autoimmune
    • Autoimmune conditions such as Sjögren’s syndrome can involve the salivary glands. Parotitis occurs when the body’s own immune cells target the tissues of the salivary glands.
  • Inflammatory
  • Infectious
    • Bacterial
    • Viral: Mumps and HIV
  • Parotid Hypertrophy
    • Bulimia
  • Systemic Illness
  • Trauma
    • Trauma sustained to the face especially in the area overlying the parotid gland can lead to swelling, inflammation, and possible damage to the glandular structure. Facial trauma from a vehicle, sporting, or work accident can result in salivary gland damage.

Facial trauma often includes damage to underlying structures that is not readily apparent. Specialized evaluation and diagnostic imaging is typically required to uncover a potentially complicating injury.

CONDITION SPOTLIGHT: SALIVARY GLAND CYSTIC DISEASE

HIV parotid glands
Figure: Patient before and after treatment for bilateral parotid gland hypertrophy.

HIV/ Human immunodeficiency virus

HIV is a complex disease process that is characterized by immune dysregulation and progressive susceptibility to opportunistic infections. HIV/AIDS has a variety of associated conditions and symptoms that may manifest depending on the patient’s individual health picture.

HIV associated parotid swelling is a condition that causes the parotid glands to become enlarged and prominently visible. Immune dysregulation potentially leads to the accumulation of immune cells within the parotid glands, subsequent obstruction of the salivary ducts, and formation of cystic lesions. The swelling seen in HIV patients is most often due to these cystic lesion formations that are formally known as benign lymphoepithelial cyst (BLEC). While these lesions in themselves are relatively benign, they can cause undesirable cosmetic change and distress to the patient.

 

Bulimia Nervosa

Bulimia nervosa is an eating disorder that predominantly affects women and is characterized by episodes of binge eating followed by purging. Bulimia is a complex disorder with various serious health complications that require close followup and treatment by qualified health professionals.

One of the permanent complications of bulimia is parotid hypertrophy. Purging behaviors typically lead to damage of the delicate mucosal tissues of the esophagus, oral cavity, and gastrointestinal tract. Consequently, the body’s protective mechanisms are engaged to increase production of mucus and saliva. If this mechanism is engaged chronically, the salivary glands, including the parotid, increase in size (hypertrophy) to keep up with demand. Parotid hypertrophy leads to the characteristic appearance seen above.

Rehabilitation can be a prolonged and difficult ordeal for the bulimia patient. Oftentimes patients request that the appearance of their parotid glands be returned to their original appearance. Because parotid surgery is a delicate procedure it is recommended that a evaluation and treatment for this condition be sought from a qualified salivary gland specialist.

ANATOMY

The parotid glands are part of the salivary gland network that is responsible for saliva production. They exist in pairs and are located at the sides of the face overlying the rear of the jaw near the temporomandibular joint.

The parotid gland’s primary function is production of saliva to lubricate the oral cavity and assist in the breakdown and swallowing of food. Saliva is produced within the gland’s intricate structure and is released into the oral cavity through the parotid duct (Stensen’s Duct).

The location of the parotid gland makes it particularly important when considering treatment options. The facial nerve, responsible for controlling the muscles of facial expression courses beneath the parotid gland and is prone to surgical damage during classically invasive procedures.

RISK FACTORS

Factors that can increase the likelihood of parotitis include:

  • Dehydration
  • Surgical Trauma
  • Physical Trauma
  • Obstruction of normal salivary flow (i.e., salivary duct stone, neoplasm, etc.)
  • Medical Conditions
    • HIV
    • Bulimia
    • Diabetes
    • Sjögren’s
    • Alcoholism
    • Malnutrition
  • Cancer Treatment – Radiation therapy
  • Advanced age
  • Medications that decrease the production or flow of saliva

EVALUATION & TREATMENT

Salivary gland specialists are highly qualified physicians with years of specialty training in salivary gland ailments. These specialized surgeons can oftentimes evaluate and treat cases of parotitis that can often times be misdiagnosed by other providers or altogether dismissed as “untreatable”.

Every patient’s case of parotitis is unique and specific to his or her individual health status. Consequently, each patient requires individualized attention and treatment customized to their specific pathology.

Comprehensive evaluation and treatment from a salivary gland specialist should include the following items:

  • In depth examination of the patient’s medical history
  • Comprehensive evaluation of the patient’s symptoms
  • Accurate diagnosis
  • Customization of a treatment plan unique to the patient’s individual case.
  • Preservation or improvement of the patient’s quality of life.
  • Recognition and minimization of potential complications.
  • Close follow-up

The physicians at the Osborne Head and Neck Institute are internationally renowned experts at the treatment of salivary gland disease, including parotitis. Our physicians have developed new cutting edge techniques that have revolutionized the treatment of these conditions. By developing and implementing cutting edge evaluation and diagnostic protocols, the specialists at OHNI have repeatedly diagnosed cases that have previously gone unnoticed or have been misdiagnosed. Our physicians also treat difficult and previously labeled “untreatable” cases with unmatched success rates.

FREQUENTLY ASKED QUESTIONS

What is parotitis?

Parotitis is the inflammation or infection of one or both of the parotid salivary glands.

What are the parotid glands?

The parotid glands are part of the salivary gland network and are responsible for the production of saliva.

What is the cause of parotitis?

Parotitis can occur from a variety of different causative agents or scenarios. The most common causes of parotitis are as follow:

  • Dehydration
  • Physical Trauma
  • Surgical Trauma
  • Bacterial Infection
  • Viral Infection
  • Autoimmune Condition
  • Salivary Duct Obstruction
  • Some Chronic Medical Conditions (i.e., Diabetes)

How is parotitis evaluated?

Parotitis is a condition that is commonly initially misdiagnosed. Symptoms of parotitis are nonspecific and often times mistaken by traditional healthcare providers for a variety of other disease processes. Patients suffering from this condition typically seek evaluation from multiple providers before receiving an accurate diagnosis.

Evaluation and treatment by a qualified salivary gland specialist is highly recommend in cases of suspected parotitis. By using advanced evaluation protocols and specialized imaging modalities, the salivary gland specialist can accurately diagnose and effectively treat each patient’s individual and unique case.

Why is parotitis commonly misdiagnosed?

Parotitis typically presents with pain and swelling of one or both parotid glands. Symptoms can vary slightly depending on the conditions that have led to parotitis. Facial pain, headache, and swelling are all nonspecific symptoms that can indicate a multitude of different possible etiologies.

Parotitis can easily be misdiagnosed as the following conditions:

  • Temporomandibular Joint Disease (TMJ)
  • Dental Disease
  • Sinus Disease
  • Atypical Facial Pain
  • Trigeminal Neuralgia
  • Lymphadenopathy
  • Neoplasm/Cancer

How do I know if I have parotitis?

Parotitis symptoms can be variable and not immediately indicative of a salivary gland issue. Symptoms can cycle between periods of improvement followed and episodes of reemergence. The challenges associated with accurate parotitis diagnosis commonly lead to misdiagnosis by traditional clinicians. To minimalize complications and improve treatment outcomes, all symptoms suggestive of parotitis should be promptly evaluated by a qualified salivary gland specialist.

Is parotitis treatment safe?

Yes. A salivary gland specialist is the medical professional of choice for evaluating and treating parotitis while minimizing any possible complications. Depending on the cause and degree of gland involvement cutting edge surgical and minimally invasive non-surgical options can be explored.

GLOSSARY

Endoscope: A device with a camera and light source that is used to examine areas inside the body. A miniaturized endoscope is used to look inside the duct network of the salivary glands during sialendoscopy.

Facial Nerve: A critical nerve that originates from the brain stem and courses through the skull and face. The facial nerve is responsible for movement of the muscles of facial expression and the sensation of taste. Because of the facial nerves position near the area of the cheek and parotid gland, it is of particular concern during surgical procedures or facial trauma. 

Mandible: The lower jawbone.

Parotidectomy: A surgical procedure that involves the removal of the parotid gland.

Parotitis: A term used to describe an inflammatory or infectious process involving the parotid gland.

Salivary Gland: Glandular structures located within the face that are responsible for the production of saliva. The salivary glands include the parotid, submandibular, and sublingual glands.

Sialadenitis: Bacterial infection/inflammation of a salivary gland.

Sialendoscopy: A procedure used to diagnose and treat salivary gland disease. Very small instruments and cameras are passed through the natural opening of the salivary gland to evaluate and treat issues related to the salivary gland.

Sialolith: Salivary gland stone.

Sialolithiasis: A term that refers to the formation of stones within the salivary gland’s duct network. 

Stensen’s Duct: The main duct or drainage pathway through which the parotid gland transports saliva into the oral cavity.

Temporomandibular Joint (TMJ): The temporomandibular joint is what is commonly referred to as the “jaw joint”. Formally, this joint is involves the interaction of the lower jaw bone (mandible) and the skull’s temporal bone. The temporomandibular joint is commonly sited in people that suffer from TMJ disease or other dental disorders.

Xerostomia: A term used to refer to dry mouth.

PATIENT STORIES

Patient J.R.

About two months ago I was experiencing pain on one side of my face that seemed to not get better over the course of a couple of days. I was under a significant amount of stress at work and did not have a lot of time to dedicate to this issue. I sought evaluation from a few doctors that diagnosed me with several different things from TMJ dysfunction to dental disease. I was finally referred to a salivary gland specialist where an accurate diagnosis of parotitis was made and a treatment plan was developed.

Patient H.G.

I have been a long time sufferer of recurrent parotitis. I would occasionally get painful swelling of one or both of my parotid glands. This was usually treated with antibiotics and other temporarily effective measures such as hot compresses and gland massage. Unfortunately, I have been to a variety of physicians that have told me that the only solution to definitively treat my problem is to have my parotid gland removed.

Patient D.M.

I have been dealing with recurrent episodes of pain that come and go around the area of my cheek. After several trips to my doctor, I was told that I had salivary gland stones (sialolithiasis). The pain in my cheek gets worst around meal times. I have been told that I have to have my parotid gland removed to effectively treat this obstruction and resulting parotitis. I have taken several courses of antibiotics in the past for similar episodes but the problem eventually recurs.

CONTACT OHNI