RESUMO
Dysfunction of the masseter muscle may cause pathological kinking of the parotid duct leading to parotitis; MR sialography is a non-invasive radiological examination that allows to evaluate dynamically the ductal system of the parotid glands. In the present study we aimed to assess the relationships between Stensen's duct and masseter muscle and their implications in the aetiopathogenesis of recurrent parotitis secondary to masseter muscle dysfunction. Forty-one patients with recurrent unilateral parotitis and nine with bilateral recurrent parotitis, all with a clinical suspicious of masseter muscle hypertrophy due to bruxism were enrolled. They underwent ultrasonography as a first line examination and then MR sialography and sialendoscopy. Different anatomical features were studied. Involved parotid glands had a wider duct compared to contralateral unaffected parotid glands of patients with recurrent parotitis (p = 0.00134); male subjects with parotitis had a longer duct compared to the salivary glands of healthy patients (p = 0.00943 for affected glands and p = 0.00629 for the contralateral). A concordance between the evidence of an acute duct angle during sialendoscopy and a wider duct in patients with parotitis was observed although not statistically significant. These initial findings suggest that the masticatory muscle dysfunction related to bruxism seems to condition alteration of parotid duct course and anatomy thus favouring the occurrence of recurrent parotitis. A specific diagnostic iter based on clinical evaluation, dynamic ultrasonography and MR sialography, is therefore, mandatory to confirm the relationship between masseter muscle anatomy and parotid duct anomalies; this is the premise for an adequate therapeutic approach to underlying masticatory muscle disorder.
Assuntos
Imageamento por Ressonância Magnética , Músculo Masseter , Parotidite , Recidiva , Sialografia , Humanos , Masculino , Parotidite/diagnóstico por imagem , Feminino , Músculo Masseter/diagnóstico por imagem , Adulto , Pessoa de Meia-Idade , Imageamento por Ressonância Magnética/métodos , Sialografia/métodos , Ductos Salivares/diagnóstico por imagem , Ultrassonografia/métodos , Idoso , Bruxismo/diagnóstico por imagem , Bruxismo/complicações , Endoscopia/métodosAssuntos
Doenças do Recém-Nascido , Parotidite , Infecções Estafilocócicas , Lactente , Recém-Nascido , Humanos , Recém-Nascido Prematuro , Parotidite/diagnóstico por imagem , Parotidite/tratamento farmacológico , Antibacterianos/uso terapêutico , Infecções Estafilocócicas/tratamento farmacológico , Doenças do Recém-Nascido/tratamento farmacológico , SupuraçãoRESUMO
Rapidly growing mycobacteria rarely causes parotitis. We report a rare case of Mycobacteroides abscessus subspecies abscessus (MAB) parotitis in a previously healthy 26-year-old woman. She presented to the previous hospital with a swelling over the right parotid region, and a computed tomography scan revealed multiple abscesses in the swollen parotid gland. Histopathology showed granulomatous inflammation with acid-fast bacilli; however, a subsequent culture failed to isolate mycobacterium. Despite repeated antibiotic therapy and multiple surgical interventions including partial incision and drainage of the abscesses, the parotitis did not resolved. At six months after presentation, she was referred to our institute. We performed enlarged resection of the necrotic tissue and abscesses, and the sample cultivated after homogenization was positive for mycobacterium. The isolate was finally identified as MAB. She underwent long-term postoperative antibiotic therapy for MAB, with a favorable outcome. To the best of our knowledge, this is the first case of MAB parotitis where the subspecies has been identified. MAB is much more intractable than the other subspecies. We highlight the importance of the correct identification of MAB, which leads to the appropriate treatment.
Assuntos
Infecções por Mycobacterium não Tuberculosas , Mycobacterium abscessus , Parotidite , Abscesso/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Feminino , Humanos , Infecções por Mycobacterium não Tuberculosas/complicações , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/microbiologia , Parotidite/diagnóstico por imagem , Parotidite/tratamento farmacológicoRESUMO
BACKGROUND: Chronic parenchymal parotitis is the most common salivary gland disease in children which occurs in about 85% cases. Diagnosis errors in chronic parenchymal parotitis are frequent and important but represent an underemphasized and understudied area of patient safety. OBJECTIVE: The objective of this study was to elaborate the most effective and acceptable strategies for the diagnosis of chronic parenchymal parotitis in children. MATERIAL AND METHODS: We studied the histories of 211 patients with a primary diagnosis of chronic parenchymal parotitis. All patients underwent ultrasound diagnostic, as well as medical and genetic counseling and examination of 1st degree relatives and probands. RESULTS: After additional examinations, 100 children were given other diagnoses. Having analyzed the results of medical-genetic and echographic examinations of 111 patients with chronic parenchymal parotitis and their family members, we have developed a pattern of chronic parenchymal parotitis inheritance. All patients were divided into 3 groups according to the type of inheritance: monogenic inheritance, multifactorial inheritance, and sporadic cases. CONCLUSION: A complex approach to the differential diagnosis of chronic parenchymal parotitis is what is needed to reduce the frequency of diagnostic errors.
Assuntos
Parotidite , Doenças das Glândulas Salivares , Criança , Doença Crônica , Diagnóstico Diferencial , Humanos , Parotidite/diagnóstico por imagem , Segurança do Paciente , UltrassonografiaRESUMO
BACKGROUND: Ultrasound is the imaging modality of choice in children presenting to the emergency department (ED) with soft tissue neck swelling. Point of care ultrasound (POCUS) has good accuracy when compared to comprehensive radiology department ultrasound (RADUS). POCUS could potentially improve ED length of stay (LOS) by improving efficiency. We aimed to evaluate the LOS of pediatric patients seen in ED with soft tissue neck swelling who received POCUS compared to RADUS. We determined unscheduled 30-day return visit rates in both groups as a balancing measure. METHODS: We performed a retrospective review of the electronic medical record for our cross-sectional study of discharged patients ≤21â¯years of age who had a neck ultrasound performed by a credentialed POCUS physician or by the radiology department between July 2014 and January 2020. We included patients who had both POCUS and RADUS in the POCUS group. We compared median ED LOS in both groups using the Mann Whitney U test and proportion of unscheduled return visits to the ED in both groups using odds ratio and 95% CI. RESULTS: There were 925 patients: 76 with only POCUS, 6 with POCUS and RADUS, and 843 with only RADUS performed. Median LOS in the POCUS group was 68.5 min (IQR 38.3120.3) versus 154.0 min (IQR 111.0, 211.0) in the RADUS group (pâ¯<â¯0.001). Return visit overall was 7.6%: 13.2% in the POCUS group versus 7.1% in the RADUS group (pâ¯=â¯0.07). CONCLUSION: Pediatric patients evaluated in the ED for soft tissue neck swelling had a shorter LOS with POCUS than with RADUS without a statistically significant increase in 30-day return visits. We suggest a "POCUS First" approach to the care of these patients.
Assuntos
Abscesso/diagnóstico por imagem , Celulite (Flegmão)/diagnóstico por imagem , Edema/diagnóstico por imagem , Serviço Hospitalar de Emergência , Tempo de Internação/estatística & dados numéricos , Linfadenopatia/diagnóstico por imagem , Pescoço/diagnóstico por imagem , Parotidite/diagnóstico por imagem , Abscesso/complicações , Adolescente , Celulite (Flegmão)/complicações , Criança , Pré-Escolar , Edema/etiologia , Feminino , Humanos , Lactente , Recém-Nascido , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfadenopatia/complicações , Masculino , Necrose , Parotidite/complicações , Readmissão do Paciente/estatística & dados numéricos , Testes Imediatos , Estudos Retrospectivos , Ultrassonografia , Adulto JovemRESUMO
OBJECTIVE/HYPOTHESIS: Current literature has confirmed the benefits of sialendoscopy for the treatment of juvenile recurrent parotitis (JRP). However, this procedure is often performed unilaterally, although the disease can affect both sides. This article investigated the clinical course of the contralateral parotid (CL) gland in children requiring unilateral sialendoscopy with the goal of clarifying the necessity of primary bilateral sialendoscopy. STUDY DESIGN: Prospective cohort study in a tertiary center. METHODS: Over an eight-year period, 77 children with JRP underwent unilateral sialendoscopy. We observed the clinical course of the CL parotid over a minimum follow-up period of 24 months. New episodes of sialadenitis were recorded on both sides along with the need for a second sialendoscopy. These data were correlated with the preoperative symptoms of the contralateral side as well as ultrasound (U/S) findings at baseline assessment. RESULTS: In total, six children required sialendoscopy on the CL side (7.8%), 62 children remained asymptomatic or with scarce swellings (80.5%), and nine children improved (11.7%). The preoperative U/S findings on the CL side positively correlated with the number of postoperative swellings. The proportion of children needing CL sialendoscopy was higher (21.4%) among children needing a second sialendoscopy on the operated side. CONCLUSIONS: In the long term, the vast majority of children needing unilateral sialendoscopy do not require similar treatment of the CL parotid gland. However, a history of bilateral swellings along with U/S findings of parenchymal disorganization on the CL side significantly increases the risk of needing further sialendoscopy at a later time. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1404-1409, 2021.
Assuntos
Endoscopia/métodos , Glândula Parótida/cirurgia , Parotidite/cirurgia , Reoperação/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Glândula Parótida/diagnóstico por imagem , Parotidite/diagnóstico por imagem , Estudos Prospectivos , Sialografia/métodos , Resultado do Tratamento , Ultrassonografia/métodosRESUMO
OBJECTIVE: When conservative therapy fails for chronic parotitis, sialendoscopic treatment or surgical excision can be considered. However, these are financially costly or invasive. Thus, this study aimed to evaluate the clinical efficacy and safety of botulinum toxin (BTX) injection and to further analyze its effect on parotid gland function and volume using salivary single-photon emission computed tomography (SPECT)-computed tomography (CT). METHODS: This clinical trial has been registered in the Clinical Research Information Service, Republic of Korea. Fourteen patients with chronic parotitis received BTX injections into the parotid glands. Pain, postprandial pain, swelling, aesthetic discomfort, and salivary flow rate were assessed before injection, at 2 weeks, and at 1, 3, and 6 months. Salivary SPECT-CT was performed before injection and again 3 and 6 months after to assess the volume and uptake changes. RESULTS: All subjective symptoms decreased significantly until 1 month and then increased. However, at 6 months, all subjective symptoms were determined to be better than before injection. The unstimulated and stimulated salivary flow rate did not show a significant difference over time. No significant difference was noted in parotid gland volume or uptake on salivary SPECT-CT over time. CONCLUSION: BTX injection can be an alternative treatment option for chronic parotitis. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E1903-E1909, 2021.
Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Fármacos Neuromusculares/uso terapêutico , Parotidite/tratamento farmacológico , Adulto , Idoso , Toxinas Botulínicas Tipo A/administração & dosagem , Doença Crônica , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/administração & dosagem , Medição da Dor , Parotidite/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Estudos Prospectivos , República da Coreia , SalivaçãoAssuntos
Fraturas Ósseas/etiologia , Doenças Mandibulares/etiologia , Osteomielite/etiologia , Parotidite/complicações , Cálculos Salivares/complicações , Administração Intravenosa , Doença Crônica , Feminino , Floxacilina/administração & dosagem , Fraturas Ósseas/diagnóstico por imagem , Humanos , Doenças Mandibulares/diagnóstico por imagem , Metronidazol/administração & dosagem , Pessoa de Meia-Idade , Osteomielite/tratamento farmacológico , Parotidite/diagnóstico por imagem , Parotidite/tratamento farmacológico , Combinação Piperacilina e Tazobactam/administração & dosagem , Cálculos Salivares/cirurgia , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
The differential diagnosis for facial swelling is broad and can be a diagnostic challenge in the pediatric emergency department. We describe the first pediatric case of acute parotitis with sialolithiasis where the diagnosis was facilitated by point-of-care ultrasound.
Assuntos
Parotidite/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia/métodos , Pré-Escolar , Diagnóstico Diferencial , Edema/complicações , Edema/diagnóstico por imagem , Face , Humanos , Masculino , Glândula Parótida/diagnóstico por imagem , Glândula Parótida/patologia , Parotidite/complicações , Punica granatum , Cálculos das Glândulas Salivares/complicações , Cálculos das Glândulas Salivares/diagnóstico por imagemRESUMO
Neonatal suppurative parotitis is a rare condition characterized by swelling, pain and erythema over the parotid gland. There may be a purulent exsudate from the Stensen duct. The predominant etiology is Staphylococcus aureus but cases with gram negative bacteria and streptococci have been reported. Most cases are managed conservatively with intravenous antibiotic therapy, and early treatment reduces risks of complications like sepsis and intraglandular abscess. We report two cases of neonatal suppurative parotitis; two 14-days-old males, both with one day history of parotid swelling and erythema. In one of them purulent exudate could be extracted from the Stensen duct. One of them had positive blood culture with Staphylococcus aureus. Ultrasound examination showed an enlarged parotid gland but no abscess. Growth of Staphylococcus aureus was found in both cases and the patients responded well to intravenous antibiotic therapy.
Assuntos
Parotidite , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Exsudatos e Transudatos/microbiologia , Humanos , Recém-Nascido , Masculino , Parotidite/diagnóstico , Parotidite/diagnóstico por imagem , Parotidite/tratamento farmacológico , Parotidite/microbiologia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/diagnóstico por imagem , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , UltrassonografiaAssuntos
Vírus da Influenza A , Influenza Humana/complicações , Parotidite/complicações , Parotidite/virologia , Amilases/sangue , Pré-Escolar , Edema/diagnóstico por imagem , Feminino , Humanos , Influenza Humana/diagnóstico por imagem , Japão , Masculino , Glândula Parótida/diagnóstico por imagem , Parotidite/diagnóstico por imagem , UltrassonografiaRESUMO
INTRODUCTION: Juvenile recurrent parotitis (JRP) is characterized by recurrent episodes of painful parotid swelling, generally associated with non-obstructive sialectasia of the parotid gland. The aim of this study was to evaluate the diagnostic and therapeutic effectiveness of sialography in children affected by JRP. METHODS: Clinical records of 110 outpatients with a diagnosis of JRP followed up from 2008 to 2017â¯at the Unit of Paediatric Otorhinolaryngology, Surgery Department of the Bambino Gesù Children's Hospital of Rome, were retrospectively reviewed. Data on demographics, number of acute episodes/year, course of disease, site of symptoms and duration of follow up were collected. The inclusion criteria were: at least two or more episodes of intermittent swelling of the parotid glands on one side or both sides during the last 6 months, age <16 years. Exclusion criteria were: obstructive lesions, dental malocclusion, Sjogren syndrome, congenital IgA immunodeficiency, and relevant systemic diseases. Outcome of the procedure was measured by evaluating number and degree of episodes of parotid swelling before and after sialography. RESULTS: Sialography has been shown in all cases to be a valid method in the diagnosis of JRP. Following the execution of the sialography, in 98 patients (89% of cases) there was a statistically significant improvement of disease with a mean reduction of 67.4% of episodes of parotid swelling (pâ¯<â¯0.05). In 75 patients there was marked improvement of the symptomatology (pâ¯<â¯0.05). In 23 patients partial resolution occurred (pâ¯<â¯0.05); in 12 patients there was no resolution or a reduction less than 30% of episodes (pâ¯>â¯0.05). There was a statistically significant relationship between the number of attacks/year and the degree of glandular function, pre and post-sialography in 2-way ANOVA test (pâ¯<â¯0.05). CONCLUSION: Sialography is effective method not only as a diagnostic procedure but also as a therapeutic procedure in treatment of JRP. It is a method that can be carried out in ambulatory setting, without anaesthesia, with a minimum cost and with a very low rate of complications. In a disease with tendency to spontaneous resolution like JRP, sialography represent a therapeutic option alternative to more invasive treatment.
Assuntos
Parotidite/diagnóstico por imagem , Parotidite/cirurgia , Sialografia , Criança , Pré-Escolar , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Estudos RetrospectivosAssuntos
Coinfecção/diagnóstico , Edema/etiologia , Parotidite/diagnóstico , Infecções Estafilocócicas/diagnóstico , Infecções Estreptocócicas/diagnóstico , Streptococcus mitis/isolamento & purificação , Streptococcus salivarius/isolamento & purificação , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Coinfecção/tratamento farmacológico , Coinfecção/microbiologia , Exsudatos e Transudatos/microbiologia , Humanos , Recém-Nascido , Masculino , Parotidite/diagnóstico por imagem , Parotidite/tratamento farmacológico , Parotidite/microbiologia , Ductos Salivares/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologiaRESUMO
This is the 36th installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at http://www.aseronline.org/curriculum/toc.htm .
Assuntos
Parotidite/diagnóstico por imagem , Parotidite/virologia , Criança , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Humanos , Influenza Humana/complicações , MasculinoRESUMO
IIntroduction: Sjögren's syndrome in childhood is a rare autoimmune disease and mostly under-diagnosed. The aim of this study is to highlight the importance of ultrasonographic assessment of the salivary glands in children with recurrent parotitis and positive autoantibodies. Two cases of ultrasonographic patterns typical of Sjögren's syndrome have been described below. Case 1: Female, 7 years old, reporting for 2 years recurrent parotitis, xerophthalmia, xerostomia, polyarthralgia and fever. Immunological tests were positive for antinuclear antibodies, rheumatoid factor, anti-SSA/Ro and anti-SSB/La. Salivary glands ultrasound was consistent with Grade 4 by the B-mode method and the spectral Doppler with presence of intense Power Doppler signal and decreased vessels internal resistance, supporting the diagnosis of juvenile Sjögren's syndrome. Case 2: Female, 10 years old, reporting recurrent parotitis for 1 year and polyarthritis for 10 days. The supplementary tests revealed positive antibodies for Sjögren's syndrome. Salivary glands Ultrasound and Spectral Doppler were consistent with chronic and active inflammatory process of the salivary glands in the juvenile Sjögren's syndrome. DISCUSSION: Salivary glands ultrasound can be a useful exam in the diagnosis of juvenile Sjögren's syndrome.
Assuntos
Parotidite/diagnóstico por imagem , Parotidite/etiologia , Glândulas Salivares/diagnóstico por imagem , Síndrome de Sjogren/complicações , Criança , Feminino , Humanos , UltrassonografiaRESUMO
BACKGROUND: Sialadenitis by iodinated contrast medium (i.c.m) oriodine mumps (IM) is a rare and late benign manifestation that occurs independently of intravenous or endoarterial administration modality. If renal function is normal, i.c.m. does not reach salivary glands concentrations able to induce sialadenitis. However, a critical glomerular filtration reduction may lead to salivary ducts edema and glandular swelling after i.c.m. injection. We report a rare case report of IM in a patient on chronic hemodialysis. METHODS: A 72-year-old woman affected by chronic kidney disease on chronic hemodialysis, underwent to endoscopic removal of a rectal cancer. For disease staging, a total body TC with i.c.m. was performed. The following morning, patient showed a soft and aching bilateral paroditidis swelling. Salivary glands ultrasound was diagnostic for sialadenitis. The patient was rapidly treated with betamethasone following by a 240 minutes post-dilution online hemodiafiltration session. RESULTS: Within the next 24h, a complete remission of IM was obtained. CONCLUSION: In our patient, a compensatory hyperactivity of the sodium / iodine symporter (NIS) on salivary gland cells may have played a crucial role in IM induction. An high efficiency hemodialysis session within the few following hours after i.c.m injection is a fundamental tool in patients on renal replacement treatment to prevent IM that is an epiphenomenon of i.c.m. accumulation.
Assuntos
Meios de Contraste/efeitos adversos , Iopamidol/análogos & derivados , Parotidite/induzido quimicamente , Diálise Renal , Idoso , Anti-Inflamatórios/uso terapêutico , Betametasona/uso terapêutico , Feminino , Humanos , Iopamidol/efeitos adversos , Falência Renal Crônica/complicações , Parotidite/diagnóstico por imagem , Parotidite/tratamento farmacológico , Neoplasias Retais/complicações , Neoplasias Retais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
BACKGROUND: Parotid swelling is rarely caused by pneumoparotitis from retrograde insufflation of air into Stensen's duct. Previous reports have identified occupational exposures, self-induced habits, exercise, spirometry, and short-term positive pressure airway ventilation as causes of salivary duct insufflation. METHODS: We present 2 cases of pneumoparotitis in patients on long-term oronasal continuous positive airway pressure (CPAP) for obstructive sleep apnea. RESULTS: A diagnosis of pneumoparotitis was made by CT scan in case 1 and sialography in case 2. Patients were advised to transition from oronasal to nasal-only CPAP. One patient was successfully transferred and had good symptomatic improvement, whereas the second patient did not tolerate nasal CPAP and had persistent symptoms on oronasal CPAP. CONCLUSION: Long-term use of oronasal CPAP is a potential cause of pneumoparotitis.