Bi-institutional analysis of microbiological spectrum and therapeutic management of parotid abscesses.

BACKGROUND: A parotid abscess (PA) is a complication of an acute bacterial parotitis with a potentially life-threatening course. To date, data on the diagnosis and therapy of PA is sparse and mostly consists of case reports or case series. Therefore, this study aimed at comprehensively analyzing the microbiological spectrum and the therapeutic management in a bi-institutional setting. METHODS: A retrospective clinical chart review was performed to identify all patients surgically treated for PA at two tertiary care centers in Germany. Data on demographics, clinical management and microbiological data including species identification, pathogenicity, type of antibiotic therapy, adjustment of antibiotics, antibiotic sensitivity testing, and smear test results were extracted. Intervention-related variables and etiology were analyzed for their statistical association with outcome variables. RESULTS: Overall, 85 patients were included. Most patients (92.9%) underwent surgical incision. Around half of the patients (45.9%) were treated under local anesthesia. No facial nerve palsy was observed. The most frequently detected pathogens were Streptococci (n = 23), followed by Staphylococcus aureus (n = 6) including one case of methicillin-resistant Staphylococcus aureus. Most patients (68.2%) received an aminopenicillin ± beta-lactamase inhibitor as empiric antibiotic therapy. In 6 cases the antibiotic therapy was modified after receiving the antibiogram. Four patients (5.2%) presented with recurrent PA. Etiology was idiopathic (42.4%), followed by tumorous (12.9%), obstructive, and immunosuppressive (each 11.8%). Patients with a dental focus (p = 0.007) had a longer duration of hospitalization. CONCLUSION: The results show that the surgical therapy of PA under local anesthesia is safe. A dental examination should routinely be performed to rule out a dental focus. Obtaining a microbiological specimen in order to modify antibiotic therapy if necessary and a histopathological specimen to rule out a tumorous etiology is obligate.

Treatment of juvenile recurrent parotitis with irrigation therapy without anesthesia.

PURPOSE: No standardized treatment regimen exists for juvenile recurrent parotitis (JRP). The investigators hypothesized that irrigation with saline only without local anesthesia will be an effective and beneficial option. METHODS: Using a retrospective study design, a series of children with typical symptoms of JRP who were treated with at least one irrigation therapy were evaluated. This treatment consisted of irrigation of the affected gland with 3-10 ml saline solution without any type of anesthesia. The outcome variables were patient/parent satisfaction, frequency and duration of acute JRP episodes, and the need for antibiotics before and after irrigation therapy. RESULTS: The case series was composed of six boys aged 3.3-7.7 years who experienced one to eight sessions of irrigation therapy. The period of follow-up was 9-64 months. We observed a total resolution of symptoms in two children and an improvement in the other four. No relevant side effects were seen. CONCLUSION: Our results suggest that irrigation therapy is a reasonable, simple, and minimally invasive treatment alternative for JRP. In contrast to sialendoscopy or sialography, there is no need for general anesthesia or radiation exposure.

Rare case of tubercular parotid abscess.

Acute parotitis progressing to parotid abscess is rare in children. Staphylococcus aureus is the usual pathogen in parotid abscess. Granulomatous parotid abscess due to tubercular aetiology is extremely rare. Authors report a case of chronic parotid abscess in a child who received multiple courses of antibiotics without any cure. The ultrasonography and CT scan of the parotid gland confirmed the extent of parotid abscess and the changes in the parotid lymph nodes. The surgical drainage and the biopsy of the lymph nodes lead to the diagnosis of granulomatous abscess. The antitubercular therapy finally cured the disease without further recurrence.

L-asparaginase-induced Parotitis in an Elderly Patient with Acute Lymphoblastic Leukemia.

A 67-year-old woman received induction chemotherapy comprising vincristine, daunorubicin, cyclophosphamide, L-asparaginase and prednisolone for acute lymphoblastic leukemia with a common B-cell phenotype. The administration of L-asparaginase at 3,000 U/m2 for 6 days was planned. Before the fourth administration on day 16, left parotid swelling was identified along with increased serum amylase (991 U/L; 94% derived from salivary glands). An enlarged left parotid gland was apparent on computed tomography. The symptoms resolved after cessation of L-asparaginase, with serum amylase normalizing by day 20. This rare adverse event should be recognized as improving within a week after ceasing L-asparaginase.

Sialendoscopy in treatment of adult chronic recurrent parotitis without sialolithiasis.

OBJECTIVE: The aim of this prospective study was to evaluate the efficacy of sialendoscopy in the management of adult chronic recurrent parotitis without sialolithiasis. In addition, preliminary results of an initial randomized placebo-controlled trial of single-dose intraductal steroid injection given concurrently with sialendoscopy, are presented. METHODS: Forty-nine adult patients with chronic recurrent parotitis without sialoliths were included in this study. They underwent sialendoscopy and were randomized to receive either a concurrent intraductal injection of isotonic saline solution or 125 mg of hydrocortisone. Symptom severity was evaluated with visual analogue scale (VAS) and by recording symptom frequency and course with a multiple-choice questionnaire completed preoperatively and at 3, 6, and 12 months after the procedure. RESULTS: The mean VAS score was 5.6 preoperatively and dropped to 2.9 at 3 months, 3.0 at 6 months, and 2.7 at 12 months after the procedure. The VAS score and the frequency of symptoms were significantly lower at 3 (p < 0.001), 6 (p < 0.001) and 12 (p < 0.001) months after the procedure when compared with the preoperative scores indicating that sialendoscopy reduces the symptoms of recurrent parotitis. However, complete permanent resolution of symptoms was rare. Single-dose steroid injection concomitant to sialendoscopy provided no additional benefit, but the current study is not sufficiently powered to determine a clinical difference between the steroid and non-steroid groups. CONLUSION: Sialendoscopy appears to reduce the symptoms of chronic recurrent parotitis. While total permanent symptom remission is rare, sialendoscopy can be considered a safe and relatively efficacious treatment method for this patient group.

Sialoendoscopy combined with an internal stent and postoperative massage as a comprehensive treatment of delayed I131-induced parotitis.

A common complication of radioiodine (I131) treatment of thyroid cancer is parotitis. Here we describe our clinical experience in treating delayed I131-induced parotitis using sialoendoscopy together with an internal stent and postoperative massage. In this retrospective cohort study we reviewed 32 patients who were treated in that way under general anaesthesia between July 2010 and March 2015. Their age, sex, and the time to development of the parotitis were collected from the hospital's database. All patients were evaluated using a visual analogue scale (VAS), sialography, and computed tomography preoperatively. The analyses of VAS scores were made during postoperative follow-up visits. We used the paired Student's t test and one-way ANOVA to assess the significance of differences, and probabilities of < 0.05 were accepted as significant. The mean (SD) age of the 32 patients was 50 (11) years, and they developed symptoms of delayed parotitis after a mean (SD) of 12 (11) months. The mean time between treatment with I131 and sialoendoscopy was 26 (10) months. Ductal stenosis was the most common sialoendoscopic feature, together with mucous plugs and fibrosis. Fifty of the 56 ducts were successfully dilated by sialoendoscopy, and VAS scores significantly decreased from a preoperative 7.3 (1.1) to a postoperative 3.3 (2.1) (p=0.000) during follow-up of 3 - 41 months. Sialoendoscopic interventions combined with an internal stent and postoperative massage may be optimal comprehensive treatment for delayed I131-induced parotitis.

Concomitant Suppurative Parotitis and Condylar Osteomyelitis.

Parotitis is a common occurrence in the immunocompromised, dehydrated, and malnourished patient as a result of dysfunctional ductal and parotid cells. Inflammation can be acute or chronic based on clinical history, and it can be suppurative based on the presence of micro or macro abscess formation within the substance of the gland. This report presents a case of concomitant condylar osteomyelitis and chronic suppurative parotitis in the setting of previous methicillin-susceptible Staphylococcus aureus foot infection. Ultimately, resection of osteomyelitis, drainage of parotid infection, and intravenous antibiotic therapy led to full resolution of the infection and symptoms. The final pathology of osteomyelitis of the temporomandibular joint and methicillin-resistant S aureus infection is an unusual consequence of chronic parotitis. The patient was restored with a total joint replacement approximately 3 months after resection with no recurrence of infection after 24 months.

Parotiditis crónica recurrente infantil: una revisión actualizada de la literatura / Recurrent chronic parotiditis in childhood: an update of the literature

La parotiditis crónica recurrente infantil (PCRI) es una patología relevante. Su diagnóstico es principalmente clínico, pero se apoya en exámenes imagenológicos. El enfoque actual del tratamiento es diverso. El objetivo es realizar una revisión actualizada sobre las características clínicas, exámenes complementarios, modelos etiopatogénicos y protocolos terapéuticos. MATERIAL Y MÉTODO: Se realizó una búsqueda bibliográfica en PUBMED utilizando los términos libres y términos MESH: PCRI, parotiditis recurrente, parotiditis crónica y parotiditis. Los filtros utilizados fueron pacientes humanos, hasta 18 años, con resumen. En el buscador Scielo se incluyeron los términos libes Parotiditis y crónica. Se incluyeron artículos publicados en idiomas inglés, español o portugués hasta el año 2017. RESULTADOS: En el buscador PUBMED se encontraron 119 artículos de los cuales sólo se incluyeron 44. La exclusión de los artículos restantes se debió a idioma, acceso al artículo o ausencia de relación entre el artículo y la revisión propuesta. En el buscador Scielo se encontraron 6 artículos de los cuales 5 fueron seleccionados. La evaluación multidisciplinaria permite el tratamiento oportuno. Su diagnóstico es clínico pero se apoya en exámenes imagenológicos, como la ecografía y la sialografía. CONCLUSIONES: El enfoque actual de tratamiento es conservador, y la mejor evidencia disponible apoya el uso de sialendoscopia con irrigación y administración de antibióticos y/o corticoides vía conducto parotídeo, sin embargo, existirían buenos resultados con lavados intraglandulares con soluciones fisiológicas sin necesidad de sialendoscopio.

Recurrent childhood chronic parotiditis (RCCP) is a relevant pathology. Its diagnosis is mainly clinical, but it relies on imaging tests. The current treatment approach is diverse. The aim of this article is to update the clinical features, complementary tests, etiopathogenic models and therapeutic protocols of this disease. MATERIAL AND METHOD: A bibliographic search was performed in PUBMED using the free terms and MESH terms: RCCP, recurrent parotiditis, chronic parotiditis and parotiditis. The filters used were human patients, up to 18 years old, with abstract. In SCIELO the free terms included were Parotiditis and chronic. Articles published in English, Spanish or Portuguese until 2017 were included. RESULTS: In PUBMED 119 articles were found and 44 were included. The exclusion of the remaining articles was due to language, access to the article or absence of relationship between the article and the proposed revision. In SCIELO 6 articles were found 6 of which 5 were selected. The multidisciplinary asses of patients with RCCP is considered the appropriate treatment. Its diagnosis is clinical but it relies on imaging tests, such as echography and sialography. CONCLUSIONS: The current treatment approach is conservative, and the best available evidence supports the use of sialendoscopy with irrigation and administration of antibiotics and/or corticosteroids via the parotid duct. However, there would be proper results with intraglandular lavage with physiological solutions without the need for a sialendoscope.

Thirty-Day Perioperative Outcomes in Pediatric Parotidectomy.

IMPORTANCE: Limited information exists about the short-term morbidity of parotidectomy in children. This information is important when counseling parents and planning treatment for children with parotid masses. OBJECTIVE: To examine 30-day perioperative outcomes after parotidectomy in the pediatric population. DESIGN, SETTING, AND PARTICIPANTS: A prospective case series of 87 pediatric patients who underwent parotidectomy from January 1, 2008, to June 30, 2015, performed by 2 pediatric head and neck specialists in a tertiary care pediatric hospital. MAIN OUTCOMES AND MEASURES: Thirty-day perioperative complications, postoperative facial nerve function, reoperation rates, and readmission rates were the main outcome measures. Secondary outcome measures were operative time and length of stay. RESULTS: Ninety parotidectomies (71 superficial and 19 total) were performed in 87 patients (48 male and 39 female). Mean age at operation was 8.3 years. Eighty-five of the cases (94%) were performed for benign disease. Mean operative time was 4.09 hours (range, 1.58-10.43 hours) and mean length of stay was 2.24 days (range, 0.97-4.33 days). Immediate postoperative facial weakness was observed in 32 cases (36%); 10 of these cases (31%) involved the upper branch and 29 (90%) involved the lower branch. Immediate postoperative paresis occurred more often after total parotidectomy vs superficial parotidectomy (11 of 19 [58%] vs 21 of 71 [30%]; P = .03) but was unrelated to the etiologic cause of the patients' parotid disease. Thirty of 32 cases (94%) of facial nerve weakness were transient, and the mean time to resolution was 61 days. Eleven complications (12%) other than facial nerve weakness occurred during the 30-day postoperative period. Three patients (3%) required a return to the operating room for hematoma or wound dehiscence. One patient (1%) required readmission in the 30-day postoperative period for contralateral parotitis. CONCLUSIONS AND RELEVANCE: We observed a low rate of 30-day perioperative complications as a result of superficial or total parotidectomy for pediatric parotid disease. Major adverse events included return to the operating room and 1 wound infection. Only 1 patient required readmission. Transient weakness of the facial nerve is relatively common, observed more often in the lower division, and can be expected to resolve in most patients by an average of 2 months.

Acute neonatal parotid abscess: A rare case report.

Acute suppurative parotitis is uncommon in children and is very rare in neonates. Most common organism isolated is Staphylococcus aureus. We present a 15-day-old full-term breast-fed female neonate with left-sided acute parotid abscess. The baby presented with a left preauricular swelling, pain and redness. Pus was exuded from left Stensen's duct on compression of the gland externally. Early diagnosis and proper intravenous antibiotics are the keys to the treatment.

Treatment of juvenile recurrent parotitis of childhood: an analysis of effectiveness.

IMPORTANCE: Juvenile recurrent parotitis (JRP) is characterized by recurrent painful swelling of the parotid gland that occurs in the pediatric population. Sialendoscopy with and without ductal corticosteroid infusion (DCI) has been found to be effective in the treatment of JRP and autoimmune parotitis. OBJECTIVE: To determine the utility of instrumentation vs pharmacotherapy alone for juvenile recurrent parotitis. DESIGN, SETTING, AND PARTICIPANTS: A retrospective medical record review of pediatric patients undergoing DCI without sialendoscopy at a tertiary pediatric hospital was conducted. The medical records were reviewed to determine the frequency of parotitis events before and after treatment. A multiquestion telephone survey of patients and their parents who underwent the procedure was then conducted to determine patient satisfaction. INTERVENTIONS: Ductal corticosteroid infusion with hydrocortisone through catheter inserted in the parotid duct. MAIN OUTCOMES AND MEASURES: Frequency of symptoms before and after treatment and parental satisfaction with the treatment. RESULTS: Twelve patients with a mean age of 6.7 years were identified. The mean duration and frequency of symptoms before the procedure were 22 months and every 2 months, respectively. Five patients had a recurrence, on average 4 months after the procedure. Four patients underwent repeated surgical procedures. All had a longer duration between episodes compared with before DCI. Eight parents participated in the survey on satisfaction with the procedure, and 75% reported improvement in their child's life postprocedure. CONCLUSIONS AND RELEVANCE: Current literature shows sialendoscopy with corticosteroid application is successful in treating JRP, but it is unclear whether corticosteroid application alone would treat JRP equally. This study shows that DCI alone has similar results as sialendoscopy with corticosteroid application, indicating that it is the corticosteroid application and not the sialendoscopy causing improvement in symptoms. Because JRP must be differentiated from sialolithiasis, we recommend ultrasonography of the involved parotid(s) prior to using DCI alone to ensure no stone is present. Sialendoscopy should be reserved to rule out other parotid ductal pathologic conditions.

Salivary gland disorders.

Salivary gland disorders include inflammatory, bacterial, viral, and neoplastic etiologies. The presentation can be acute, recurrent, or chronic. Acute suppurative sialadenitis presents as rapid-onset pain and swelling and is treated with antibiotics, salivary massage, hydration, and sialagogues such as lemon drops or vitamin C lozenges. Viral etiologies include mumps and human immunodeficiency virus, and treatment is directed at the underlying disease. Recurrent or chronic sialadenitis is more likely to be inflammatory than infectious; examples include recurrent parotitis of childhood and sialolithiasis. Inflammation is commonly caused by an obstruction such as a stone or duct stricture. Management is directed at relieving the obstruction. Benign and malignant tumors can occur in the salivary glands and usually present as a painless solitary neck mass. Diagnosis is made by imaging (e.g., ultrasonography, computed tomography, magnetic resonance imaging) and biopsy (initially with fine-needle aspiration). Overall, most salivary gland tumors are benign and can be treated with surgical excision.

Sialoendoscopy: a viable treatment for I(131) induced sialoadenitis.

To evaluate the viability, efficacy, and safety of sialoendoscopy for the diagnosis and management of radioiodine I(131-) related sialoadenitis, we retrospectively reviewed 30 patients referred between September 2007 and July 2013 from the Thyroid Surgery Unit to the Maxillofacial Unit of the Second University of Naples Hospital with persistent sialoadenitis after treatment with I(131). After the affected gland had been isolated, the endoscope was introduced into the duct under local anaesthesia with 2% lignocaine and continuous lavage with isotonic saline, and was advanced until it reached the ductal system. We studied 24 women and 6 men, mean (SD) age 52 (??) years. In 25 patients I(131) was given for papillary (83%), in 3 for medullary (10%), and in 2 for follicular thyroid carcinoma (7%). Stenosis alone was found in 30 glands (40%), mucous plugs alone in 35 (47%), and mucous plugs, stenosis, and kinks in 10 (13%). Of the 75 glands, dilatation of the ducts was successful in 70, and we completely removed all mucous plugs and kinks. We achieved symptomatic improvement in 23 patients (77%) during a follow-up ranging from 2 weeks to 84 months. Sialoendoscopy is a viable technique for the diagnosis of obstructive salivary disease, and is a safe and effective way to treat sialoadenitis, the most common complication of treatment with I(131).

Sialendoscopy for the diagnosis and treatment of juvenile recurrent parotitis.

PURPOSE: The aim of the current study was to analyze the use of sialendoscopy for the diagnosis and treatment of juvenile recurrent parotitis (JRP), note possible complications, and the rate of disease recurrence. We believe that this cutting edge procedure may be very effective both for the diagnosis and treatment of JRP, with few complications and low rates of recurrence. PATIENTS AND METHODS: A retrospective descriptive case study was conducted on a sample of patients presenting with JRP. Data was collected from the patient's medical records. Diagnostic sialendoscopy was performed to identify and classify the ductal pathology, treated by interventional therapeutic sialendoscopy. We carefully noted all complications and the disease recurrence rates. RESULTS: The patient sample included 50 children presenting with JRP (33 M, 17 F; age range: 2 to 16 years). Seven children presented with bilateral parotitis, the remaining 43 with unilateral parotitis. The study was conducted from 2003 to 2012. There was a statistically significant association between sialendoscopic data and the actual outcome. Seven children underwent additional sialendoscopy because of recurrence. They were all in the group of children presenting with unilateral parotitis. DISCUSSION: Our results validate the expected outcome. Sialendoscopy is an accurate technique for the diagnosis of JPR, and an effective tool for the treatment of JRP, with a low rate of complications and recurrence.

[The new S2k AWMF guideline for the treatment of obstructive sialadenitis in commented short form]. / Die neue S2k AWMF Leitlinie zur Behandlung der obstruktiven Sialadenitis in kommentierter Kurzform.

A new and interdisciplinary S2k AWMF guideline for the treatment of obstructive sialadenitis has been published. There have been several technical achievements, for instance in the field of ultrasonography, via sialendoscopy, or by MR-sialography, that have increased the possibilities for diagnosis and treatment of patients with obstructive sialadenitis. In the past, the treatment of choice in case of unsuccessful medical treatment was a complete extirpation of the affected salivary gland. Nowadays, using a variety of modern treatment options (like sialendoscopy, or extracorporeal shock-waves lithotripsy sometimes combined with salivary duct incision), it is possible in most patients, especially in cases of sialolithiasis, to preserve the affected gland. A functional recovery after gland-sparing surgery is described but more data is needed to finally evaluate the long-time results. The new guideline describes all relevant steps to diagnose an obstructive sialadenitis and values all diagnostic tools critically. Finally, all recommendable therapy options are described and valued, too.

Sialoendoscopy with and without holmium:YAG laser-assisted lithotripsy in the management of obstructive sialadenitis of major salivary glands.

Obstructive sialadenitis is a major cause of dysfunction of the salivary glands, and increasingly sialoendoscopy is used in both diagnosis and treatment. At present the limit of the endoscopic approach is the size of the stone as only stones of less than 4mm can be removed. Endoscopic laser lithotripsy has the potential to treat many stones larger than this with minimal complications and preservation of a functional salivary gland. The holmium:YAG laser has been widely and safely used in urology, and its use has been recently proposed in salivary lithotripsy for the removal of bigger stones. We describe our experience with sialoendoscopy for stones in the parotid and submandibular glands and assess the feasibility and the efficacy of holmium:YAG laser lithotripsy. We have used the procedure 50 times for 43 patients with obstructive sialadenitis; 31 patients had sialolithiasis, 15 of whom (48%) had stones with diameters between 4 and 15mm (mean 7). Total extraction after fragmentation was possible in 14 of the 15 patients without complications. Intraductal holmium:YAG laser lithotripsy is effective and safe, and allows the treatment of large stones in Stensen's and Wharton's ducts.

Salivary gland emergencies.

Salivary gland disorders are uncommon in the emergency department setting. Given the vast differential that spans infectious, autoimmune, neoplastic, and metabolic processes, they can pose a diagnostic challenge even to skilled clinicians. There is a paucity of evidence-based data regarding the management of these disorders with frequent incongruence between specific sources. Although by no means exhaustive or absolute, this article reconciles existing literature and serves as a concise and informative guide to salivary gland disorders encountered by the emergency care practitioner.

Idiopathic recurrent pneumoparotitis.

Parotid swelling in a child can represent any of a variety of pathologies, including lymphadenitis, autoimmune disorders, other inflammatory conditions, vascular malformations, or neoplasms. Parotitis is usually infectious in etiology and is generally treated with antibiotics and supportive management. We report a case of a child with recurrent idiopathic pneumoparotitis, and a review of literature and the disease process is provided.

Tratamiento de la parotiditis recurrente infantil / Treatment of infantile recurrent parotiditis

La parotiditis recurrente infantil es una enfermedad frecuente de las glándulas parótidas en edad pediátrica. Su causa aún no está bien definida y se reconocen varias alternativas en su tratamiento. La utilización de antimicrobianos es discutida. Objetivo: mejorar el tratamiento de esta enfermedad una vez realizado su diagnóstico clínico y ecográfico. Método: se realizó un ensayo clínico, aleatorizado, controlado a ciego simple, en niños tratados en el servicio de cirugía máxilo facial del Hospital Pediátrico Universitario Eduardo Agramonte Piña de Camagüey, en el período de un año; desde febrero de 2008 hasta enero de 2009. El universo de estudio estuvo constituido por 38 niños atendidos con algún proceso inflamatorio en las regiones de las glándulas parótidas. La muestra se conformó con 22 pacientes que por examen clínico y ecográfico se les diagnosticó parotiditis recurrente infantil, estos se organizaron en dos grupos de 11 infantes; uno de estudio, que recibió tratamiento de sostén y otro de control que fue tratado con antimicrobianos más sostén. Resultados: de los 22 pacientes estudiados 59,1 % se incluyeron en el grupo de 2 a 6 años y la mayoría con 63,6 % fueron masculinos. El aumento de volumen de la glándula parótida acompañado del dolor, estuvo presente en todos los infantes. Los exámenes de laboratorio no demostraron alteraciones de interés. No hubo diferencia significativa en el tiempo de evolución entre los dos grupos. Conclusiones: el estudio demostró que sólo la terapia de sostén, puede convertirse en un esquema de tratamiento suficiente para reducir los episodios de la parotiditis recurrente infantil.

Infantile recurrent parotiditis is a frequent disease of parotid glands in pediatric age. Its cause is not very well defined yet and several alternatives in its treatment are recognized. The utilization of antimicrobials is discussed. Objective: to improve the treatment of this disease once its clinical and echographic diagnosis was accomplished. Method: a clinical, randomized, controlled simple blind trial was carried out, in children treated in the maxillofacial surgery service at the University Pediatric Hospital Eduardo Agramonte Piña of Camagüey city, from February 2008 to January 2009. The universe of study was constituted by 38 children attended with some inflammatory process in the parotid glands regions. The sample was constituted by 22 patients through clinical and echographic examination who were diagnosed them infantile recurrent parotiditis, patients were split into two groups of 11 infants; a study group, which received support treatment and a control one that was treated with antimicrobials and support treatment. Results: of the 22 studied patients, the 59,1 % were included in the group from 2 to 6 years and the majority were masculine for 63,6 %. The increase of volume of the parotid gland accompanied of pain, were presented in all infants. The laboratory examinations did not demonstrate significance alterations. There was no significant difference in the time of evolution between the two groups. Conclusions: the study demonstrated that only the support therapy may become in a scheme of treatment enough to reduce episodes of infantile recurrent parotiditis.

Endoscopic treatment of salivary glands affected by autoimmune diseases.

PURPOSE: To asses the possibility of an endoscopic technique to diagnose, treat, and maintain the salivary glands in patients with Sjögren syndrome and systemic lupus erythematosus. PATIENTS AND METHODS: A total of 8 patients with Sjögren syndrome and 2 with systemic lupus erythematosus with affected salivary glands were included in the present study. The treatment approach included parotid sialoendoscopy with thorough rinsing, and Stenson's duct dilation using hydrostatic pressure and a high-pressure balloon. Hydrocortisone 100 mg was injected through direct vision into the duct. The study was exempt by the Barzilai Medical Center review board. RESULTS: The main diagnosis of the patients was chronic recurrent parotitis, with the exception of 1 patient, who presented with salivary stones. CONCLUSIONS: The pathologic features of the salivary glands resulting from Sjögren syndrome and systemic lupus erythematosus can be managed successfully using an endoscopic approach.