Inflammatory Disorders

Acute sialoadenitis is a common cause of painful enlargement of the parotid and submandibular glands. The organism is usually S. aureus, but it can also be caused by S. pneumoniae and other bacteria. The infection is secondary to salivary stasis caused by decreased production (dehydration, poor oral hygiene) or intrinsic or extrinsic obstruction (stones, strictures, masses). Patients present with exquisite tenderness over the gland, fever, and sometimes skin erythema. Purulence can be expressed from the duct with manual massage of the gland. Treatment includes antistaphylococcal antibiotics, adequate hydration, massage of the gland, sialagogues, and warm compresses. Abscess can occur and requires incision and drainage.

Mumps is a relatively common cause of painful unilateral or bilateral parotid gland enlargement in children. It is caused by a paramyxovirus, and diagnosis is confirmed by elevation of antibodies to the S and V virus antigens or by isolation of the virus in the urine. The incubation period is 2 to 3 weeks, and infection lasts 7 to 10 days. Treatment is conservative, with close follow-up to observe for possible complications such as pancreatitis, meningitis, orchitis, and hearing loss.

Sialolithiasis is a cause of intermittent salivary gland enlargement and is usually associated with eating. Most calculi occur in the submandibular duct, and most are radi-opaque. Calculi arising in the parotid duct are less common and tend to be radiolucent. Symptoms include recurrent, unilateral, tender salivary enlargement that subsides within 24 to 48 hours. Physical examination usually reveals a palpable stone in the duct of the gland. Sialography is successfully diagnostic if a calculus is not palpable. CT scan and ultrasound are also effective in identifying calculi. Treatment depends on the location of the obstruction. Calculi near the terminal orifice are easily removed transorally. Symptomatic calculi located near the hilum of the gland usually require excision of the gland.

Patients with HIV infection can present with enlargement of salivary glands. Glands can become infiltrated with benign lymphoid tissue or lymphoepithelial cysts. The cystic lesions often occur in the tail of the parotid gland, and aspiration can provide temporary relief of symptoms. These patients are treated conservatively because cysts tend to recur after excision or aspiration procedures. Differential diagnosis of salivary gland enlargement in HIV-infected patients includes non-Hodgkin's lymphoma and Kaposi's sarcoma. Fine-needle aspiration or excisional biopsy of suspicious masses is performed for diagnosis of malignancy.

Included in the differential diagnosis of inflammatory lesions of the major salivary glands are tuberculosis, cat-scratch disease, CMV infection, and first branchial arch cysts and sinuses.

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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