Review Question - QID 220786

This patient who presents with fever, pain, and swelling of the parotid gland after a dental procedure most likely has acute bacterial parotitis.

Acute bacterial parotitis is an infection of the parotid gland that occurs in older patients after minor head and neck procedures. Patients will present with fever, pain, swelling, and redness over the parotid gland. The gland will be tender to palpation and can often have expressible purulence. Risk factors for this condition include immunocompromised states, diabetes, and poor oral hygiene. Prevention of this disease includes good oral hygiene and adequate fluid intake. The most common organisms that cause this condition include Staphylococcus aureus, followed by other bacteria like Streptococcus species and anaerobes. Treatment is with antibiotics such as amoxicillin-clavulanate depending on the etiology of the infection.

Wilson et al. review the etiology of disorders of the salivary glands. They discuss how tumors, infection, and autoimmune diseases can all affect these glands. They recommend treatment of acute bacterial parotitis with antibiotics.

Figure/Illustration A is a clinical photograph that demonstrates swelling and redness of the parotid gland. This finding is classically seen in patients with acute bacterial parotitis.

Incorrect Answers:
Answer 1: Abscess of tooth can also be an infection that occurs after a dental procedure; however, the main findings in this condition are usually inside the oral cavity. Anaerobic organisms are a common cause of this condition. It would not have expressible purulence from the parotid gland.

Answer 3: Measles presents with a maculopapular rash that classically proceeds from the head down. It is preceded by a prodrome that includes cough, coryza, conjunctivitis, and Koplik spots. It is also covered in the same vaccination that treats mumps.

Answer 4: Mucormycosis can cause a highly aggressive facial infection in patients with poorly controlled diabetes or diabetic ketoacidosis. This disease would present with a necrotizing infection that can be rapidly fatal and often involves the sinuses.

Answer 5: Mumps can cause asymmetric swelling of the parotid gland and typically occurs in children who are not vaccinated. This disease would not present with expressible purulence from the parotid gland.

Bullet Summary:
Acute bacterial parotitis presents with fever, painful swelling of the parotid gland, and expressible purulence.