From the Guidelines
Unilateral parotitis is typically caused by viral infection, such as mumps, and treatment should focus on supportive care, including adequate hydration, warm compresses, and pain management. The causes of unilateral parotitis can be varied, including viral infections like mumps, as discussed in the study by 1, which highlights the epidemiology and risk factors of mumps, characterized by fever and inflammation of the salivary glands. Other causes may include bacterial infection, salivary duct obstruction from stones or strictures, autoimmune conditions, or poor oral hygiene in elderly or dehydrated patients. Treatment depends on the underlying cause, and for viral parotitis, supportive care with adequate hydration, warm compresses, and pain management with acetaminophen or NSAIDs is recommended. For bacterial parotitis, empiric antibiotic therapy may be necessary, and alternatives like clindamycin or a fluoroquinolone like levofloxacin can be considered. It's essential to note that vaccine coverage, as mentioned in the study by 1, is high, but outbreaks can still occur, emphasizing the importance of maintaining good oral hygiene and increasing fluid intake during treatment. Key considerations in treatment include:
- Maintaining good oral hygiene
- Increasing fluid intake
- Using sialagogues like lemon drops or sugar-free candies to stimulate saliva flow
- Applying warm compresses and performing parotid massage
- Managing pain with acetaminophen or NSAIDs
- Suspecting abscess formation if symptoms worsen despite antibiotics, potentially requiring surgical drainage.
From the Research
Causes of Unilateral Parotitis
- Decreased salivary flow or obstruction can lead to repeated infection and inflammation of the parotid gland, resulting in unilateral parotitis 2
- Bacterial infections, such as Staphylococcus aureus and anaerobic bacteria, can cause acute bacterial suppurative parotitis 3
- Viral infections, including paramyxovirus (mumps), Epstein-Barr virus, coxsackievirus, and influenza A and parainfluenza viruses, can also cause parotitis 4, 5
- Predisposing factors to suppurative infections include dehydration, malnutrition, oral neoplasms, immunosuppuration, sialolithiasis, and medications that diminish salivation 5
Treatment Options for Unilateral Parotitis
- Conservative medical management, including maintenance of hydration and administration of parenteral antimicrobial therapy, can be effective in treating parotitis 2, 3
- Surgical interventions, such as parotidectomy or surgical drainage of an abscess, may be necessary in some cases 2, 3, 5, 6
- Antimicrobial therapy should be directed against the specific causal agent, and initial empiric therapy may be required until a specific diagnosis is available 3, 5
- Maintenance of good oral hygiene, adequate hydration, and early and proper therapy of bacterial infection of the oropharynx may reduce the occurrence of suppurative parotitis 3