Management of Viral Sialadenitis (Mumps)
For viral sialadenitis secondary to mumps, treatment is entirely supportive and conservative, focusing on symptom relief and hydration, as antibiotics are not indicated for viral etiologies. 1, 2
Immediate Assessment
Airway Evaluation
- Assess airway patency immediately upon presentation, as acute submandibular or parotid swelling can progress rapidly and cause life-threatening airway compromise. 3
- While airway obstruction is more commonly reported in post-surgical sialadenitis (84% requiring intervention), any patient with significant bilateral gland swelling from mumps warrants close airway monitoring. 3
Clinical Confirmation
- Mumps remains the most common viral cause of sialadenitis globally in children, though juvenile recurrent parotitis predominates in vaccinated populations. 2
- Confirm the diagnosis with serological testing if needed, and evaluate for systemic manifestations including fever, malaise, and potential complications like orchitis or pancreatitis. 4
Conservative Medical Management
Hydration and Salivary Stimulation
- Provide aggressive oral or intravenous hydration to maintain salivary flow and prevent stasis—target at least 2 liters daily if tolerated. 3, 5
- Administer sialagogues (lemon drops, vitamin C lozenges, pilocarpine, or cevimeline) to stimulate salivary flow and reduce glandular stasis. 3, 1
Physical Measures
- Apply warm compresses to the affected glands multiple times daily to promote salivary excretion and reduce inflammation. 3, 6
- Perform gentle gland massage to facilitate drainage, though use caution in elderly patients or those with suspected carotid stenosis. 3, 5
Pain Management
- Provide oral analgesics for symptomatic relief of glandular pain and tenderness. 7
What NOT to Do
Antibiotic Therapy
- Do NOT routinely prescribe antibiotics for viral sialadenitis, as mumps is a viral infection and antibiotics are only indicated if bacterial superinfection develops (fever >38.5°C, purulent discharge, severe systemic toxicity). 3, 1
- If bacterial superinfection is suspected, cephalosporins are preferred as they achieve highest salivary concentrations and cover Staphylococcus aureus, Viridans streptococci, gram-negatives, and anaerobes. 3, 2
Corticosteroid Consideration
- Consider systemic corticosteroids (e.g., prednisone) only if there is significant airway swelling or severe inflammatory response, though this is more commonly needed in post-surgical cases than uncomplicated mumps. 3, 6
Monitoring for Complications
Neurologic Complications
- Monitor for rare neurologic sequelae including facial nerve palsy, brachial plexopathy, or Horner syndrome from inflammatory compression of adjacent neural structures. 3, 5
Systemic Complications
- Watch for mumps-specific complications including orchitis (in post-pubertal males), oophoritis, pancreatitis, meningitis, and encephalitis. 1
Chronic Sequelae
- In cases with persistent xerostomia, monitor for dental caries and tooth loss requiring dental referral. 3
Expected Recovery Timeline
- Most patients with viral sialadenitis achieve complete resolution within 1-2 weeks with supportive care alone. 4
- Bilateral salivary gland swelling from mumps typically resolves completely within 7-10 days without intervention. 4
- Recovery is generally favorable (78.9% complete recovery in inflammatory sialadenitis cases) when appropriate supportive measures are implemented. 3
Critical Pitfalls to Avoid
- Do not delay airway intervention if swelling progresses rapidly—maintain extremely low threshold for reintubation or tracheostomy. 3
- Avoid routine antibiotic use in the absence of clear bacterial superinfection, as most viral cases are self-limited and antibiotics provide no benefit. 3, 1
- Do not perform aggressive massage in elderly patients or those with vascular disease to avoid carotid complications. 3, 5