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Cases presenting as parotid abscesses in children
Riitta T Saarinen1, Kaija-Leena Kolho, Anne Pitkäranta
1Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland. riitta.t.saarinen@hus.fi
Insights
Parotid abscesses in children often stem from acute bacterial infections. While intravenous antibiotics are key, surgical drainage aids recovery without causing complications like fistulas.
Area of Science:
- Pediatric Infectious Diseases
- Otolaryngology
- Surgical Pathology
Background:
- Parotid abscess is a rare but serious complication of acute suppurative parotitis.
- Management typically involves hospitalization, intravenous antibiotics, and surgical drainage.
Purpose of the Study:
- To describe the clinical presentation, treatment strategies, and outcomes for children with parotid abscess.
- To inform the development of optimal clinical guidelines for managing pediatric parotid abscesses.
Main Methods:
- Retrospective chart review of 10 pediatric patients (age ≤17) diagnosed with parotid abscess between 1996 and 2005.
- Analysis of clinical data, including prior symptoms, causative pathogens, diagnostic imaging, and treatment interventions.
Main Results:
- Bacterial cultures were positive in 60% of cases, with aerobic Gram-positive pathogens identified in four. One case involved parotid tuberculosis.
- All patients received intravenous antibiotics. Diagnostic imaging included ultrasound (90%) and MRI (10%).
- Surgical drainage or ultrasound-guided needle aspiration was performed in seven patients without complications; spontaneous rupture occurred in three cases. Two patients developed brachial cleft fistulas, with one experiencing abscess recurrence.
Conclusions:
- Pediatric parotid abscesses are frequently acute, multi-bacterial infections, not always linked to pre-existing parotid conditions.
- Intravenous antibiotic therapy is the primary treatment, complemented by surgical drainage to facilitate recovery.
- Appropriate drainage procedures minimize the risk of fistula formation.
Background:
A parotid abscess is a rare complication of acute suppurative parotitis which most often requires hospitalization, intravenous antibiotic therapy, and surgical drainage.
Objective:
To investigate the clinical picture, treatment, and prognosis of children with a parotid abscess in a search for optional clinical guidelines for treatment.
Methods:
A retrospective chart review was performed for 10 children (age
Results:
Of the 10 cases of parotid abscess found, 4 children had had parotid-related symptoms before; bacterial culture was positive in 6; 4 had aerobic Gram-positive pathogens, and 1 girl had parotid tuberculosis. All patients received intravenous antibiotic therapy. The initial diagnostic method was ultrasound in nine cases and MRI in one. Four children underwent surgical drainage, and in three cases there was an ultrasound guided needle aspiration of the abscess. Neither surgical drainage nor aspiration led to fistula formation or any other complication. The abscess ruptured spontaneously through the skin of the periauricular area in two cases and into the ear canal in one. During follow-up, all were symptom-free except for two girls diagnosed with first brachial cleft fistulas. One of these also had a reoccurrence of the parotid abscess. Both later underwent superficial parotidectomy due to persistent symptoms.
Conclusions:
Most parotid abscesses in children are acute multi-bacterial infections not necessarily related to other parotid gland pathologies. Intravenous antibiotic therapy is the cornerstone of treatment, but surgical drainage assists in recovery and should not lead to fistula formation.
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