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Diseases of the Salivary Glands and Jaws
With the exception of mumps (see Chapter 275 ), diseases of the salivary glands are rare in children. Bilateral enlargement of the submaxillary glands can occur in HIV/AIDS, cystic fibrosis, Epstein-Barr virus infection, malnutrition, and transiently during acute asthmatic attacks. Chronic vomiting can be accompanied by enlargement of the parotid glands. Benign salivary gland hypertrophy has been associated with endocrinopathies: thyroid disease, diabetes, and Cushing syndrome. Infiltrative disease or tumors are uncommon; red flags include facial nerve palsy, rapid growth, fixed skin, paresthesias, ulceration, or a history of radiation to the head or neck region.
Parotitis
Acute parotitis is often caused by blockage, with further inflammation due to bacterial infection. The blockage may be due to a salivary stone or mucous plug. Stones can be removed by physical manipulation, surgery, or lithotripsy. Recurrent parotitis is an idiopathic swelling of the parotid gland that can occur in otherwise healthy children. The swelling is usually unilateral, but both glands can be involved simultaneously or alternately. There is little pain; the swelling is limited to the gland and usually lasts 2-3 wk. Treatment may include local heat, massaging the gland, and antibiotics. Suppurative parotitis is usually caused by Staphylococcus aureus . It is usually unilateral and may be accompanied by fever. The gland becomes swollen, tender, and painful. Suppurative parotitis responds to antibacterial therapy based on culture obtained from the Stensen duct or by surgical drainage. Viral causes of parotitis include mumps (often in epidemics), Epstein-Barr virus, human herpesvirus 6, enteroviruses, and HIV.
Ranula
A ranula is a cyst associated with a major salivary gland in the sublingual area. It is a large, soft, mucus-containing swelling in the floor of the mouth. It occurs at any age, including infancy. The cyst should be excised, and the severed duct should be exteriorized.
Mucocele
Mucocele is a salivary gland lesion caused by a blockage of a salivary gland duct. It is most common on the lower lip and has the appearance of a fluid-filled vesicle, or a fluctuant nodule with the overlying mucosa being normal in color. Treatment is surgical excision, with removal of the involved accessory salivary gland.
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