Recurrent enlargement of the parotid and submaxillary glands, as well as of the lachrymal glands, is occasionally met with in adults, and was first described by Mikulicz. It may be associated with salivary lithiasis, xerostomia, or organic narrowing of the ducts, but in the majority of cases no such cause can be discovered (D. M. Greig). When the parotid is affected the condition tends to be bilateral and there is some constitutional disturbance. The submaxillary form is usually unilateral and the symptoms are entirely local. The affected gland rapidly becomes swollen, painful and tender to the touch, and the swelling increases markedly while the patient is eating. Each attack lasts for a few hours to one or two weeks, and then subsides spontaneously. The intervals between attacks vary from a few weeks to a year or more. In the course of a few years there is considerable deformity, and sometimes deficiency in the glandular secretion, but the disease is not attended by other inconvenience. Benefit has followed the administration of arsenic and iodides, and the use of radium and X-rays.
The treatment of these non-suppurative forms of parotitis consists in relieving the symptoms.
Suppurative parotitis may be due to direct spread of infection from the mouth along the parotid duct, or to extension of suppurative processes from the temporo-mandibular joint, the jaw, or a lymph gland. It is liable to occur also in the course of any disease in which there is an infection of the blood with pyogenic bacteria, and has been met with in diphtheria, typhoid fever, scarlet fever, measles, and other eruptive fevers.
The post-operative form of parotitis is most frequently met with after laparotomy for such conditions as suppurative appendicitis, perforated gastric ulcer, ovarian cyst, and pyosalpinx.
These secondary forms are probably due to infection from the mouth under conditions in which the secretion of saliva is arrested or its escape from the gland interfered with.
The early symptoms are apt to be overshadowed by those of the general disease from which the patient suffers. At first the gland is swollen, hard, and tender, and the seat of constant, dull, boring pain; later there is redness, œdema, and fluctuation. The movements of the jaw are restricted and painful, the patient is unable to open the mouth, and has difficulty in swallowing. The inflammation reaches its height on the third or fourth day, and usually ends in suppuration. The pus is scattered in numerous foci throughout the gland, and sometimes large sloughs form. The dense capsule of the gland prevents the pus reaching the surface and causes it to burrow among the tissues of the neck, giving rise to dyspnœa and dysphagia. It may find its way downwards towards the mediastinum, inwards towards the pharynx—where it constitutes one form of retro-pharyngeal abscess—or upwards towards the base of the skull. Not infrequently it burrows into the temporo-mandibular joint, or escapes by bursting into the external auditory meatus. Serious hæmorrhage may result from erosion of the vessels traversing the gland or of the internal jugular vein, or venous thrombosis may ensue. Persistent paralysis may follow destruction of the facial nerve; and salivary fistulæ may form. Death may take place from toxæmia even before pus forms.
Treatment.—During the first two or three days hyperæmia is induced by means of poultices, hot fomentations, or Klapp's suction bells, and the mouth is frequently washed out with an antiseptic. As soon as there is reason to believe that pus has formed an incision is made behind the angle of the jaw, parallel to the branches of the facial nerve, the abscess opened by Hilton's method, a finger passed into the gland, and all septa broken down and drainage secured.
Acute infection of the submaxillary gland is met with under the same conditions as that of the parotid. Both glands are occasionally attacked at the same time.
The acute phlegmonous peri-adenitis of the submaxillary gland, known as angina Ludovici, is referred to at [p. 597].
The treatment consists in making incisions through the deep fascia in order to relieve the tension, or to let out pus if it has formed.