Concomitant Suppurative Parotitis and Condylar Osteomyelitis

Bi-institutional analysis of microbiological spectrum and therapeutic management of parotid abscesses

BACKGROUND

A parotid abscess (PA) is a complication of an acute bacterial parotitis with a potentially life-threatening course. To date, data on the diagnosis and therapy of PA is sparse and mostly consists of case reports or case series. Therefore, this study aimed at comprehensively analyzing the microbiological spectrum and the therapeutic management in a bi-institutional setting.

METHODS

A retrospective clinical chart review was performed to identify all patients surgically treated for PA at two tertiary care centers in Germany. Data on demographics, clinical management and microbiological data including species identification, pathogenicity, type of antibiotic therapy, adjustment of antibiotics, antibiotic sensitivity testing, and smear test results were extracted. Intervention-related variables and etiology were analyzed for their statistical association with outcome variables.

RESULTS

Overall, 85 patients were included. Most patients (92.9%) underwent surgical incision. Around half of the patients (45.9%) were treated under local anesthesia. No facial nerve palsy was observed. The most frequently detected pathogens were Streptococci (n = 23), followed by Staphylococcus aureus (n = 6) including one case of methicillin-resistant Staphylococcus aureus. Most patients (68.2%) received an aminopenicillin ± beta-lactamase inhibitor as empiric antibiotic therapy. In 6 cases the antibiotic therapy was modified after receiving the antibiogram. Four patients (5.2%) presented with recurrent PA. Etiology was idiopathic (42.4%), followed by tumorous (12.9%), obstructive, and immunosuppressive (each 11.8%). Patients with a dental focus (p = 0.007) had a longer duration of hospitalization.

CONCLUSION

The results show that the surgical therapy of PA under local anesthesia is safe. A dental examination should routinely be performed to rule out a dental focus. Obtaining a microbiological specimen in order to modify antibiotic therapy if necessary and a histopathological specimen to rule out a tumorous etiology is obligate.

Ultrasound-Guided Needle Aspiration vs. Surgical Incision of Parotid Abscesses

OBJECTIVE

Standard treatment of parotideal abscesses consists of surgical drainage. This often has to be carried out in general anesthesia and carries the risk of iatrogenic injury of the facial nerve. Ultrasound-guided needle aspiration is an alternative therapy. Up until now a lack of systematic data concerning this subject exists. The study at hand aims to answer the question whether needle aspiration is a viable alternative for surgical drainage.

METHODS

All patients who had been treated surgically (n = 39) or via ultrasound-guided needle aspiration (n = 18) at our clinic were included into this monocentric retrospective analysis.

RESULTS

There was no statistically significant difference (p = 0.142) regarding the mean abscess volume in both groups (5.7 vs. 10.1 mL). Therapy of the abscesses on average required 1.88 (1-5) ultrasound-guided needle aspirations or 1.10 (1-4) surgical interventions. There was a trend to a shorter inpatient treatment period (5.88 vs. 7.33 days) after ultrasound-guided needle aspiration. This trend did not reach statistical significance (p = 0.301). Facial nerve alterations did not occur in any of the patients. Postoperative bleeding did never occur after needle aspirations but in 2% of the patients after surgical abscess revision.

CONCLUSION

Ultrasound-guided needle aspiration is safe and effective in the treatment of parotid abscesses.

Percutaneous drainage of a parotid gland abscess under contrast-enhanced ultrasound guidance: A case report

A parotid gland abscess is uncommon and if not responding to conservative management, requires surgical intervention. However, surgery is invasive with the risk of complicating facial nerve damage and possible poor cosmetic outcome. We present a case of a parotid gland abscess in association with an underlying Warthin's tumour requiring percutaneous drainage, as patient co-morbidity precluded a safe surgical approach. Percutaneous drainage was aided by a contrast-enhanced ultrasound examination, which permitted delineation of the fluid aspects of the collection from the underlying tumour and allowed successful percutaneous ultrasound-guided aspiration without complication.