- Department of Otolaryngology, James Paget Hospital, Great Yarmouth, Norfolk
- Mr V V Chitre, Flat 6, Rosemont, 80/81 Mount Ephraim, Tunbridge Wells, Kent TN4 8BS.
Recurrent parotitis is defined as recurrent parotid inflammation, generally associated with non-obstructive sialectasis of the parotid gland.1 Also known as juvenile recurrent parotitis,2 3 this disease is characterised by recurring episodes of swelling and/or pain in the parotid gland, usually accompanied by fever and malaise. It usually affects children, but may persist into adulthood.
It is a rare condition, and its aetiology remains an enigma. Its natural history is variable, and in adults more aggressive intervention is often needed. In addition, there is no satisfactory explanation for its usual tendency to resolve spontaneously after puberty. All this has resulted in considerable uncertainty concerning its appropriate management. This review was undertaken to collate all the information available on this uncommon and distressing condition. Diagnosis and management of this condition is also discussed.
Its cause remains unknown despite several studies. Though the affected glands demonstrate sialectasis of the distal ducts, there seems to be no element of obstruction in most cases. Several theories of causation have been put forward over the years.
Traditionally, ascending infection from the oral cavity has been considered the primary event, with sialectasis being a secondary change. Maynard proposed that the recurrent episodes of parotid swelling was the end result of a sequence of events4:
• There is first a low grade inflammation of the gland and duct epithelium, possibly caused by a low salivary flow rate due to dehydration and debility.
• This results in distortion and stricturing of the distal ducts, and metaplasia of the duct epithelium.
• The metaplasia results in excessive mucus secretion.
These changes, along with possibly a further reduction in salivary flow rate, then predispose to recurrent parotid inflammations.
A reduced salivary flow rate may result from glandular damage caused by the primary infection. However, it may be a primary factor …