Surgical treatment of chronic suppurative parotitis. A critical review.

Abstract

AbstractChronic suppurative parotitis, manifest by recurrent acute parotid enlargement and purulent sialorrhea, is usually seen with sialolithasis, sialectasis, or duct strictures. These conditions have a common pathophysiology, the predisposition to infection associated with fluid stasis.Chronic suppurative parotitis can usually be successfully treated with conservative mechanical and medical measures. Occasionally the disease is severe enough to require vigorous surgical treatment. Parotidectomy is currative and provides tissue to confirm the diagnosis. Because of concern about risk to the facial nerve in parotidectomy, tympanic neurectomy and parotid duct ligation—which theoretically cause atrophy of the gland by interruption of secretomotor nerves or pressure effects—are advocated as alternative treatment.Basic physiological and clinical studies do not confirm that tympanic neurectomy consistently interrupts all secretomotor nerves to the gland nor that parasympathetic denervation can induce complete atrophy of the gland. Studies of parotid duct ligation also do not conclusively demonstrate that this procedure will induce complete atrophy of the gland. There is a suggestion that it may have some role in protecting an already functionless gland from ascending infection.Published studies indicate that parotidectomy is the most effective treatment for this disease, and that the risk of permanent facial injury after the operation is slight.A review of 86 consecutive parotidectomies is reported. Fourteen of the surgical specimens showed inflammatory pathology and 6 of the patients had frank chronic suppurative parotitis preoperatively. The patients with chronic parotitis are asymptomatic 2 to 7 years after parotidectomy and there was no instance of permanent facial paresis after operations done for inflammatory disease.Parotidectomy is the treatment of choice for chronic suppurative parotitis when it is resistant to conservative measures. Operations such as tympanic neurectomy and parotid duct ligation, which approach the disease in an indirect manner, are not founded on carefully considered basic or clinical information and are of questionable effectiveness. The risk of permanent facial nerve paresis following parotidectomy for inflammatory disease is an important question. Our review indicates that the risk is well within acceptable limits.