Managing Recurrent Parotitis: Insights and Treatment Options

Recurrent parotitis?

Hello doctor, my wife is 30 years old and a few months ago, after accidentally consuming pure lemon juice, she started experiencing pain and swelling under her jaw after eating.
She has seen an ENT specialist at a general clinic and an oral and maxillofacial surgeon at a large hospital, both concluding that it is parotitis.
After several visits, there was some improvement, but she still experiences flare-ups occasionally.
Therefore, we consulted a rheumatologist, who ordered a neck ultrasound and blood tests, all of which came back normal, indicating no issues with her immune system.
However, she still experiences occasional swelling.
Currently, she is taking traditional Chinese medicine for two weeks.
Initially, we thought it was effective since she hadn't had any flare-ups for the past week, but recently, she has experienced swelling again after eating.
Initially, both sides were swollen, but now the swelling is less severe, occurring occasionally on the left or right side, and she has not been able to fully recover.

Question 1: What should we do next?
Question 2: My wife has a history of total thyroidectomy.
I once heard from a hematologist that the removal of the thyroid may also involve surrounding lymph nodes, which could lead to parotid gland enlargement as a potential sequela.
How accurate is this statement?

Niming, 30~39 year old female. Ask Date: 2020/07/03

Dr. Zheng Jueyi reply Otolaryngology

Hello,
1.
If the swelling continues to recur, you may visit a medical center to evaluate the suitability for sialendoscopy for examination and treatment.

2.
Total thyroidectomy generally does not involve the removal of lymph nodes near the parotid gland, and it rarely causes complications such as parotid gland enlargement.
If there are any effects, symptoms should typically appear within three months post-surgery.

Wishing you safety and health,
Director of the Department of Otolaryngology, Taoyuan General Hospital, Ministry of Health and Welfare,
Dr.
Jue-Yi Cheng

Reply Date: 2020/07/03

More Info

Managing recurrent parotitis can be quite challenging, especially when conventional treatments have not yielded satisfactory results. Your wife's case, characterized by recurrent swelling of the parotid gland after consuming acidic foods like lemon juice, suggests a possible underlying issue that may not be fully addressed by standard medical interventions.

Understanding Recurrent Parotitis
Parotitis, or inflammation of the parotid gland, can be caused by various factors, including viral infections (like mumps), bacterial infections, or even non-infectious causes such as dehydration, duct obstruction, or autoimmune conditions. Given that your wife has undergone a thorough evaluation with normal results from imaging and blood tests, it seems that infectious causes have been ruled out.

Next Steps in Management
1. Hydration and Salivary Stimulation: Encourage your wife to stay well-hydrated, as dehydration can exacerbate parotitis. Additionally, stimulating saliva production can help keep the ducts clear. Sour candies or lemon-flavored drinks (in moderation) can promote salivation, but given her sensitivity to lemon juice, it may be wise to explore other options.

2. Warm Compresses: Applying warm compresses to the affected area can help alleviate discomfort and promote drainage if there is any obstruction.

3. Sialogogues: These are substances that stimulate saliva flow. While lemon juice is acidic, other options like sugar-free gum or lozenges may be less irritating and still effective.

4. Consultation with a Specialist: If the symptoms persist, it may be beneficial to consult with an oral and maxillofacial surgeon or a specialist in salivary gland disorders. They can evaluate for potential ductal obstructions or other anatomical issues that might not have been identified in previous assessments.

5. Consideration of Autoimmune Conditions: Since your wife has a history of thyroid surgery, it may be worth exploring whether there is an autoimmune component to her symptoms. Conditions like Sjögren's syndrome can affect salivary glands and lead to recurrent inflammation.

Thyroid Surgery and Parotid Gland Issues
Regarding the claim that thyroid surgery, particularly total thyroidectomy, can lead to parotid gland enlargement as a complication, this is somewhat nuanced. While thyroid surgery can affect surrounding structures, including lymphatic drainage, it is not a common direct cause of parotid gland swelling. However, if lymph nodes were removed or if there was significant tissue alteration during surgery, it could potentially lead to changes in the drainage patterns of the parotid gland, resulting in swelling or inflammation.

Conclusion
In summary, managing recurrent parotitis involves a multifaceted approach that includes hydration, salivary stimulation, and possibly further evaluation by specialists. While the connection between thyroid surgery and parotid gland issues is not straightforward, it is essential to consider all aspects of your wife's health history in her ongoing management. If symptoms persist or worsen, further investigation into potential underlying causes, including autoimmune conditions, may be warranted. It is crucial to maintain open communication with healthcare providers to ensure a comprehensive approach to her care.

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