Parotitis: Symptoms, Causes, and Complications

Parotitis?

Since the 15th of this month, I have been experiencing pain at the junction of the upper and lower left jaw (below the left ear).
The pain is particularly noticeable when chewing or opening my mouth wide.
Aside from this, I have no other discomfort.
Could this be parotitis? What are the symptoms of parotitis that I can use for self-assessment? Additionally, I have been undergoing treatment for acne and have been taking isotretinoin (oral retinoid) for three weeks; could this be a side effect of the medication? I have heard that severe parotitis can lead to orchitis and infertility; what degree of severity can cause this complication? Is this complication common in clinical practice? Thank you for your detailed response.

zh, 20~29 year old female. Ask Date: 2002/12/17

Dr. Zhao Chongliang reply Internal Medicine

The parotid gland generally refers to the salivary gland known as the parotid gland, and parotitis is commonly known as mumps.
It is an acute viral disease unrelated to oral retinoic acid.
It primarily affects the parotid gland, but may also involve the submandibular or sublingual glands.
Clinical manifestations include fever, headache, and swelling and tenderness of the parotid gland or multiple salivary glands simultaneously.
Prodromal symptoms may include fatigue and loss of appetite for 1 to 2 days, followed by parotid pain, fever, and sore throat.

Complications are rare in children, but 20-30% of adult males who contract the virus may develop orchitis, typically unilateral; if bilateral, it may lead to infertility.
About 5% of adult females may experience oophoritis, but it rarely causes infertility.
Mumps can also invade the central nervous system in the early or late stages, leading to aseptic meningitis.
The incidence of encephalitis is approximately 1 in 6,000, with an average mortality rate of 1.4%.
Meningoencephalitis and orchitis can occur even without involvement of the salivary glands.
Other complications, such as permanent sensorineural hearing loss, usually unilateral, are less common.
Infection with mumps during the first trimester of pregnancy increases the risk of miscarriage, but there is currently no definitive evidence that mumps infection during pregnancy leads to congenital malformations.
However, individuals of your age group in Taiwan have received the combined measles, mumps, and rubella (MMR) vaccine, so even if reinfection occurs, symptoms should be mild, and serious complications are unlikely.

However, I am concerned about your report of pain when chewing or opening your mouth wide, which could also indicate issues with your teeth, tongue, or oral cavity.
Have you been chewing betel nut? It would be prudent to have a thorough examination by both a dentist and an otolaryngologist.

Reply Date: 2002/12/17

More Info

Parotitis, or inflammation of the parotid gland, can indeed present with symptoms such as pain near the jaw, particularly when chewing or opening the mouth wide. The location you described, near the lower jaw and under the ear, is consistent with parotid gland involvement. Common symptoms of parotitis include swelling of the gland, tenderness, dry mouth, and sometimes fever. In some cases, there may be pus or discharge from the duct of the gland, especially if there is an infection.

There are several potential causes of parotitis. Viral infections, such as mumps, are well-known causes, but bacterial infections can also occur, particularly if there is a blockage in the salivary duct, often due to dehydration or salivary stones. Given that you are currently on isotretinoin (Roaccutane), a medication that can reduce salivary flow and potentially lead to dry mouth, it is plausible that this could contribute to your symptoms. Isotretinoin is known to have side effects that include dryness of mucous membranes, which may predispose you to salivary gland issues.

In terms of self-assessment, if you notice swelling in addition to the pain, or if the pain worsens, it would be advisable to seek medical attention. Other signs to watch for include fever, chills, or any discharge from the mouth or duct of the gland. If you experience any of these symptoms, it may indicate a more serious infection that requires treatment.

Regarding your concern about complications such as orchitis (inflammation of the testes) leading to infertility, this is a rare complication associated with viral parotitis, particularly mumps. While mumps can lead to orchitis in post-pubertal males, the incidence of this complication is relatively low. It is important to note that not all cases of parotitis will lead to such complications, and they are more commonly associated with viral infections rather than bacterial ones.
In clinical practice, the occurrence of orchitis as a complication of parotitis is not common, especially in the context of bacterial infections. However, if you are experiencing significant pain or swelling, or if you have any concerns about fertility, it is essential to consult with a healthcare provider for a thorough evaluation. They may recommend imaging studies or laboratory tests to determine the underlying cause of your symptoms and to rule out any serious conditions.

In summary, while your symptoms may suggest parotitis, particularly given the location and nature of the pain, it is crucial to consider other factors such as your current medication and any additional symptoms. Monitoring your condition and seeking medical advice if symptoms worsen or new symptoms arise is the best course of action.

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