PANCE Blueprint EENT (7%)

Salivary disorders (PEARLS)

NCCPA™ PANCE EENT Content Blueprint  Oropharyngeal disorders  salivary disorders

Sialadenitis
Patient will present as → a 39-year-old female complaining of episodic left-sided jaw pain and swelling. The symptoms are typically aggravated by eating or by the anticipation of eating. Over the last 2-days, the patient has been experiencing worsening pain, redness, and fever. On physical exam, the left salivary gland is exquisitely tender. High-resolution noncontrast computed tomography (CT) scanning reveals a left-sided salivary gland stone. 

Sialadenitis is a bacterial infection of a salivary gland usually caused by sialolithiasis which is an obstructing stone in the salivary gland

  • Acute swelling of the cheek which worsens with meals
  • etiology: S. aureus
  • Affects the parotid or submandibular gland, occurs with dehydration or chronic illness (Sjogren syndrome), ductal obstruction
  • Diagnose with CT, ultrasonography, or MRI

TX:

  • IV antibiotics: Nafcillin
  • Hydration, warm compresses, sialagogues (lemon drops), massage gland
  • Oral antibiotics for less severe cases - Dicloxacillin, 1st gen cephalosporin, or clindamycin
  • Resolves in 2-3 Wks
Parotitis (ReelDx)
Patient will present as → an 11-year-old boy with malaise and swelling of his face.  He has no significant past medical history, but it is documented in his chart that his mother declined the recommended standard immunizations for children because of personal beliefs. Vital signs are stable with the exception of a mild fever. In addition to the facial swelling, physical exam is also notable for swelling around the testes. There are no rashes.

Mumps is caused by paramyxovirus. Likely in a child without a complete vaccination series

  • Typically, it begins with a few days of fever, headache, myalgia, fatigue, and anorexia, followed by parotitis; the illness is usually self-limited
  • In adult males look for an associated orchitis
  • Viral infections associated with parotitis include influenza A virus, parainfluenza, adenovirus, coxsackievirus, Epstein-Barr virus (EBV), cytomegalovirus, herpes simplex virus, human immunodeficiency virus (HIV), and lymphocytic choriomeningitis virus

TX: Self-limiting treat with hydration and rest

  • Vaccination is effective for prevention
Acute pharyngitis (ReelDx + Lecture) (Prev Lesson)
(Next Lesson) Sialadenitis (Lecture)
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