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Recurrent Parotitis in Children Michael Katze , M.B., B.Ch

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Recurrent Parotitis in Children Michael Katze , M.B., B.Ch 122 S.A. MEDICAL JOURNAL 15 February 1964 to their own overseas specialist journals in any case, and make a positive contribution towards the ideal of attaining since the number of specialists in each specialty is so unity within diversity. (relatively) small, it would appear unwise to publish a Anangements have already been made to publish the separate journal for each group. South African Journal of Obstetrics and Gynaecology A possible solution to this problem has, howeve.r, been and the South African Journal of Radiology as separate found by using the weekly Journal of the Association jou.rnals during the course of the year. The South African (which is being circulated to all members of the Medical Journal of Laboratory and Clinical Medicine, which was Association) as the basis for the publication of specialist published previously as a quarterly journal on its own, supplements. On the request of the various groups con­ and which had a relatively small circulation, will now cerned, we have now gone a step further in deciding to also be published in the same way as the other journals publish these supplements in 1964 as separate journals mentioned above and distributed to all members of the under their own titles. During the weeks when the supple­ Association. ments would normally have appeared, the new journals In addition to these special journals we hope to publish will now appear under their own titles. They will, how­ a number of interesting special issues of the South African ever, be distributed to all members of the Association and Medical Journal during the course of the year, e.g. the not only to members of the respective groups. Every mem­ Proceedings of the Nutrition Society of Southern Africa, ber will therefore still receive fifty-two weekly publica­ the Proceedings of the Ophthalmological Society, a Stel­ tions every year, as in the past. lenbosch number, and possibly also special issues on plas­ By approaching the problem along these lines it will be possible to publish specialist journals in South Africa. tic surgery. Moreover by merely supporting the Medical Association The wholehearted cooperation and support of every and its Journal, every member will have access to other member of the Association in this undertaking will be South African specialist journals. In this way we hope to greatly appreciated. RECURRENT PAROTITIS IN CHILDREN MICHAEL KATZE , M.B., B.CH. (RAND), F.R.C.S. (EDIN.) and D. J. DU PLESSIS, CH.M. (RAND), F.R.C.S. (ENO.) Department of Surgery, University of the Witwatersrand, and Johannesburg General Hospital, Johannesburg Recurrent parotitis is a well-documented condition and is erythema of the overlying skin. Flakes of pus (the 'snow­ ll usually described as oecuning in both adults and chil­ storm' appearance ) could usually be expressed from dren.l-3 Only a few authors have specifically described the Stensen's duct, and the orifice of the duct was frequently syndrome as it occurs in childhood:-· and the following red and oedematous. The systemic reaction to the infec­ review of 44 children suffering from recurrent parotitis tion varied from trivial to severe, with a high tempera­ is presented in an attempt to elucidate the aetiology and ture necessitating, in some cases, confinement to bed and pathogenesis, natural history, and management of the consequent loss of schooling. condition. The series comprises 23 patients under the care When examined between attacks, several children ex­ of the surgical unit at the Transvaal Memorial Hospital hibited a slight residual firm swelling of the parotid gland, for Children, Johannesburg, over the past 12 years and 21 but in most cases the gland was impalpable. The orifice personal patients of one of the authors (D. J. du P.). of Stensen's duct was oedematous in a few cases, though REVIEW OF 44 CASES usually of normal appearance. In only one patient was residual swelling between attacks really marked, but this Race incidence. Of the 44 children, 40 were White and patient also complained of pain and swelling in the gland 4 Cape Coloured. This racial incidence is partly due to while eating, and was one of those found to have a secon­ the fact that there are only White children at the Trans­ dary obstruction of the duct system. vaal Memorial Hospital for Children. However, no case The inflammatory process sometimes also affected the in a Bantu child has been encountered by us, and this is accessory parotid gland which lies close to the main duct probably significant. The condition is known to be very 6 anterior to the parotid gland." On two occasions this pre­ rare in Bantu children;·'· and Royce has reported that sented clinically with a palpable mass in the region of the the condition is seldom seen in American Negro children. main parotid duct in the cheek. These swellings were first Sex incidence. Twenty-six of the patients were boys and thought to be parotid calculi in the duct, but both, on 18 girls. This confirms the findings of others··r that re­ exploration, proved to be enlarged accessory parotid current parotitis in childhood is slightly more common in glands. boys than in girls. Age at onset and frequency of attacks. The- age at Symptoms and signs. The attacks of parotitis consisted onset of attacks varied from 8 months to 12 years, though of pain and swelling in the region of one or both parotid in most cases the attacks started between the ages of 3 glands, of sudden onset and lasting on the average 3 - 7 and 6 years. With the exception of 2 patients who first days. presented to us as adults (aged 21 and 34 years), the chil­ On examination during an acute attack, the parotid dren had been suffering from the condition from 1 month gland was found to be swollen and tender, but with no to 8 years when first seen. The acute attacks occurred 15 Februarie 1964 S.A. TYDSKRIF VIR GENEESKUNDE 123 with varying frequency, most commonly every 3 - 4 Sialography. Sialograms were obtained from 29 patients, months. 10 bilaterally. In the earlier cas in the series lipiodol was used as contrast medium, but thi was later changed to Side involved. In 26 patients the attacks of parotitis neohydriol fluid. A standard technique was not used in all occurred on one side only (right side---l4, left side-12) cases since the earlier sialograms in the series were performed while in 18 patients both sides were involved, though most by various radiologists; and one technique used, for instance, was to inject dye until the patient complained of pain in the of these patients had started with unilateral attacks, the gland, usually after 1 - 1t m!. of dye had been injected. This opposite side becoming involved months or years later. In method tended to produce an over-filled gland exhibiting a patients with bilateral involvement both sides rarely suf­ general moWing owing to acinar filling which obscured the fered attacks simultaneously, and the frequency and clear outline of the duct pattern" (Fig. I). Our method i to inject only t - t m!. of dye lowly to avoid exces ive extrava­ severity of attacks usually varied considerably from side sation of dye within the gland substance and the foreign-body to side. reaction which it produces." Complications. The only complication due to parotitis All the ialograms demon trated the abnormality of was the development of a parotid abscess in 1 patient. 'sialectasis'" consisting of mall globules of contrast medium associated with the intralobular ducts. The di tribution was This was drained at another hospital, and it healed with­ usually diffuse (Fig. 2), but occa ionally patchy. out fistula formation. A common explanation for this radiological appearance is Associated conditions. In 2 children there was a definite that the contra t medium has entered dilated duct (similar to bronchiectasis), and in view of the young age of these history of allergy, e.g. asthma or hay fever. patients this was formerly thought to be a congenital abnor­ Two children suffered simultaneous attacks of parotitis mality-hence the term 'congenital sialectasis' used for this and acute tonsillitis, while in 11 others there was a his­ condition. There is, however, much evidence to how that tory of recurrent tonsillitis not coinciding with the attacks the sialectatic appearance is produced by rupture of the intralobular ducts with extrava ation of the contrast medium of parotitis. into the interstitial tissue of the gland. In 4 patients the parents associated the first attacks of Patey and Thackray" howed thi to be the case by mean parotitis with the cutting of teeth, and in 5 it was noted of serial hi tological ections after sialography, and Ranger" that several carious teeth were present. has demonstrated that sialectasis may be produced by injecting a normal gland under very great pres ure. We have also noticed Family history. Two mothers and one father reported that 'sialectasis' appears before the acini are completely filled, having suffered from a similar condition during childhood proving the abnormal fragility of the intralobular ducts in with spontaneous resolution. There were no patients whose this disease, since good acinar filling can usually be produced siblings suffered from a similar condition. without the appearance of sialectasi ." In addition, if these globules of contrast medium were in dilated duct, the flow of saliva would be expected to flush out the ducts; but we INVESTIGATIONS have often seen contrast medium still in the gland on X-rays taken days or even weeks, and on 1 occa ion as long as 5 Serum proteins alld electrophoretic pattern. These tests years, after sialography.
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