parotid space infection
Introduction
Introduction to parotid gland infection Inflammatory lesions caused by epidemic mumps complicated with bacteria or adjacent tissues, such as parapharyngeal abscess and secondary infection secondary infection, due to improper treatment or improper treatment, the spread of inflammation, can lead to the disease. The disease is treated with a sufficient amount of antibiotics to control the infection. Early local hot compress, physiotherapy or anti-inflammatory cream, such as fish stone grease, to absorb or limit inflammation. Once the abscess is formed, the drainage should be cut open, and the incision is made in the most prominent part of the swelling of the parotid gland, parallel to the facial nerve. If the abscess is extensive, the incision can be placed in front of the auricle, perpendicular to the humeral condyle, and then bent to the rear of the earlobe to the tip of the mastoid. The parotid fascia, which is closely attached to the skin, is widely exposed, and then multiple parallel nerve branches are made on the fascia, and the vascular clamp is used to extend from the incision, and the drainage is chronically opened. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: respiratory transmission Complications: meningitis polyneuritis deafness
Cause
Cause of parotid gland infection
Inflammatory lesions caused by epidemic mumps complicated with bacteria or adjacent tissues, such as parapharyngeal abscess and secondary infection secondary infection, due to improper treatment or improper treatment, the spread of inflammation, can lead to the disease.
Prevention
Prevention of parotid gland infection
1. Isolation of the patient early until the swelling of the parotid gland completely subsides. Tell your child not to be in close contact with the patient.
2, indoors should pay attention to ventilation, keep air circulation, home disinfection with 0.2% peracetic acid. Do not participate in large-scale group activities during the popular period.
3, inoculation of measles, rubella, mumps triple vaccine. Strengthen health knowledge publicity, educate children to develop good personal hygiene habits, participate in exercise and enhance physical fitness. However, a live attenuated mumps vaccine cannot be used in pregnant women, congenital or acquired immunocompromised individuals, and those who are allergic to chicken protein.
4, drug prevention, using Banlangen 30 grams or 9 grams of honeysuckle decoction, 1 day, for 6 consecutive days.
Complication
Complications of parotid gland infection Complications meningitis polyneuritis deafness
1. The incidence of meningitis or meningoencephalitis is 5 to 25%, and local area can reach 35%. It is generally believed that the virus is directly invaded by the central nervous system. 6 days before the swelling of the parotid gland or within 2 weeks after the swelling, usually occur within 1 week. Clinical manifestations of acute high fever with severe headache, vomiting, lethargy or disturbance of consciousness, meningeal irritation positive, etc., cerebrospinal fluid examination showed viral encephalitis or meningitis changes. The general prognosis is good, and some severe cases can cause death.
2. Multiple neuritis and myelitis occur occasionally 1 to 3 weeks after mumps, and the prognosis is good. A swollen parotid gland may compress the facial nerve to cause temporary facial paralysis. Sometimes there are balance disorders, trigeminal neuritis, hemiplegia, paraplegia, ascending paralysis. Occasionally, meningoencephalitis is caused by a narrowing of the aqueduct and hydrocephalus.
3. Deafness manifests as vomiting, stun, tinnitus and other symptoms, mainly caused by endolymphatic labyrinthitis and auditory neuritis. Although the incidence is very low (about 1/15,000), it can be permanent and complete deafness. Fortunately, it occurs mostly on one side (75%), so it still retains certain hearing.
Symptom
Parotid gland infection symptoms common symptoms suppurative mumps teeth closed tight dysphagia neck pain pharyngeal burning pain
diagnosis
According to the history and examination, the diagnosis is not difficult, puncture and pus can help diagnose.
Differential diagnosis
Because it is close to the posterior pharyngeal space, the symptoms are similar. The pain in the affected side of the pharynx and neck is severe and can be radiated into the ipsilateral ear. The pain affects swallowing and neck activity, but the pharynx is not swollen, and the tonsils are not displaced. The teeth are tightly closed, and the parotid gland is red and swollen at the corner of the mandible. It is hard and tender. If the abscess of the inflammation has formed, it will become soft locally.
Examine
Examination of parotid gland infection
1. Peripheral blood
Most of the white blood cell counts are normal or slightly increased, and lymphocytes are relatively increased. When there are complications, the white blood cell count can be increased, and occasionally leukemia-like reactions.
2, serum and urine amylase determination
A mild to moderate increase in serum amylase in 90% of patients is helpful in diagnosis. The degree of amylase increase is often proportional to the degree of swelling of the parotid gland.
However, its increase may also be related to pancreatic and intestinal effusion.
3, serological examination
(1) Neutralizing antibody test: a low titer such as 1:2 indicates a current infection. In recent years, the gel hemolysis test has been applied, which is basically consistent with the neutralization test, and the detection of the neutralizing antibody is simple and rapid, but the method needs further improvement.
(2) Complement binding test: It has auxiliary diagnostic value for suspicious cases, and the titer of double serum (early course and 2nd to 3rd week) is increased by more than 4 times, or a serum titer of 1:64 is diagnostic. . S and F antibodies should be assayed simultaneously if conditions permit. An increase in the S antibody indicates a recent infection, and the increase in the V antibody and the increase in the S antibody only indicates that the infection has occurred in the past.
(3) Hemagglutination inhibition test: chicken embryos infected with virus, amniotic fluid and allantoic fluid can agglutinate red blood cells of chickens, and the recovery serum of mumps patients has strong inhibition of agglutination, while early serum inhibition is weak. If the titer of the two determinations differs by more than 4 times, it is positive.
4, virus separation
In early cases, mumps virus can be isolated from saliva, urine, blood, cerebrospinal fluid, and other tissues such as the brain and thyroid. The procedures are more complicated and are currently unconditionally carried out.
5, urine routine examination
When the kidney is involved, there may be proteinuria in the urine, red blood cells, etc., and even changes in urine like nephritis.
6, ECG check
ECG icon when combined with myocarditis: arrhythmia, T wave low level, ST segment depression.
Diagnosis
Diagnosis and diagnosis of parotid gland infection
diagnosis
Diagnosis can be performed based on clinical manifestations and examinations.
Differential diagnosis
It is differentiated from mumps, pharyngitis, and tonsillitis.
