Parotid gland swelling
Introduction
Introduction The anterior boundary of the parotid gland is the anterior border of the mandibular branch, the posterior border is the upper kyphosis of the sternocleidomastoid and the external auditory canal. The upper boundary is the lower edge of the zygomatic arch, the lower boundary is the lower mandibular angle or lower than the mandibular angle l-2cm. There are many causes of swelling of the parotid gland, which may be diseases of the parotid gland itself, local signs of systemic diseases, or diseases of non- parotid tissues such as chewing muscles.
Cause
Cause
The parotid gland originates from the ectodermal epithelium near the upper and lower jaw bifurcations. At the cheek corresponding to the opening of the parotid duct, the epithelium grows outward and then turns to the dorsal side, reaching the surface of the mandibular and chewing muscles, and then inward. Human posterior fossa. During development, the parotid gland and lymphoid tissue are closely related. At the same time as the parotid gland develops, lymph nodes in the neck and parotid glands also occur. There is lymphatic infiltration around the original parotid tissue. Therefore, there may be lymph nodes in the parotid gland tissue, and the parotid gland tissue may also protrude into the lymph nodes. At the same time, the cervical lymph nodes may also contain parotid tissue. Therefore, lymphoid tissue lesions such as adenolymphoma can be seen in the parotid gland. When the syndrome is qualified, the cervical lymph nodes can also be swollen.
The parotid gland is open to the oral cavity through the parotid duct opening in the cheek stimuli opposite the crown of the maxillary second molar. Dehydration caused by high fever and difficulty in eating can lead to reduced salivation, lack of mechanical washing, and reduced antibacterial ability. In the case of low systemic resistance of the patient, the bacteria can be caused by acute suppurative mumps through the parotid duct. When the young patient's wisdom tooth erupts, there is a ductal stimuli bite, and the original scar is healed, causing the catheter to narrow. Older patients can also cause scarring and stenosis due to bad dentures due to bad dentures. In addition, trauma, foreign bodies, stones and diffuse inflammation of the catheter cause sputum outflow, and retrograde infection leads to chronic obstructive mumps.
(1) Tumor and tumor-like lesions in the parotid gland
1. Benign tumors include pleomorphic adenomas, adenolymphomas, and myoepithelial tumors.
2. Malignant tumors Primary malignant tumors such as epidermoid carcinoma, adenoid cystic carcinoma, squamous cell carcinoma, acinar cell carcinoma and malignant pleomorphic adenoma, as well as metastatic carcinoma of the parotid gland.
3. Tumor-like lesions include the first cleft palate cyst, parotid cyst, eosinophilic lymphogranuloma, parotid hemangioma and vascular malformation.
(B) inflammatory parotid swelling
1. Acute inflammation such as mumps, acute suppurative mumps, parotid lymphadenitis, etc.
2. Chronic inflammatory chronic suppurative mumps, parotid tuberculosis, actinomycosis in the parotid gland.
(3) Parotid swelling caused by other causes
Such as benign hypertrophy of the parotid gland, drug-responsive enlargement, and some syndromes such as Sjogren's syndrome, uveal gland heat, etc. caused by parotid swelling.
(4) Non-thyroid diseases
Such as benign swelling of the chewing muscles, infections under the chewing muscles.
Examine
an examination
Related inspection
X-ray lipiodol imaging head palpation
Serous cavity effusion --
In the case of disease, excess fluid accumulated in the thoracic cavity, abdominal cavity, or pericardial cavity (collectively referred to as the serosal cavity) is collectively referred to as serous effusion.
T cell garland formation test --
The surface of T cells has a receptor for sheep red blood cells (SRBC), which forms a wreath-like cell with SRBC, called red blood cell rosette formation or E rosette formation.
Ear, nose, throat swab bacterial culture --
The bacteria in the ear, nose and throat are all from the outside world and do not cause disease under normal circumstances. However, infection may occur due to a decrease in body or local body resistance and other external factors. Therefore, bacterial culture of ear, nose and throat swabs can isolate pathogenic bacteria and contribute to the diagnosis of otitis media, rhinitis, sinusitis, diphtheria, suppurative tonsillitis and acute pharyngitis. The specimen is taken by a doctor using a sterile cotton swab and the secretion of the patient's lesion is taken for examination.
Anti-keratin antibody (AKA) --
Anti-keratin antibody (AKA), Young et al found in 1979, found that rheumatoid arthritis (RA) serum has an antibody that reacts with the rat's esophagus, and is specific for rheumatoid arthritis (RA). For AKA. In 1989, Vincent et al. suggested that AKA should be renamed as an anti-keratinocyte antibody. AKA can occur several years before the onset of RA, so it has early diagnostic value.
AKA test method: The lower third of the esophagus of 6-week-old male Wistar rats was taken as an antigen, and frozen sections were made, and the thickness was 4 m to 5 m, and stored at -70 °C for use. The serum was diluted 1:20, incubated in a humid box at 37 ° C for 30 minutes, rinsed with PBS, blown dry, and fluorescein-labeled goat anti-human IgG diluted 1:20, incubated at 37 ° C for 30 minutes, rinsed, blow dried, buffered glycerin seal Tablets were observed under a fluorescence microscope.
Judging criteria: linear or lamellar fluorescence with typical regularity in the stratum corneum is positive.
Diagnosis
Differential diagnosis
1. Tumor and tumor-like lesions in the parotid gland
Benign tumor of the parotid gland
Mixed tumors of the parotid gland are most common. It is a painless mass and grows slowly. The surface is smooth or nodular, medium-hard and active. The angiography is shown as the catheter being displaced. Most of the adenomas are located in the posterior pole of the parotid gland. The surface area of the tumor is smooth and the texture is soft. 99m tin nuclide imaging showed "hot nodules.
2. Parotid malignant tumor
Low-grade malignant tumors include well-differentiated mucoepidermoid carcinoma, acinar cell carcinoma, and papillary cystic carcinoma. The clinical manifestations are rapid tumor growth, adhesion of the mass to the surrounding area, inactivity, and hard texture. Highly malignant tumors are more common with adenocarcinoma, adenoid cystic carcinoma, poorly differentiated sputum epidermoid carcinoma, and squamous cell carcinoma. In addition to low-grade malignant tumor performance, it is accompanied by neurological symptoms such as pain and tenderness. In severe cases, facial paralysis may occur, surface skin may be ulcerated, cervical lymph nodes may occur, and even distant metastasis may occur through the blood. .
3. Tumor-like lesions in the parotid gland
More common parotid hemangioma and vascular malformations. Capillary hemangioma is more common in infants with clear tumor boundaries, greater toughness, and less compressibility. Cavernous hemangioma is more common in older children and adults. The tumor is soft in texture, unclear in boundaries, compressible, and positive in bow down test.
Second, mumps swelling
1. Mumps is mainly composed of children aged 5-15 years. It is often popular in spring and has a history of exposure. The parotid gland enlarges first from one side, and the other side becomes swollen after 3-5 days. The parotid gland is diffusely swollen and tender. The opening of the parotid duct is slightly red, but the clear discharge is visible in the parotid gland. Symptoms such as fever, fatigue and headache can occur throughout the body. The blood routine white blood cell count is normal or low, and the course of disease is about 7-10 days. After life, you can get lifelong immunity.
2. Acute suppurative mumps
Most of them occur in middle-aged and elderly patients who have been fasting to bed for a long time and have weak constitution. Usually unilateral parotid gland involvement. The swelling is centered on the earlobe and has a distinct red color. Swelling, heat, pain, severe symptoms of systemic poisoning. The opening of the parotid duct was significantly red and swollen, and there was pus out of the parotid gland. Laboratory tests for elevated white blood cell counts.
3. Chronic suppurative mumps
According to clinical characteristics, they are divided into two categories.
(1) Chronic recurrent mumps: common in children. Adults are also visible, but there is a history of childhood. More men than women. The parotid gland has a history of repeated swelling, and the sputum of the parotid gland can be seen as purulent or jelly-like secretion. As the age increases, the number of episodes and symptoms gradually decrease. Parotid angiography showed that the distal catheter was punctate and globular.
(2) Chronic obstructive mumps: more often in middle age, more common on one side. The swelling is related to eating, and it reaches a peak in a short time. The general duration is about 2d. The sputum of the parotid gland can be seen to flow out of the turbid sample. Elderly patients with a history of the disease can be under the buccal membrane and a thick, cord-like parotid duct. Parotid gland angiography showed partial dilatation, partial stenosis, and a change in sausage-like appearance of the main catheter and inter-leaf duct.
Third, non-inflammatory parotid swelling
Benign hypertrophy of the parotid gland
More common in middle-aged and elderly, mostly bilateral swelling. The parotid gland gradually enlarges and can be recurrent but not painful. The gland is diffusely swollen, soft, no tenderness, no redness in the mouth of the catheter, and a clear liquid flow out of the extruded parotid gland. There are often associated diseases such as diabetes, liver disease, malnutrition, etc. and the history of taking antihypertensive drugs. Parotid angiography showed normal appearance but increased volume. The emptying function was slightly delayed, and the ultrasound showed diffuse enlargement of the gland and enhanced echo, but no localized echo abnormalities.
2. Sjogren syndrome
More common in middle-aged and older women, the incidence is slow. The disease can be diagnosed by the presence of two of the three symptoms of dry mouth, dry keratoconjunctivitis and connective tissue disease. Most of the parotid glands are bilateral and can be recurrent. It is diffuse, no tenderness, and there is no secretion or secretion of saliva in the duct of the parotid gland. In the case of secondary infection, there is tenderness and turbid snowy saliva can flow out. A small number of patients can reach a nodular mass and are easily misdiagnosed as a tumor. Oral symptoms are mainly dry mouth, can not enter dry food, oral hair, abnormal taste. The film of the tongue and tongue is red, the tongue is cracked, the back of the tongue is atrophied, and the tongue is smooth. Eye symptoms are dry eyes, itching, pain and foreign body sensation. Laryngeal gland enlargement can cause difficulty in blinking and cleft palate. Most of the connective tissue diseases are rheumatoid arthritis, and systemic lupus erythematosus, scleroderma, polymyositis, and nodular arteritis can also occur. Parotid gland angiography showed a spherical expansion of the distal catheter. It can also be expressed as only the main catheter and the inter-leaf duct development, and the peripheral gland tissue is not developed, so-called centripetal atrophy, which is a late lesion. The emptying function is obviously slow. The histological examination of the small parotid gland showed lymphatic and plasma cell infiltration and atrophy of the glandular parenchyma. Laboratory tests showed accelerated erythrocyte sedimentation rate, elevated immunoglobulin, rheumatoid factor, antinuclear antibody, SS-A, SS-B, etc. may be positive.
Fourth, parotid disease
1. chewing muscle good test hypertrophy
The patient's face was asymmetrical and had no obvious symptoms. There is generally a history of unilateral chewing. The chewing muscles are clearly visible when the patient sees the entire chewing muscle. The parotid gland is normal to the mouth, and the parotid gland has a clear liquid outflow. No abnormalities were found in the parotid gland.
2. Gummy muscle gap infection
Patients have a history of pain in the pericardial periodontitis or mandibular molar infection. The chewing muscle area is obviously red, swollen and hot, and the tenderness is obvious, accompanied by limited mouth opening. Puncture can extract purulent secretions. No abnormalities were found in the parotid duct opening. Saliva is well secreted.
