Acute suppurative parotitis is initially managed with medical therapy. When that treatment course does not deliver the expected clinical response, escalation to a further approach is indicated. This protocol addresses what comes next.
Initial management — antibiotic therapy (antistaphylococcal penicillins, first-generation cephalosporins, or clindamycin) together with supportive measures — is expected to produce improvement in symptoms, reduction of parotid gland swelling, and resolution of fever and pain within 3 to 5 days. Failure to achieve these goals triggers escalation to this protocol.
When medical management has not achieved the expected response, surgical intervention is the next step. The specific approach, indications, and decision criteria are detailed in the full protocol.
DOI: 10.1053/joms.2002.31234
Should medical management fail, surgery should be considered.
Surgical intervention, including incision and drainage of the gland in the direction of the facial nerve via a standard parotidectomy incision, is indicated for the following: 1) lack of improvement after 3 to 5 days of antibiotic therapy, 2) facial nerve involvement, 3) involvement of adjacent vital structures (lateral pharyngeal space, deep fascial spaces), and 4) frank abscess formation within the gland parenchyma.
There also is support for surgical intervention in the form of superficial parotidectomy for patients with ASP in whom chronic recurrent parotitis then develops.
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