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Patients with pathologic conditions of the parotid gland and/or duct often present to the Emergency Department prior to formal evaluation by an Otolaryngologist. These conditions include obstruction of the duct, abscesses, infections, and tumors. The Emergency Physician can provide temporary relief of a parotid duct abscess until the patient receives definitive care.

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The parotid gland is the largest salivary gland. It is located on the face between the ramus of the mandible and mastoid process1,2 (Figure 153-1). The parotid duct travels across the surface of the masseter muscle and crosses the anterior aspect of the mandible, approximately 1 cm below the zygomatic arch. The duct turns medially to penetrate the buccinator muscle and the buccal fat pad to enter the oral cavity (Figure 153-2). The ostium of the parotid duct is located at the level of the second maxillary molar (Figure 153-3). Abscesses of the parotid duct are often seen in patients with strictures of the parotid duct or a sialolith causing proximal dilatation.3

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Figure 153-1
Graphic Jump Location

Anatomy of the parotid gland and surrounding structures.

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Figure 153-2
Graphic Jump Location

Anatomy of the parotid gland and duct. Note that the duct travels over the masseter muscle and through the buccinator muscle to gain access into the oral cavity.

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Figure 153-3
Graphic Jump Location

The ostium of the parotid duct is located on the buccal mucosa at the level of the second maxillary molar.

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Parotid duct abscesses require intraoral incision and drainage.

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There are no absolute contraindications to the incision and drainage of a parotid duct abscess. Consult an Otolaryngologist prior to proceeding with the procedure. There are a large number of important structures in the area adjacent to the parotid duct. The procedure has the potential to result in complications. Patients with severe trismus limiting visibility and access may require intravenous analgesics and muscle relaxants, procedural sedation, and intraoperative drainage. Consult an Otolaryngologist for all patients who are coagulopathic, taking oral anticoagulants, or with a known bleeding disorder. These patients are at risk for bleeding and associated complications. Admit children to the hospital for intravenous antibiotics, incision and drainage under general anesthesia, and observation.

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  • Gauze 4×4 squares
  • Suction source and tubing
  • Yankauer or Frazier suction catheter
  • #11 scalpel blade on a handle
  • Mosquito hemostat
  • Sterile Penrose drain
  • Ribbon gauze
  • Headlight or overhead spotlight
  • Culturette or culture bottles
  • 4–0 silk suture
  • Suture scissors
  • Oral rinse solution, hydrogen peroxide or Peridex
  • Topical anesthetic spray (lidocaine, tetracaine, or benzocaine)
  • 1 to 2 mL of local anesthetic solution with epinephrine
  • 5 mL syringe
  • 25 or 27 gauge needle, 2 inches long

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Explain the procedure, ...

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