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.
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
Anatomy of the parotid gland and surrounding structures.
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.
The ostium of the parotid duct is located on the buccal
mucosa at the level of the second maxillary molar.
Parotid duct abscesses require intraoral incision and drainage.
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.
- 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
Explain the procedure, ...