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HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

DIAGNOSTICS

■ MRI or CT

■ Blood cultures and Gram stain to evaluate for infection and bacteremia

TREATMENT

■ Early and aggressive intravenous antibiotics

■ Although evidence is limited, heparin is generally used to prevent septic

emboli.

■ Admit to ICU

■ Surgical consultation for drainage of the sphenoid sinus if sphenoid sinusitis

is present

SALIVARY GLAND PROBLEMS

Sialoadenitis

ETIOLOGY

■ Inflammation/infection of the parotid (Stenson) duct or the salivary

gland.

■ Viral infection of the parotid gland (mumps)

■ Bacterial (suppurative) infection usually due to staph or strep but often

concomitant anaerobic pathogens are found

■ Predisposing factors include: Recent anesthesia, dehydration, elderly,

sialolithiasis, oral cancers, ductal foreign body.

SYMPTOMS/EXAM

■ Painful swelling of the parotid or salivary gland area

■ Worse at mealtime

■ On oral exam note drainage from the salivary ducts

■ Viral

■ 90% bilateral

■ Increase in amylase

■ Bacterial

■ Seen in elderly, diabetic, dehydrated patients.

■ Pus from Stensen duct

■ 30% postoperative

■ 20% bilateral

TREATMENT

■ IV fluids for hydration

■ Antibiotics to cover Gram-positive and anaerobic organisms

■ Sour lozenges or sialologues to stimulate salivaries

Sialolithiasis

ETIOLOGY

■ Calculi/stone in the duct

■ 80% are submandibular.

Not all infections in the head

are meningitis. Cavernous

sinus thrombosis must be

considered in patients with

cranial nerve or visual deficits.

Wharton duct =

submandibular duct.

Stensen duct = parotid duct.