0071643192.pdf

HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

SYMPTOMS/EXAM

■ Swelling of the duct area

■ Tenderness and pain along the salivary duct, worse with meals

■ Palpable thickened mass felt along the path of the duct when attempting

to milk salivary gland (see Figures 14.16A and 14.16B)

DIAGNOSIS

■ Plain X-ray is used to confirm the presence of a stone (70% are radiopaque).

■ CT imaging and/or sialogram may be used to characterize the duct or the

presence of an obstructive lesion such as a neoplasm not seen on X-ray.

TREATMENT

■ IV fluids

■ Sour lozenges or sialologues to stimulate salivaries (most pass with this

treatment)

■ Possible surgical excision of the stone by ENT

■ Antibiotics if secondary infection

COMPLICATIONS

■ Infection

■ Facial nerve (CN VII) palsy

OROPHARYNGEAL EMERGENCIES

Upper Airway Foreign Body

ETIOLOGY

■ Children (<3 years old), eg, food, coins, toys

■ Adults: Increased risk associated with elderly, alcohol, dentures, CNS disease

The parotid gland and facial

nerve are in close proximity to

each other. Assess both in

infection or trauma.

A

FIGURE 14.16. (A) Sialoadenitis with drainage from the parotid duct. (B) Sialoadenitis
with associated inflammation of the parotid gland.

(Reproduced, with permission, from Knoop KJ, Stack LB, Storrow AB. Atlas of Emergency
Medicine,2nd ed. New York: McGraw-Hill, 2002:146.)

B