Conservative Management of Chronic Suppurative Parotitis in Patients with Sjögren Syndrome: A Case Series

Case series Patients: Female, 82-year-old • Female, 77-year-old • Female, 47-year-old Final Diagnosis: Chronic suppurative parotitis Symptoms: Dry mouth • pus discharge • swelling Medication: — Clinical Procedure: Drainage Specialty: Dentistry • Infectious Diseases OBJECTIVE: Unusual clinical course BACKGROUND: Parotitis is an inflammation of the parotid gland, which can be caused by factors including infection, radiation, and hyposalivation secondary to systemic conditions, such as Sjögren syndrome, rheumatoid arthritis, or medication. Bacterial parotitis is a rare complication that can be observed in patients with hyposalivation. However, it is also observed in elderly and immunocompromised patients. Lack of continuous flushing of salivary glands and their ducts due to decreased salivary flow renders the glands prone to retrograde colonization with oral microflora. Several microorganisms have been associated with bacterial infections of the parotid glands; Staphylococcus aureus is the most common, accounting for 80% of cases, followed by mixed bacterial communities, including streptococci, anaerobes, and gram-negative bacilli. Bacterial parotitis presents as tenderness, swelling, and purulent sialorrhea from the salivary gland’s duct. Immediate administration of broad-spectrum antibiotics, based on the results of the patient’s culture and sensitivity test, has shown success in treating these cases. CASE REPORTS: We report 3 cases of chronic suppurative parotitis secondary to dry mouth and due to Sjögren syndrome that did not respond to oral or intravenous antibiotics and was successfully managed using conservative methods, such as the local application of superficial moist heat and periodic pus drainage by manipulating the parotid glands at dental clinics. CONCLUSIONS: We concluded that conservative approaches, such as massaging the glands, local application of superficial moist heat, and periodic pus drainage without using antibiotics, should be considered as the first-line management of bacterial infection of the parotid glands.