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Diagnosis of ABP requires a thorough history and physical examination followed by laboratory and radiographic corroboration of the clinical diagnosis. Whether occurring in outpatient or inpatient arenas, a history of use of anti‐sialogogue medications, dehydration, malnutrition, diabetes mellitus, immunosuppression, surgery, or systemic disease supports this diagnosis. A predilection for males exists for ABP, and the average age at presentation is 60 years (Miloro and Goldberg 2002). A systemic disorder will result in both glands being affected, but when one gland is affected, the right gland seems to be involved more commonly than the left gland (Miloro and Goldberg 2002). The declaration of acute requires that the parotitis has been present for one month or shorter.

The classic symptoms include an abrupt history of painful swelling of the parotid region, typically when eating. The physical findings are commonly dramatic, with parotid enlargement, often displacing the ear lobe, and tenderness to palpation. If the Stensen duct is patent, milking the gland may produce pus (Figures 3.4 and 3.5). A comparison of salivary flow should be performed by also examining the contralateral parotid gland as well as the bilateral submandibular glands. The identification of pus should alert the clinician to the need to obtain a sterile culture and sensitivity. Constitutional symptoms may be present, including fever and chills, and temperature elevation may exist provided the gland is infected. If glandular obstruction is present without infection, temperature elevation may not be present. Laboratory values will show a leukocytosis with a bandemia in the presence of true bacterial infection, with elevated hematocrit, blood urea nitrogen, and urine specific gravity if the patient is dehydrated. Electrolyte determinations should be performed in this patient population, particularly in inpatients and outpatients who are malnourished. Probing of Stensen duct is considered contraindicated in ABP. The concern is for pushing purulent material proximally in the gland, although an argument exists that probing may relieve duct strictures and mucous plugging.

The radiographic assessment of ABP is discussed in detail in Chapter 2. Briefly, plain films are of importance to rule out sialoliths, and special imaging studies may be indicated to further image the parotid gland depending on the magnitude of the swelling and the patient's signs and symptoms (Figure 3.7). The presence of an intraparotid abscess on special imaging studies, for example, may direct the clinician to the need for expedient incision and drainage.