Читать книгу Salivary Gland Pathology - Группа авторов - Страница 121

Chronic bacterial parotitis occurs in at least three clinical settings. The first is in which the patient defers evaluation such that the condition has persisted for at least one month. The second includes the setting in which acute bacterial parotitis was managed conservatively, but without resolution (refractory sialadenitis). Finally, it is possible for a successfully treated parotitis to become recurrent such that periods of remission separate recurrent episodes of ABP. The parotid gland may demonstrate evidence of latent infection despite clinical resolution of the disease. The result is scarring in the gland such that function is impaired. Histology will show dilation of glandular ducts, abscess formation, and atrophy (Patey 1965). Pus is rarely observed in chronic bacterial parotitis (Baurmash 2004). Rather, there is a marked reduction of salivary flow, and the parotid secretions are viscous and milky in appearance. The microbiologic etiology of chronic bacterial parotitis is most commonly streptococci and staphylococci, but other organisms may be found as a function of the patient's immune status, the setting in which the parotitis originally occurred, and medical comorbidity. It has been suggested that the accumulation of a semisolid material that obstructs the parotid duct is the culprit in chronic bacterial parotitis (Baurmash 2004). The clinical course of the disease shows pain and swelling waxing and waning. As with acute bacterial parotitis, a screening panoramic radiograph or CT scans should be obtained to rule out the presence of a sialolith (Carlson 2009).