A case report of parotitis secondary to mandibular osteomyelitis

Abstract

We experienced unilateral acute purulent parotitis due to mandibular osteomyelitis. Clinical findings suggested a malignant tumor of the parotid gland, but cytology showed inflammatory changes and no malignant findings, and the patient was diagnosed with purulent parotitis. However, there was no drainage from the parotid duct confirmed in typical purulent parotitis. Bacterial examination detected Porphyromonas gingivalis, and CT showed a radicular cyst and mandibular osteomyelitis in the ipsilateral mandible. Based on these results, the patient was diagnosed with acute purulent parotitis caused by mandibular osteomyelitis associated with a dental infection. Long-term antibiotic administration for 4 weeks improved osteomyelitis. Patients with inflammation of the head and neck region triggered by such dental infection or osteomyelitis often first see a dentist, and there are not many opportunities for an otolaryngologist to see them. However, osteomyelitis patients are treated for a long period of time, and osteotomy may be required if they resist treatment, so early diagnosis is important. We suggest that when treating patients with refractory parotitis, the involvement of osteomyelitis should be suspected as the cause. In addition, this paper examined how to distinguish between typical retrograde infection-induced parotitis and osteomyelitis-induced parotitis based on differences in physical findings, bacterial test results, and imaging findings.