Indian J Pediatr DOI 10.1007/s12098-014-1380-0
SCIENTIFIC LETTER
Facial Nerve Palsy Caused by Parotid Abscess in an Infant C. Anitha & K. Jagadish Kumar & M. G. Anil Kumar & Abhishek Chavan
Received: 3 August 2013 / Accepted: 16 February 2014 # Dr. K C Chaudhuri Foundation 2014
To the Editor: A 10-mo-old girl presented with 7 d of fever, redness of the left preauricular area since 5 d and ear discharge since 1 d. She was febrile (105 °F), toxic, conscious and an erythematous, nonfluctuant tender swelling in the left preauricular area of about 1.5 cm in diameter was noted. Otoscopy revealed purulent discharge from the external auditory canal with normal tympanic membrane. The child developed left lower motor neuron (LMN) facial palsy after a period of 12 h. A probable diagnosis of acute suppurative parotitis with left LMN facial palsy was entertained. She was started on intravenous metrogyl, co-amoxyclav and ceftriaxone. Her investigations revealed a Hemoglobin of 9.3 g/dL, total count of 38,400/mm3 (76 % of neutrophils), platelets were 4.63 lakhs/mm3, blood sugar 124 mg/dL, serum amylase and serum lipase values were 131 IU/L (Normal amylase= 25–125 U/L) and 98 U/L (Normal lipase=5.6–51.3 U/L) respectively. Her human immunodeficiency virus (HIV) status was negative. Ultrasound of the parotid gland showed abscess measuring 2*1.5 cm (Fig. 1). Surgical drainage was performed and 10 mL of pus was removed. Blood culture and pus culture were sterile. Facial palsy improved completely by 10 d and she was discharged.
Acute parotitis is rare in children [1]. Parotid abscess is potentially a life-threatening complication of acute suppurative parotitis and is of utmost significance as it can result in septicemia, fasciitis and deeper neck abscesses [2, 3]. Ultrasound imaging is the initial diagnostic method and is successful in detecting abscess in nine out of ten cases [3]. Out of 21 children with a diagnosis of parotitis, two children required surgical drainage of the abscess [1]. Facial palsy in association with suppurative parotitis is rare and only few cases are reported in Adults [4]. Out of 39 pediatric suppurative parotitis cases in Cambodia only one child had developed facial palsy and all of them required surgical incision and drainage procedure [5]. Out of ten pediatric cases, parotid abscess ruptured through the periauricular area in two cases
C. Anitha : K. J. Kumar : A. Chavan Department of Pediatrics, JSS Medical College, JSS University, Mysore, India M. G. A. Kumar Department of Pediatric Surgery, JSS Medical College, JSS University, Mysore, India K. J. Kumar (*) 85/B, 9th Cross, Navilu Road, Kuvempu, Nagar, Mysore 570023, Karnataka, India e-mail: [email protected]
Fig. 1 Ultrasound of the parotid gland showing an abscess measuring 2*1.5 cm
Indian J Pediatr
and into the ear canal in one, but none of the children developed facial palsy [3]. The proposed mechanisms are perineuritis, virulence of the organisms, toxic effects and ischemic neuropathy due to nerve compression [4]. Facial palsy in our patient recovered completely after 10 d of intravenous antibiotics and it forms the cornerstone of treatment. Out of 21 children with parotitis 2 of them developed parotid abscess, which warranted surgical drainage and therefore authors concluded that other than abscess drainage, surgery for parotitis in children is not routinely recommended [1]. In the present child, the development of facial palsy could have been probably prevented if the abscess were to be detected and drained early .To conclude, even though parotid abscess is rare in children, a high index of suspicion is necessary and ultrasound is mandatory to detect abscess, and thereby helps in preventing facial palsy and other morbidities.
Conflict of Interest None. Role of Funding Source None.
References 1. Stong BC, Sipp JA, Sobol SE. Pediatric parotitis: A 5-year review at a tertiary care pediatric institution. Int J Pediatr Otorhinolaryngol. 2006;70:541–4. 2. Ganesh R, Leese T. Parotid abscess in Singapore. Singap Med J. 2005;46:553–6. 3. Saarinen RT, Kolho KL, Pitkaranta A. Cases presenting as parotid abscesses in children. Pediatr Otorhinolaryngol. 2007;71:897–901. 4. Noorizan Y, Chew YK, Khir A, Brito-Mutunayagam S. Parotid abscess: An unusual cause of facial nerve palsy. Med J Malays. 2009;64:172–3. 5. Stoesser N, Pocock J, Moore CE, Soeng S, Chhat HP, Sar P, et al. Pediatric suppurative parotitis in Cambodia 2007 and 2011. Pediatr Infect Dis J. 2012;31:865–8.
SCIENTIFIC LETTER
Facial Nerve Palsy Caused by Parotid Abscess in an Infant C. Anitha & K. Jagadish Kumar & M. G. Anil Kumar & Abhishek Chavan
Received: 3 August 2013 / Accepted: 16 February 2014 # Dr. K C Chaudhuri Foundation 2014
To the Editor: A 10-mo-old girl presented with 7 d of fever, redness of the left preauricular area since 5 d and ear discharge since 1 d. She was febrile (105 °F), toxic, conscious and an erythematous, nonfluctuant tender swelling in the left preauricular area of about 1.5 cm in diameter was noted. Otoscopy revealed purulent discharge from the external auditory canal with normal tympanic membrane. The child developed left lower motor neuron (LMN) facial palsy after a period of 12 h. A probable diagnosis of acute suppurative parotitis with left LMN facial palsy was entertained. She was started on intravenous metrogyl, co-amoxyclav and ceftriaxone. Her investigations revealed a Hemoglobin of 9.3 g/dL, total count of 38,400/mm3 (76 % of neutrophils), platelets were 4.63 lakhs/mm3, blood sugar 124 mg/dL, serum amylase and serum lipase values were 131 IU/L (Normal amylase= 25–125 U/L) and 98 U/L (Normal lipase=5.6–51.3 U/L) respectively. Her human immunodeficiency virus (HIV) status was negative. Ultrasound of the parotid gland showed abscess measuring 2*1.5 cm (Fig. 1). Surgical drainage was performed and 10 mL of pus was removed. Blood culture and pus culture were sterile. Facial palsy improved completely by 10 d and she was discharged.
Acute parotitis is rare in children [1]. Parotid abscess is potentially a life-threatening complication of acute suppurative parotitis and is of utmost significance as it can result in septicemia, fasciitis and deeper neck abscesses [2, 3]. Ultrasound imaging is the initial diagnostic method and is successful in detecting abscess in nine out of ten cases [3]. Out of 21 children with a diagnosis of parotitis, two children required surgical drainage of the abscess [1]. Facial palsy in association with suppurative parotitis is rare and only few cases are reported in Adults [4]. Out of 39 pediatric suppurative parotitis cases in Cambodia only one child had developed facial palsy and all of them required surgical incision and drainage procedure [5]. Out of ten pediatric cases, parotid abscess ruptured through the periauricular area in two cases
C. Anitha : K. J. Kumar : A. Chavan Department of Pediatrics, JSS Medical College, JSS University, Mysore, India M. G. A. Kumar Department of Pediatric Surgery, JSS Medical College, JSS University, Mysore, India K. J. Kumar (*) 85/B, 9th Cross, Navilu Road, Kuvempu, Nagar, Mysore 570023, Karnataka, India e-mail: [email protected]
Fig. 1 Ultrasound of the parotid gland showing an abscess measuring 2*1.5 cm
Indian J Pediatr
and into the ear canal in one, but none of the children developed facial palsy [3]. The proposed mechanisms are perineuritis, virulence of the organisms, toxic effects and ischemic neuropathy due to nerve compression [4]. Facial palsy in our patient recovered completely after 10 d of intravenous antibiotics and it forms the cornerstone of treatment. Out of 21 children with parotitis 2 of them developed parotid abscess, which warranted surgical drainage and therefore authors concluded that other than abscess drainage, surgery for parotitis in children is not routinely recommended [1]. In the present child, the development of facial palsy could have been probably prevented if the abscess were to be detected and drained early .To conclude, even though parotid abscess is rare in children, a high index of suspicion is necessary and ultrasound is mandatory to detect abscess, and thereby helps in preventing facial palsy and other morbidities.
Conflict of Interest None. Role of Funding Source None.
References 1. Stong BC, Sipp JA, Sobol SE. Pediatric parotitis: A 5-year review at a tertiary care pediatric institution. Int J Pediatr Otorhinolaryngol. 2006;70:541–4. 2. Ganesh R, Leese T. Parotid abscess in Singapore. Singap Med J. 2005;46:553–6. 3. Saarinen RT, Kolho KL, Pitkaranta A. Cases presenting as parotid abscesses in children. Pediatr Otorhinolaryngol. 2007;71:897–901. 4. Noorizan Y, Chew YK, Khir A, Brito-Mutunayagam S. Parotid abscess: An unusual cause of facial nerve palsy. Med J Malays. 2009;64:172–3. 5. Stoesser N, Pocock J, Moore CE, Soeng S, Chhat HP, Sar P, et al. Pediatric suppurative parotitis in Cambodia 2007 and 2011. Pediatr Infect Dis J. 2012;31:865–8.
![[A parotid abscess caused by Salmonella typhimurium].](/assets/img/hold.png)
