Cases presenting as parotid abscesses in children.

BACKGROUND: A parotid abscess is a rare complication of acute suppurative parotitis which most often requires hospitalization, intravenous antibiotic therapy, and surgical drainage.

OBJECTIVE: To investigate the clinical picture, treatment, and prognosis of children with a parotid abscess in a search for optional clinical guidelines for treatment.

METHODS: A retrospective chart review was performed for 10 children (age<or=17) with a parotid abscess between January 1996 and December 2005.

RESULTS: Of the 10 cases of parotid abscess found, 4 children had had parotid-related symptoms before; bacterial culture was positive in 6; 4 had aerobic Gram-positive pathogens, and 1 girl had parotid tuberculosis. All patients received intravenous antibiotic therapy. The initial diagnostic method was ultrasound in nine cases and MRI in one. Four children underwent surgical drainage, and in three cases there was an ultrasound guided needle aspiration of the abscess. Neither surgical drainage nor aspiration led to fistula formation or any other complication. The abscess ruptured spontaneously through the skin of the periauricular area in two cases and into the ear canal in one. During follow-up, all were symptom-free except for two girls diagnosed with first brachial cleft fistulas. One of these also had a reoccurrence of the parotid abscess. Both later underwent superficial parotidectomy due to persistent symptoms.

CONCLUSIONS: Most parotid abscesses in children are acute multi-bacterial infections not necessarily related to other parotid gland pathologies. Intravenous antibiotic therapy is the cornerstone of treatment, but surgical drainage assists in recovery and should not lead to fistula formation.