Q & A - Painful parotid salivary gland

[Guest guest]

In a message dated 10/10/06 9:00:28 PM Central Daylight Time,

Matsumura_Clan@... writes:

> I drink a lot

> of water, but it doesn't seem to help the swelling and pain. Is there

> something else I can do?

>

lemon drops will help it to go down ...I also suffer with the swollen

glands, my doctor told me that lemon will help

peace,gayle the quiet one

[Guest guest]

Painful Parotid Salivary Gland

by Hoffman, MD, PhD

Question:

I have Sjogren's syndrome and have been managing my symptoms fairly well.

However, I have problems with parotid gland swelling and pain. I drink a lot

of water, but it doesn't seem to help the swelling and pain. Is there

something else I can do?

Answer:

Sjogren's syndrome is an autoimmune disease, an illness in which the body's

immune system mistakenly attacks itself -- not haphazardly, for only

particular tissues are affected. Dry eyes and dry mouth are the hallmark of

Sjogren's syndrome, but dryness of the nose, throat, skin and vagina are

also occasionally noted. As with any autoimmune disease, chronic fatigue

troubles some patients. Sjogren's syndrome often accompanies other

autoimmune diseases such as rheumatoid arthritis. Physicians may suspect

Sjogren's is present when a patient known to have another autoimmune disease

complains of dry eyes or mouth. Certain blood tests support the diagnosis of

Sjogren's disease, but a salivary-gland biopsy is essential to be certain of

the diagnosis. The biopsy is most commonly done by an ear, nose and throat

surgeon (ENT), who can remove a few minor salivary glands through a small

incision on the lower lip.

One critical aspect of your question is something that you may not have

considered: Have you been correctly diagnosed with Sjogren's syndrome? It is

an unfortunate fact of life that, thanks to HMOs and other insurers,

medicine is not always practiced as it should be. If you have not had a

biopsy to prove the diagnosis, you should ask your doctor, " How can you be

certain that I have Sjogren's syndrome? "

Recurrent, painful swelling of the parotid gland (located on the side of the

face, in front of the ear) is known as " chronic sialadenitis, " and Sjogren's

syndrome is only one of many possible causes. In all cases, there is

obstruction of the flow of saliva through the parotid duct (the tube that

channels saliva from the parotid gland into the mouth). With Sjogren's

syndrome, obstruction presumably occurs because swelling of the gland puts

pressure on the duct.

Conservative treatment of chronic sialadenitis involves the following

measures:

Staying well hydrated. I recommend that patients drink eight to 10

eight-ounce glasses per day of nonalcoholic, noncaffeinated beverages.

Avoiding any alcohol or caffeine is helpful.

Stimulating the flow of saliva. I often recommend that patients suck

on sour candies, but this is damaging to the teeth in the long run. A safer

course is to chew sugar-free gum frequently throughout the day. FIRM massage

of the parotid gland (no bruises, please) can also help stimulate salivary

flow.

Using soothing warm packs when the glands are particularly tender.

Watching for infection. If one or both parotids becomes very swollen,

tender and red, I worry about bacterial infection. A staphylococcus species

is the usual culprit. Antibiotics are necessary, and it is imperative that

the antibiotic kill staphylococcus. Penicillin, ampicillin (Omnipen) and

amoxicillin (Amoxil) are NOT appropriate antibiotics.

If your parotid swelling is related to Sjogren's syndrome, you may want to

ask your doctor about more aggressive treatment of Sjogren's syndrome. Ask

him or her about the drug hydroxychloroquine (Plaquenil) and about drugs to

suppress the immune system. All of these medicines have associated risks and

side effects, so you will need to have a careful discussion with your doctor

before you can knowledgeably weigh your options.

If conservative treatment consistently fails to help you, and if more

aggressive treatment of your Sjogren's disease is ineffective, surgical

removal of the parotid(s) is an effective option OF LAST RESORT. This

operation (called " total parotidectomy " ) carries with it risk to the nerve

that controls the muscles of facial expression and will inevitably leave you

with a much drier mouth.

http://health.ivillage.com/autoimmune/ausjogren/0,,6blk,00.html

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org