Correspondence Address:
Dr. Jamir Pitton Rissardo
Av. Roraima, 1000 - Camobi, Santa Maria – RS 97105-900
Brazil

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Sir,

We read the article entitled “Facial Nerve Palsy in Parotid Infection - A Benign Deviance from the Malignant Norm” on the esteemed “Journal of the Scientific Society” with great interest. Pattanshetti et al. described an elderly male presenting with bilateral painful parotid swellings. After 10 days, he complained of inability to close his eye and mouth. A left-sided lower motor neuron facial nerve palsy of House–Brackmann Grade IV was observed. A contrast-enhanced computed tomography scan of the neck revealed a parotid abscess with no extension into the parapharyngeal space.[1]

Acute bacterial suppurative parotitis and parotid abscesses are uncommonly reported. But, they usually occur in immunocompromised individuals, with postoperative conditions, poor oral hygiene, and dehydration.[2] The most common clinical manifestation of parotid abscess is a very painful mass located at the angle of the mandible associated with necrosis of the parotid gland. In this context, parotid abscess presenting with seventh lower motor neuron cranial nerve palsy was rarely depicted.

A literature search was performed in MEDLINE/PubMed, on a set of terms that included parotid, abscess, and facial nerve [Table 1]. Only articles in English with a complete report of the year of the publication, authors' country, patient's sex, age, comorbidities, bacterial culture, management, and recovery status in the follow-up were included. We identified 14 studies with 17 individuals. Also, we added the case described by Pattanshetti et al. and an unreported case from our institution.{Table 1}

A recent study published by Pruijn et al. stated that malignancy needs to be excluded in facial nerve palsy and parotid gland abscess. Also, they showed that facial nerve paresis has higher recovery chances compared to facial nerve paralysis.[3] Nonetheless, we found in our literature review that only 41.17% (7/17) will have a full recovery (House–Brackmann grade I).

The predominantly reported population affected were females (13/17) approximately 60 years old. The most common comorbidity was diabetes mellitus (7/17), but some individuals had other medical conditions such as congestive heart failure, renal failure, dehydration, and neutropenia. Staphylococcus aureus and Pseudomonas aeruginosa were the most frequent bacteria in culture growths. The management should involve a combination of antibiotics with abscess incision and drainage. Apparently, only oral antibiotics are not related to good outcomes.[4] For example, the individual reported by Pattanshetti et al. refused to get admitted and was started on oral antibiotics, but the abnormal function of the facial nerve remained even after appropriate antimicrobial spectrum adjustment.[1]

Srivanitchapoom and Yata studied the clinical factors that could predict a diagnosis of parotid abscess among individuals presenting bacterial parotitis. The variables significantly related to parotid abscess were subacute presentation, enlarged glands with fluctuation, and absence of anemia. It is worthy of mentioning that, after surgical drainage, only 12% (3/25) of the individuals had complications such as septicemia and localized cellulitis.[5] Therefore, surgical intervention plays a critical role in the treatment of this condition.

The literature has scarce data regarding parotid abscesses and facial nerve palsy. In this way, we need systematic reviews with an ample analysis of the published studies, preferentially without language restriction. Furthermore, other management protocols with microsurgery and antibiotics are needed to improve long-term outcomes of cranial nerve palsies.

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 References

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