Treatment for parotid abscess: a systematic review

Abstract

SUMMARY A parotid abscess is a dangerous complication of parotitis. In this study, we aimed to define current treatment concepts for parotid abscess, focusing on different management options. The authors performed a PRISMA-compliant systematic review across multiple databases including all original studies published until January 2021 focusing on treatment of parotid abscess. Studies specifying treatment modalities and treatment success rates were included based on abstract and full-text selection. The authors assessed study quality, demographics, success rates, management modalities and adverse events. Among 1,318 citations, 18 studies met our inclusion criteria. Twelve studies relied only on incision and drainage with antibiotic therapy; the remaining 6 compared different treatment modalities (incision and drainage versus exclusive medical therapy or ultrasound-guided drainage). Heterogeneity between studies precluded meta-analysis of data. The review showed that antibiotics remain the mainstay of treatment for parotid abscess. Conversely, the role of incision and drainage, and aspiration should be studied further. The higher rate of complications following incision and drainage suggests a more conservative approach is needed. Incision and drainage remain the main salvage option for conservative treatment failures.

Ultrasound-Guided Needle Aspiration vs. Surgical Incision of Parotid Abscesses

“…A possible explanation for this fact might be the wish of younger patients to avoid scaring and the (though very small) risk of a lesion of the facial nerve as a consequence of surgical drainage. The mean age of all patients (56.12 years) in our patient population was in general consistent with the results of other retrospective data collections on parotid abscesses in adults [12,16,17]. In accordance with the literature [1,12,17], Staphylococcus aureus was also one of the most frequently detected bacterial pathogens in our data collection.…”

“…Management of parotid abscesses includes conservative antibiotic treatment and/or surgical incision and drainage, imaging-guided percutaneous drainage, or needle aspiration. The treatment decision is usually based on the individual preferences of the clinician [12]. Fully published descriptive or controlled studies on the question of whether ultrasoundcontrolled needle aspiration is a safe and effective alternative to the surgical procedure are still lacking.…”

“…To our knowledge, the present analysis represents the data collection with the highest total case number of parotid abscesses. Preliminary data indicate that ultrasound-guided needle aspiration is not inferior to surgical incision and drainage while at the same time reducing the risk of complications [12,13]. Ultrasound-guided needle aspiration can be performed repeatedly without increased risk of exposure to radiation, frequent bleeding, irreversible injuries of neurovascular structures, or harmful effects by general anesthesia [9,14].…”

“…Experience to date is primarily based on retrospectively collected case reports or series, and the number of cases is therefore limited. However, the few available observations suggest that ultrasound-based needle aspiration is generally associated with fewer complications than surgical incision or drainage-with comparable success rates [12,13]. According to a recent systematic review, 18 total patient cases of parotid abscesses treated by "ultrasound-guided aspiration" have been reported in the published literature between 1999 and 2021 without any complications [12].…”

“…However, the few available observations suggest that ultrasound-based needle aspiration is generally associated with fewer complications than surgical incision or drainage-with comparable success rates [12,13]. According to a recent systematic review, 18 total patient cases of parotid abscesses treated by "ultrasound-guided aspiration" have been reported in the published literature between 1999 and 2021 without any complications [12]. In light of the lack of systematically collected data, we performed a comprehensive retrospective evaluation of all patient cases who underwent surgical treatment or ultrasound-guided fine-needle aspiration at our clinic for parotid abscess during a period of eleven years.…”