Introduction
Parotid abscess is suppuration of the parotid space. Contents of parotid space include parotid gland and its associated parotid lymph nodes, facial nerve, external carotid artery and retromandibular vein. The fascial layer is very thick superficially but very thin on the deep side of the parotid gland where the parotid abscess can burst to form a parapharyngeal abscess and then spread to the mediastinum.[1]
Dehydration, particularly in postsurgical cases and debilitated patients, with stasis of salivary flow is the predisposing cause. Infection from the oral cavity travels via the Stenson’s duct to invade the parotid gland. Multiple small abscesses may form in the parenchyma. They may then coalesce to form a single abscess. Furthermore, parotid abscess is a dangerous complication of parotitis. The most common organism is Staphylococcus aureus but Streptococci, anaerobic organisms and rarely the Gram-negative organisms have been cultured.[2]
Clinical features include swelling, redness, indurations and tenderness in the parotid area and at the angle of mandible. Parotid abscess is usually unilateral, but bilateral abscesses may occur. Fluctuation is difficult to elicit due to thick capsule. Opening of the Stenson’s duct becomes congested and may exude pus on pressure over the parotid. The patient is toxic, running high fever and dehydrated.[3]
Treatment of parotid abscess is to correct dehydration, improve oral hygiene and promote salivary flow. Intravenous antibiotics are instituted. Surgical drainage under local or general anaesthesia is carried out by a preauricular incision as employed for parotidectomy. Skin flap is raised to expose the surface of the gland, and the abscess or abscesses are bluntly opened working parallel to the branches of the VIIth nerve. Skin incision is loosely approximated over a drain and allowed to heal by secondary intention.[4]
A direct description of parotid abscess is not found in Ayurvedic texts, but it can be correlated with Pittaja Vidradhi. The classical symptoms include swelling similar to Pakwa Udumbara (ripened fruit of cluster fig), Shyava Varna (blackish discoloration), along with Jwara (fever) and Daha (burning sensation). Term Kshipra Utthana Prapakavastha denotes its rapid onset and quick suppuration.[5]
Ayurveda also highlights that not every disease is mentioned by name; rather, the line of treatment should be based on Dosha involvement and Samutthana Vishesha (the specific causative factors).[6]
The conventional treatment of parotid abscess involves incision and drainage through a preauricular incision. Although this surgical procedure is associated with several potential complications such as injury to the branches of the facial nerve, salivary fistula formation, secondary infection, and delayed wound healing. In contrast, Dashanga Lepa has significant therapeutic benefits in such cases.
Its anti-inflammatory, analgesic and Kledahara properties help in reducing pain, swelling, and suppuration without the need for invasive intervention. Clinical observations suggest that Dashanga Lepa provides a safe, simple, and effective alternative, ensuring complete healing while eliminating the risks associated with surgical management.
Case Report
Chief Complaints with Duration
A 46-year-old female patient has been suffering from swelling over the left pre auricular region associated with throbbing pain. She also complained of pus discharge from the mouth and difficulty in mastication. She reported episodes of bleeding from the gums.
The patient was asymptomatic until two years ago, when she suddenly developed swelling over the left pre auricular region accompanied by mild pain. In addition, the patient had fever, malaise, and vomiting. These symptoms persisted for 2-3 days and resolved after receiving antibiotic and antipyretic treatment from the dental hospital. However, this time the symptoms were more severe compared to the previous episode. She presented with swelling and throbbing pain over the pre auricular region, along with pus discharge from the mouth, difficulty in mastication and bleeding from the gums. She again visited a dental hospital, where surgical intervention was advised. On the same day, the patient came to our dental OPD seeking treatment for the same condition.
Past History: Recurrent history of sialadenitis
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