Introduction:
Mumps, a disease largely held at bay by effective vaccines, has undergone a resurgence characterized by an enigmatic twist, the emergence of ‘non-specific’ types of mumps infection. This resurgence challenges the conventional understanding of mumps, which is typically associated with parotitis and swollen cheeks. Instead, this new dimension of mumps reveals a complex array of non-specific manifestations, confounding healthcare professionals and raising questions about the virus's evolution.
What Is Non-Specific Mumps?
Mumps is a contagious viral childhood disease caused by the rubella virus. However, the enlargement of salivary glands would, in fact, have several ‘non-specific’ conditions or factors associated with the occurrence of the disease. While 'true mumps' disease, which commonly has a viral origin and specifically impacts the salivary glands of the oral cavity, still needs to be diagnostically differentiated by the physician or dental or oral surgeon from the nonspecific form of mumps disease. Let us have a look at the various infections that are of microbial origin that cause an enlarged salivary gland pathology which would be termed instead in medical literature as non-specific mumps.
What Are the Types of Non-Specific Mumps?
1. Chronic Non-Specific Sialadenitis -
This is an inflammatory and insidious disease that affects the major salivary glands in the mouth by clinical manifestation of fibrous masses in the mouth. This disease usually occurs in children and may subside by the puberty age. It is also colloquially termed as ‘recurrent suppurative parotitis. The obstruction of the major salivary glands in this disease is caused by the formation of salivary calculus or salivary duct calculi with an underlying bacterial cause. It would be a pyogenic bacterial infection that mimics even certain salivary gland tumors. The treatment of this condition involves eliminating the salivary duct calculi, thereby eliminating the etiologic bacterial infection behind the disease. If this disease is left untreated by the dental surgeon or physician, the salivary glands may be fully replaced by fibrous tissues that resemble tumors or cancers. Differential diagnosis can be well established either by an oral surgeon or an oral pathologist.
2. Post-Operative Parotitis -
This is an acute condition occurring post-operatively, after a surgical procedure that involves a breach or harm usually, unintentionally to the salivary glands during the course of operation or surgery. The patients debilitated by this disease would suffer from suppressed salivary secretions and a retrograde infection of the oral cavity, along with dehydration. Because the salivary flow gets stagnated in these patients, the microorganisms responsible for this infection, such as Staphylococcus aureus, Staphylococcus viridans, and Staphylococcus pyogenes, and more penetrate the parotid salivary gland commonly causing severe pain and glandular swelling in the affected patients. Glands on both sides are affected in ailing patients. The incidence of this disease is more in middle-aged or older individuals post orofacial surgery. The treatment for this condition involves oral antibiotic prophylaxis, and the focus of the oral surgeon should be to stop the purulent discharge or pus from the ducts and to prevent localized pain and swelling that causes severe oral discomfort in patients.
3. Nutritional Mumps -
This is another non-specific form of mumps or salivary gland infection affecting usually the parotid and the submandibular salivary glands. There would be bilateral enlargement of the affected glands. These kinds of infections are localized or endemic populations encounter them because of nutrition-related deficiencies or dietary lack of nutrients, especially children young adults, and even middle-aged adults. Most frequently nutritional mumps as reported in medical literature in individuals who exhibit multiple signs of deficiency:
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Anemias (a medical condition characterized by a deficiency in the number of red blood cells).
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Hypoproteinemia (a medical condition characterized by abnormally low levels of proteins in the blood).
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Pellagroid pigmentation (skin discoloration and pigmentation changes associated with pellagra) affects the face or hands.
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Angular cheilosis (a medical condition characterized by painful cracks or sores at the corners of the mouth).
This condition is very slow in progression because, like any other nutrient-related deficiency such as vitamin A or vitamin C deficiency, for instance, the clinical manifestations may be later observed after the initial onset of the condition. Also, the unique nature of this disease is that its non-inflammatory condition of the salivary glands is affected, as the enlargement of glands is caused only due to a lack of nutrient circulation in the body. This is attributed to the common hypothesis, according to oral pathologists, that there would be a hypertrophy of the acinar cells of the salivary glands initially. When the disease becomes chronic, that is, when the nutritional deficiency in the individual remains untreated, the normal salivary gland cell parenchyma tissue is replaced by fat. Although there is very little interference in this disease with salivary gland functions, such as secretions and less oral discomfort compared to other forms of mumps, this nutritional mumps form is still chronic and progresses slowly in affected individuals. Hence, the underlying cause of nutritional deficiency or anemia should be addressed by the physician or healthcare provider.
4. Chemical Mumps or Iodine Mumps -
This non-specific mumps form is so-called in the medical literature because the bilateral enlargement of salivary glands that occurs in this disease is because of the administration of inorganic or organic iodine form. For example, in the treatment of myxedema, triiodothyronine (T3) is commonly administered, which can trigger an enlargement of the salivary glands on both sides of the face (soon after this administration). This also shows the link between the thyroid and the salivary glands which are very sensitive to the administration of iodine that may potentially cause a hypertrophy of the acinar cells of the affected salivary glands.
5. Miscellaneous Diseases Causing Non-Specific Mumps -
Several diseases exist that cause salivary gland swelling:
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Sjogren's syndrome.
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Fibrocystic disease.
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Hepatic cirrhosis.
Conclusion:
To conclude, the oral surgeon always needs to differentiate and diagnose non-specific varieties of mumps that may be of an etiologically very diverse nature and sometimes even chronic in the affected individuals. Careful correlation of laboratory, pathologic, or microscopic findings is needed to confirm the diagnosis in patients. Timely diagnosis and treatment may not only improve the quality of life in patients suffering from mumps disease but also aid in restoring oral form and function. Salivary glands that secrete saliva are the main source of oral immunity and health.
