Mumps: A General Overview

Parotiditis or mumps infection is caused by a virus similar in nature to the influenza virus. Mumps can present with symptoms such as fever, headache, and swollen, painful glands under the jaw. The initial symptoms of mumps include neck or ear pain, loss of appetite, tiredness, headache, and low-grade fever. Up to one-third of infected persons have minimal or no manifestations of disease. Swelling of salivary glands in the lower jaw is the most common symptom with the involved gland soon becoming visibly enlarged.

Salivary glands on either side of the face may be affected and any combination of single or multiple salivary gland involvement may occur. Severe pain can accompany the swelling, which tends to occur within the first 2 days, and may first be noted as an earache with tenderness to touch. These symptoms tend to decrease after 1 week and are usually gone within 2 weeks. Additional symptoms include a headache, and mild meningitis, which is an inflammation in the covering of the brain or spinal cord, and about 1 out of every 4 teenage or adult males with mumps will have a painful swelling of the testicles for several days. This usually does not make a person sterile and unable to father children.

The parotid gland lies just anterior to the ear. The superficial lobe lies over the ramus of the mandible, and the gland curves around behind the mandible to form the deep lobe. The gland lies within the superficial fascia of the neck and is completely invested in this connective tissue. The parotid duct leaves the anterior border of the gland to pass over the buccinator muscle and pierce the cheek opposite the second upper molar tooth. The duct may have some associated accessory glandular tissue. The gland receives its parasympathetic secretomotor innervation from the glossopharyngeal nerve. The nerve fibers form the lesser superficial petrosal nerve which leaves the skull through the foramen ovale together with the mandibular nerve.

These preganglionic fibres synapse in the otic ganglion, then join the auriculotemporal nerve of the mandibular to be distributed to the gland. Sympathetic fibers arrive at the gland through its blood supply. The terminal part of the external carotid artery runs through the gland. The deep part of the gland lies close to the carotid sheath. The facial nerve has a particularly close relationship to the gland. After emerging from the stylomastoid foramen the facial nerve dives and sends its five branches through the tissue of the gland superficially. These facial nerve branches supply the muscles on the face and platysma in the neck.

The submandibular gland lies just under the middle of the mandibular body. The gland lies on the outer surface of the omohyoid muscle and curves around the free border of that muscle posteriorly to lie in the floor of the mouth. The duct runs along the floor of the mouth to open on the floor on either side of the frenulum of the tongue. The superficial part of the gland is closely related to the facial artery before it passes upwards over the mandible.

Secretomotor innervation is from the lingual nerve. The parasympathetic fibers originate in the facial nerve, travel to the lingual nerve in the chorda tympani and synapse in the submandibular ganglion. Lymphatic drainage is to the submandibular and superior deep jugular nodes. The sublingual salivary glands lie below the tongue and open through several ducts into the floor of the mouth. Innervation is as for the submandibular gland. Lymphatic drainage is to the superior deep jugular nodes.

Mumps can also cause several more severe complications such as swelling or inflammation of the brain (encephalitis), or hearing loss. Before there was a mumps vaccine, many children had hearing loss caused by mumps. Mumps has been one of the leading causes of acquired deafness in childhood; onset may be sudden or gradual and deafness may be complete or permanent. Other complications involve organs such as the heart, pancreas, and ovaries. Transient arthritis has been reported in some males. Complete recovery is the rule. While deaths due to mumps have been reported, fatalities from mumps are rare.

Treatment of mumps is based off of complications. In cases without complications, mumps is treated with plenty of rest and home care. Medicines, such as aspirin, Tylenol, or ibuprofen are routinely delivered to alleviate pain. Do not give aspirin to anyone younger than 20 because of its link to a rare but serious illness called Reye's syndrome. Complications may require admission to a hospital. Medications to relieve pain associated with inflammation of various organs (such as the testicles or pancreas), and other complications may be given. Because mumps is a viral infection, antibiotics are normally not indicated.