other neck masses Symptomatic treatment of sialadenitis includes close attention to hydration and avoidance of foods that require excessive chewing Sour foods serve as sialagogues to hasten resolution If bacterial sialadenitis or parotitis is suspected, β-lactamase stable parenteral antibiotics (e.g., ampicillin-sulbactam) should be administered with the addition of MRSA coverage in areas with high rates of methicillin resistance Otolaryngologic consultation should be obtained if surgical drainage is needed because of the proximity of the facial nerve Much less commonly, parotid gland swelling is of noninfectious origin Causes include occlusion of Stensen duct by a calculus and traumatic insufflation of the gland with forceful blowing (e.g., trumpet blowing) or, in rare instances, primary parotid neoplasms Radiographs are highly sensitive for salivary stones though ultrasound can detect a range of pathologies and is radiation-sparing FIGURE 120.11 Parotitis (Reprinted with permission from Fleisher GR, Ludwig W, Baskin MN Atlas of Pediatric Emergency Medicine Philadelphia, PA: Lippincott Williams & Wilkins; 2004.)