Diagnosis: The differential diagnosis for this presentation includes parotid duct cyst, jaw tumor, influenza, and neck abscess. However, the presence of visible and palpable parotid edema, which may result in the earlobes being pushed upward and outward and in a diminished view of the mandible, is a clue to the true diagnosis: mumps.
The mumps virus, globally endemic, is a member of the Paramyxoviridae family. It is rare in infants younger than 1 year. Its incubation period is typically 1 to 2 weeks. In approximately 35% of cases, the disease is subclinical. A nonspecific prodrome consisting of fever, headache, malaise, and myalgia (especially in the neck) may be seen. The characteristic onset (within 24 hours) of mumps is parotitis, either unilateral or bilateral, with the glands reaching their maximum size within 48 to 72 hours. Swelling does not typically last longer than 1 week. The area is tender and painful; pain can be elicited by having the patient eat or drink sour substances, such as lemon.
The prognosis is usually excellent, although in rare situations, complications can occur, including meningoencephalomyelitis, orchitis and epididymitis, oophoritis, pancreatitis, myocarditis, arthritis, thyroiditis, deafness, and dacryoadenitis and optic neuritis. Infection usually results in lifelong immunity.
Acknowledgment: Image courtesy of Logical Images, Inc. (www.VisualDx.com/JUCM)