infectious adenitis has been rarely reported in neonates , 40 cases of neonatal suppurative parotitis and only 17 cases of isolated submandibular sialadenitis have been reported in english literature . we describe a 18 days old neonate with suppurative parotitis associated with submandibular abscess , which was treated by incision and drainage . the present case report is about an 18 days old full term female neonate presented to our department with swelling in parotid and submandibular area on left side for 6 days . the local examination revealed a swelling about 5 cm  4 cm in size in parotid area extending down to submandibular and submental area . overlying skin was erythematous and swelling was fluctuant [ figure 1 ] . left parotid and submandibular abscess further examination revealed that upon pressing the swelling , purulent material was extruding through the floor of the mouth [ figure 2 ] . the base line investigation were done which showed leucocytosis - 18,000/l with neutrophillis - 80% , kidney and liver function tests were normal , incision and drainage of the abscess was done about 30 - 40 ml of frank pus was drained . patient was already put on amoxicillin + clavulanate ( 15 mg / kg orally every 12 h ) . after two weeks and then at 1 month of discharge from hospital , baby had completely recovered . suppurative parotitis is usually unilateral and may progress to abscess formation . among salivary glands ; the involvement of parotid gland is more common than submandibular gland . . the risk of parotitis in premature babies may be related to dehydration leading to stasis in the salivary gland ducts due to reduced secretions . most common mode of spread is tracking of oral flora in a retrograde fashion into gland , although gland may get invaded with bacteria through the blood stream . decreased salivary production and stasis , dilatation of ducts through scaring or obstruction by stone , variation in ductal structure may lead to retrograde flow from oral cavity . another potential cause of transmission of bacteria is during the breast feeding and a through contaminated formula , as in the present case infant was breast fed , but the mother had no signs of mastitis , as the history of maternal mastitis can act as a source of bacterial invasion as described by tapsz et al . breast feeding can not be considered as a risk factor for suppurative parotitis as there are more chances of contamination with formula feeds . as in our case the history of initial appearance of swelling and erythema were in the preauricular area which then progressed subsequently to involve the submandibular and submental area . examination with ultrasound is readily available , cheap , noninvasive and useful for diagnosis and differential diagnosis and excluding abnormality of stenosis of the duct , siolith . purulent drainage from stensen 's duct is diagnostic of the suppurative parotitis as is demonstrated in our case . in a report of spigel et al . , the most common pathogen was s. aureus , which was found in 55% of the patients . in our patient , the main stay of the treatment is to use antibiotics to cover the causative organism i.e. , s. aureus . however as our baby had large fluctuant swelling we decided to do the incision and drainage of the abscess . we found that after incision and drainage antibiotics had to be given for 1 - 2 days and the hospital stay was also reduced by 4 - 5 days . although incision and drainage is less frequently used in this modern antibiotics era but it has still got a very important role in frank abscess formation as in our case . incision and drainage also helps to isolate the organism and appropriate antibiotic needed in case of some residual purulent material remains in the abscess cavity . although the parotitis is very rare in neonates as described it should be suspected in neonates with erythematous preauricular swelling . delay in diagnosis and treatment may lead to involvement of surrounding glands as in our case . and in case of frank purulent nature of the abscess treatment should be incision and drainage which the promptly decreases the burden of septic focus , duration of antibiotic therapy and hospital admission .
suppurative involvement of salivary gland in neonates is a rare disorder . 
 parotid gland being the most commonly involved . 
 we described a case of suppurative parotitis leading to abscess formation and subsequent involvement of the submandibular gland . 
 incision and drainage of the abscess was performed , most of the purulent material was drained . 
 symptoms and signs resolved within 2 days . 
 pus culture grew staphylococcus aureus