Parotid

Avoiding misdiagnosis in venous malformation of the parotid

August 10, 2012     Jason Hamilton, MD, FACS; Reena Gupta, MD, FACS
article

To avoid mistaking parotid masses and venous malformations for each other, based on imaging, requires a high level of clinical suspicioun, especially when operative findings and images are contradictory.

Atypical presentation of mucoepidermoid carcinoma after radiation therapy for the treatment of keloids

July 5, 2012     James K. Fortson, MD, MPH; Michael Rosenthal, DMD; Vijaykumar Patel, MBBS, FRCS; Gillian E. Lawrence, MD; Jennifer S. Lin, MD
article

Abstract

Radiation therapy to the head and neck for the treatment of benign diseases carries the potential for the late development of carcinoma. Low-dose radiation has been used as an adjunctive treatment for recurrent keloids, especially massive keloids, but the carcinogenic potential of ionizing radiation in this setting remains controversial. We report the case of a 37-year-old black woman with a history of severe earlobe keloids who had been first treated with resection and postoperative radiation at the age of 9 years. When she had reached the age of 36 years, she required reoperation for massive keloid scarring, after which she underwent a second course of postoperative radiation to the right side of her face and neck. Some 20 months after the second administration of radiation therapy, she developed a mucoepidermoid carcinoma in the right parotid gland. The tumor was successfully treated with surgery.

Intraparotid neurofibromatosis

June 4, 2012     Ryan F. Osborne, MD, FACS; Jason S. Hamilton, MD, FACS; Reena Gupta, MD, FACS
article

Neurofibromas, which occur in the peripheral nervous system, frequently begin asymptomatically, but as they grow and compress underlying nerve fascicles, they can cause pain, weakness, and numbness.

Mycobacterial tuberculosis superimposed on a Warthin tumor

April 30, 2012     Kang-Chao Wu, MD; Bo-Nien Chen, MD
article

Abstract

The concomitant occurrence of tuberculosis infection within a Warthin tumor is extremely rare, as only 6 cases have been previously reported in the English-language literature. We report a new case in a 92-year-old man, who presented with a 20-year history of a painless swelling in the right infra-auricular area that had recently become painful and larger. The patient had no history of tuberculosis, weight loss, or chronic cough. The fluctuant mass was aspirated, but histopathology and routine culture were negative. Computed tomography identified a 5-cm, heterogeneous, enhancing mass with multiple, variably sized, low-density areas without surrounding edema in the area of the right parotid gland. Complete excision was performed to relieve the patient's symptoms. Histopathology diagnosed an acid-fast bacillus infection within a Warthin tumor. On polymerase chain reaction testing, formalin-fixed, paraffin-embedded tissue was negative for tuberculosis, but subsequent culture identified Mycobacterium tuberculosis. Initially, the patient refused antituberculosis therapy, but he relented when miliary pulmonary tuberculosis was diagnosed 11 weeks postoperatively.

Neuroendocrine carcinoma of the head and neck: A 20-year case series

March 1, 2012     Ryan Meacham, MD, Laura Matrka, MD, Enver Ozer, MD, H. Gulcin Ozer, PhD, Paul Wakely, MD, and Manisha Shah, MD
article

Abstract

Neuroendocrine carcinoma (NEC) can be an aggressive disease with locoregional and distant metastasis. We present this article (1) to highlight the typical presentation of NEC in head and neck primary sites such as the parotid gland, paranasal sinuses, and supraglottis and (2) to discuss the prognosis of these tumors based on their histologic subtype and stage. We base our comments on the findings of our retrospective review of the cases of 16 adults-10 men and 6 women, aged 43 to 88 years (mean: 65.8)-who had been diagnosed with pathologically confirmed NEC of the head and neck. Analysis of subtypes revealed that 11 of these patients (68.8%) had presented with poorly differentiated NEC, 4 (25.0%) with moderately differentiated NEC, and 1 (6.3%) with well-differentiated NEC. The most common primary sites were the salivary glands (n = 5; 31.3%), paranasal sinuses (n = 4, 25.0%), and larynx (n = 4). There was no statistically significant difference in survival at 24 months between the patients with moderately differentiated NEC and those with poorly differentiated NEC (37.5 vs. 35.4%; p = 0.86); at the end of the study period, the patient with well-differentiated NEC was still living, 129 months after diagnosis. Taken together, patients with stage I, II, and III disease had a combined survival of 77.8% at 12 months, which was significantly higher (p = 0.023) than the 57.1% survival at 12 months for patients with stage IV disease.

Parotidectomy for treatment of bulimic parotid hypertrophy

February 18, 2012     Ryan F. Osborne, MD, FACS, Jason S. Hamilton, MD, FACS, and Hootan Zandifar, MD, FACS
article

A case of congenital fistula from an accessory parotid gland: Diagnosis and treatment

January 25, 2012     Fábio Roberto Pinto, MD, PhD
article

Abstract

The author reports a case of congenital fistula from an accessory parotid gland and describes its diagnosis and treatment. The patient was referred to the author's clinic for evaluation of a continuous serous discharge from a small orifice in the left cheek near the angle of the mouth. A left preauricular appendix was also noted. Fistulography detected an aberrant duct leading to an accessory parotid gland. The main parotid gland and its duct were normal. The anomalous duct was dissected in continuity with a small ellipse of skin and sutured to the buccal mucosa. The patient's recovery was uneventful. The author also discusses the embryologic origin of this rare anomaly.

Giant cell tumor of the masticator space: Case report and literature review

November 22, 2011     Melissa L. Somers, MD, Scott A. McLean, MD, PhD, and Frank Torres, MD
article

Abstract

Giant cell tumors of the head and neck are rare. We describe the case of a 50-year-old man who presented with otalgia and eustachian tube dysfunction. After his symptoms persisted despite aggressive medical management, further investigation revealed the presence of a firmness in his left parotid tail. Computed tomography identified a heterogeneously enhancing mass in the left masticator space. The tumor was removed surgically, and it was diagnosed on histopathology as a giant cell tumor. The patient recovered uneventfully and was closely followed for signs of recurrence. To the best of our knowledge, ours is the first reported case of a giant cell tumor in the masticator space. We review the literature on giant cell tumors of the head and neck, with particular attention given to cases involving the temporomandibular joint.

Bilateral multicystic parotid masses in primary Sjögren syndrome

October 26, 2011     Alex S.L. Toh, MRCS, DO-HNS, Stephen J. Broomfield, MRCS, Lee-Suan Teh, MD, FRCP, Muhammad B. Aslam, FRCPath, Gavin Duncan, FRCR, and Pradeep Morar, MD, FRCSEd(ORL-HNS)
article

Abstract

We report the case of a 48-year-old woman who presented with bilateral parotid gland enlargement as the initial manifestation of primary Sjögren syndrome. Magnetic resonance imaging demonstrated multiple areas of low-intensity signal mixed with foci of high-intensity signal, a finding suggestive of Sjögren syndrome. Autoimmune blood tests for Sjögren syndrome were positive, and a sublabial biopsy confirmed the diagnosis. Investigations for other conditions, including human immunodeficiency virus infection, were negative. After 5 years of follow-up, the parotid swellings remained essentially unchanged. We discuss the etiology of multicystic parotid gland pathology, its involvement in Sjögren syndrome, and the risk of lymphoma.

Madelung disease

March 31, 2011     Silviu Albu, MD
article

Chronic parotitis: A challenging disease entity

March 1, 2011     John M. Harbison, MD, Benjamin D. Liess, MD, Jerry W. Templer, MD, Robert P. Zitsch III, MD, and Jessica A. Wieberg, MD
article

Abstract

Chronic parotitis is a troubling clinical condition characterized by repeated infection and inflammation of the parotid gland caused by decreased salivary flow or obstruction. Unilateral swelling, pain, and other associated symptoms occur during acute exacerbations of the disease. A variety of laboratory and radiographic tools are available to aid in the diagnosis. Multiple treatment options have been proposed, ranging from conservative medical management to surgical interventions. We present 2 patients with bilateral chronic parotitis who attempted prolonged medical management and ultimately required surgical parotidectomy for control of their disease.

Acute parotitis induced by trimethoprim/sulfamethoxazole

February 1, 2011     Jayna S. Patel, DO and Edward D. Scheiner, DO, FOCOO
article

Abstract

Adverse drug reactions to the sulfonamide antibiotics are uncommon. When they do occur, they usually manifest as a rash or urticaria. Our review of the recent literature found that while sialadenitis is listed as a possible side effect of sulfonamide use, no actual case has ever been reported until now. We describe a case of acute bilateral parotitis that arose as a side effect of sulfonamide antibiotic treatment. We also examine the relevance of such pathology to the proposed mechanisms of sialadenitis, and we briefly discuss sulfonamide-induced pancreatitis. Lastly, we review the controversy over the possibility that some adverse drug reactions may be caused by cross-reactivity among different classes of sulfonamides.

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