Parotid

Mucoepidermoid carcinoma presenting as a large cyst of the parotid gland in HIV disease

July 21, 2013     Nelson Goldman, MD; Sania Shuja, MD; Raafat Makary, MD; Reginald L. Griffin, MD
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Abstract

Cystic lesions of the parotid gland may be the presenting symptom in human immunodeficiency virus (HIV)-positive patients. The most common lesion is the benign lymphoepithelial cyst. Malignant lesions may also be associated with-or be hidden by-a cystic mass. We report a case of mucoepidermoid carcinoma in a 40-year-old HIV-positive woman who presented with a large cystic mass of the parotid that had been previously misdiagnosed as benign on several fine-needle aspiration biopsies. On our histologic examination, the true pathologic nature of the lesion was revealed. We suggest that an image-guided fine-needle aspiration biopsy of the thickened wall of cystic masses of the parotid may be more diagnostic than a random sampling of the contents.

Methicillin-resistant Staphylococcus aureus as a cause of neonatal suppurative parotitis: A report of two cases and review of the literature

June 11, 2013     Sean T. Donovan, MD; Grant T. Rohman, MD; John P. Selph, MD; Roy Rajan, MD; Rosemary M. Stocks, MD; and Jerome W. Thompson, MD, MBA
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Abstract

Suppurative parotitis is an uncommon entity identified in newborns. While Staphylococcus aureus has been frequently identified as the causative pathogen among the few patients diagnosed with neonatal suppurative parotitis (NSP), there has only been one prior case described in the literature that was due to methicillin-resistant Staphylococcus aureus (MRSA). Because of its virulence, MRSA presents new and substantial challenges for the surgeon; we describe two cases of NSP caused by MRSA and the subsequent surgical intervention necessitated for cure. We also include a review of all cases of NSP described in the English-language literature.

Facial nerve preservation in total parotidectomy for parotid tumors: A review of 27 cases

June 11, 2013     Soliman El-Shakhs, MD; Yaser Khalil, MD; and Asmaa Gaber Abdou, MD
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Abstract

We conducted a study to evaluate the success of facial nerve preservation in 27 adults with a parotid tumor who underwent total parotidectomy. Of this group, 11 patients had a malignant tumor, 10 had a recurrent benign tumor, and 6 had a primary benign tumor. Preoperatively, 7 patients had facial nerve paresis. Postoperatively, facial nerve preservation was achieved in all but 1 case; in the exception, the nerve was sacrificed and grafting was necessary. In conclusion, facial nerve preservation can be achieved in almost all cases of total parotidectomy.

Letters to the Editor

June 11, 2013    

Intraparotid neurofibromatosis presenting with multiple nodules

June 11, 2013     Ryan F. Osborne, MD, FACS; Jason S. Hamilton, MD, FACS; and Reena Gupta, MD, FACS
article

Often asymptomatic initially, neurofibromas may cause pain, weakness, and numbness as they grow as a result of compression of the underlying nerve fascicles.

Secondary lymphoma of the parotid gland: Clinical experience

February 25, 2013     Lorraine Williams-Smith, MD, FACS; Reena Gupta, MD, FACS; and Ryan F. Osborne, MD, FACS
article

 It is important to remember that parotid lymphomas do occur and should be considered in the differential diagnosis for parotid masses.

Unilateral parotid agenesis associated with pleomorphic adenoma of ipsilateral accessory parotid gland

January 24, 2013     Ashu Bhalla Seith, MD, MAMS; Ankur Gadodia, MD, DNB, MNAMS, FRCR; Raju Sharma, MD, MNAMS; Rajinder Parshad, MS
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Abstract

Congenital agenesis of the parotid gland is rare, and its association with accessory parotid tissue is even rarer. We report an unusual case of unilateral agenesis of the left parotid gland associated with pleomorphic adenoma of the left accessory parotid gland. To best of our knowledge, this is only the second such published case in the literature.

Intraparotid arterial aneurysm treated with embolization followed by surgical resection

December 31, 2012     Daniel T. Ganc, MD; Charles Prestigiacomo, MD; Soly Baredes, MD
article

Abstract

We describe the case of a 41-year-old woman who presented to a local facial plastic surgeon for evaluation of a cosmetic defect of the cheek of 1 month's duration. When imaging revealed the presence of a vascular mass, the patient was referred to us. Further imaging identified the mass as an intraparotid external carotid artery aneurysm. The decision was then made to treat the patient with embolization of the lesion followed by surgical resection the next day. During the resection, the lateral-most aspect of the aneurysm was found to be adherent to and splaying the facial nerve. The embolized mass and the surrounding fascial layer were removed, and the branches of the facial nerve were retracted superiorly and inferiorly. Dissection proceeded around the aneurysm in this plane. Blood loss during the procedure was minimal. On postoperative day 1, the patient exhibited minimal lower facial asymmetry. In this case, performing embolization prior to surgical resection appeared to be a prudent and efficacious strategy. The preoperative embolization greatly reduced the risk of damage to the facial nerve.

Unusual presentation of Sjogren syndrome: Multiple parotid cysts

October 31, 2012     Ankur Gadodia, MD, DNB; Ashu Seith, MD; Raju Sharma, MD
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Abstract

Sjögren syndrome is a chronic autoimmune exocrinopathy that destroys salivary and lacrimal gland tissue. We report an unusual case of this disease in a 40-year-old woman who presented with bilateral parotid cystic masses. As this case illustrates, Sjögren syndrome should be included in the differential diagnosis of bilateral cystic parotid lesions.

Avoiding misdiagnosis in venous malformation of the parotid

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

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