Parotid

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

January 25, 2012     Fábio Roberto Pinto, MD, PhD
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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
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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)
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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
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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
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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
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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.

Solitary cysticercosis (tapeworm) of the parotid gland

October 31, 2010     Ashubhalla Seith, MD, Ankur Gadodia, MD, and Raju Sharma, MD
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Neonatal suppurative parotitis

September 30, 2010     Alba Miranda, MD and Kevin D. Pereira, MD
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Multifocal synchronous ipsilateral Warthin tumors: Case report and review of the literature

August 31, 2010     Joseph E. Hall, MD, Melissa McCarty Statham, MD, Rachel M. Sheridan, MD, and Keith M. Wilson, MD
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Abstract

We report a case of a 73-year-old woman who presented with an enlarging superficial parotid mass, a concomitant ipsilateral deep-lobe parotid mass, and associated upper jugular lymphadenopathy. The clinical presentation and radiographic imaging were suggestive of malignancy, and the patient was treated with total parotidectomy with upper jugular lymph node sampling. Pathologic examination revealed two distinct masses, one in the superficial lobe and one in the deep lobe of the parotid gland, both consistent with synchronous Warthin tumors. Analysis of the upper jugular lymph nodes was consistent with reactive lymphoid hyperplasia. Although the true incidence of multicentricity in ipsilateral Warthin tumors may be underappreciated and underreported, this entity should remain in the differential diagnosis for unilateral parotid masses.

Sebaceous lymphadenoma: A case report and review of the literature

July 31, 2010     Benjamin While, MRCS, Olivia J.H. Whiteside, MRCS, Vijayadwaja Desai, MRCPath;, and Paul Gurr, FRCS
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Abstract

An 80-year-old woman presented with a mass in her left parotid region. An ultrasound-guided core biopsy showed sebaceous glands with lymphoplasmacytic infiltration. Magnetic resonance imaging displayed a well-circumscribed lesion within the left parotid gland. The mass was completely excised, and the patient made a full recovery. Sebaceous lymphadenomas of the salivary glands are rare, benign tumors that are effectively treated by complete excision. The challenge that these tumors present lies in their accurate diagnosis. Because of their histologic similarity to related malignant tumors, such as mucoepidermoid carcinomas and sebaceous lymphadenocarcinomas, misdiagnosis could lead to unnecessarily radical treatment. We highlight the need for careful clinical and histologic diagnosis in tumors of the salivary glands.

Primary Merkel cell carcinoma of the parotid gland

June 30, 2010     Mahmoud Ghaderi, DO, Jeffrey Coury, DO, Jacqueline Oxenberg, DO, and Harvey Spector, MD
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Abstract

Primary Merkel cell carcinoma (MCC) is a neuroendocrine tumor that typically affects older whites. It usually originates in the dermis, but in rare instances it has arisen in other primary sites, including the oral mucosa and the parotid gland. Explanations for the presence of MCC in these atypical locations have included theories of malignant transformation and neuroendocrine migration. We describe the case of a 35-year-old white woman who had an MCC in the parotid gland and no evidence of any other primary cutaneous lesion. A left superficial parotidectomy with facial nerve preservation was performed, and a histologic diagnosis of MCC was made. Positron-emission tomography was negative for other lesions, and postoperative radiation therapy was administered for local control. To the best of our knowledge, this is only the sixth case of a primary MCC of the parotid gland to be reported in the English-language literature; of these 6 patients, ours was by far the youngest. Otolaryngologists should be familiar with this rare but potentially fatal neoplasm.

Hamartoma of the parotid gland: Report of a unique case

April 30, 2010     Yamileth Nicolau, MD, William C. Faquin, MD, PhD, and Daniel G. Deschler, MD, FACS
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Abstract

Hamartomas of the parotid gland are very rare. We present the case of a parotid gland hamartoma with oncocytic and sebaceous metaplasia arising as a 3-cm mass in a 70-year-old man. To the best of our knowledge, there has been no previous report of a tumor with the same features. We present this case to create awareness of hamartomas as part of the differential diagnosis of parotid masses.

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