Iodoform Gauze Packing is an Alternative Therapy for Postoperative Parotid Fistula.

Surgery-related salivary fistula is the result of intraoperative or postoperative parotid gland damage and extravasation of fluid secreted by acinar into the interstitial space. Most are treated conservatively. Local injection of botulinum toxin is an effective method, but it is relatively expensive and not available in some hospitals. In clinical practice, the authors observed that packing iodoform gauze from the fistula toward the parotid gland can quickly stop postoperative salivary fistula in several patients. This method is simple and easy to implement, and the effect is quick. The disappearance of the salivary fistula was observed on the next day after packing the iodoform gauze. Iodoform gauze packing is an alternative therapy for postoperative parotid fistula. It can be used in areas where botulinum toxin is not available.

A Functional Approach to Posttraumatic Salivary Fistula Treatment: The Use of Botulinum Toxin.

This manuscript highlights key aspects regarding the practical use of botulinum toxin for the conservative nonsurgical treatment of a rarely encountered, but significant posttraumatic complication-the parotid salivary fistula. It adds information to the scarce existing literature on the subject. The authors outline the main differences between postoperative and trauma-related parotid injury regarding salivary fistula treatment. A total of 6 patients with trauma-related salivary fistulas have been treated by Abobotulinum toxin A injections over the course of 5 years. The technique is detailed, describing the doses used in the presence of parenchyma and duct injuries, the location and number of injection points in relation to the wound pattern. The results were favorable, leading to the healing of the salivary fistulas in all patients, with 1 injection session, without additional conservative treatment. In our experience, the use of botulinum toxin is of great benefit for treating salivary fistulas in a traumatic context.

Botulinum Neurotoxin A for Parotid Enlargement in Cystic Fibrosis: The First Case Report.

Cystic fibrosis (CF) is the most common lethal autosomal recessive genetic disease associated with exocrine gland dysfunction. Salivary gland involvement is a common finding. The literature on submaxillary gland involvement has failed to address the parotid gland and any specific treatment of salivary gland manifestations of CF. Treatment is mainly symptomatic, consisting of analgesics, gustatory stimulation, and massage. Salivary secretion has clearly been linked to parasympathetic and sympathetic signals through intracellular calcium release. CF alters salivary composition with increased calcium and phosphorus concentrations and causes histologic changes (duct enlargement, dilation of acini, and abnormal mucous plugs). This study investigated whether botulinum toxin injected into the parotid gland during an acute exacerbation of CF-associated salivary gland disease could alleviate pain and control future exacerbations.

Use of Botox (OnabotulinumtoxinA) for the Treatment of Parotid Sialocele and Fistula After Extirpation of Buccal Squamous Cell Carcinoma With Immediate Reconstruction Using Microvascular Free Flap: A Report of 3 Cases.

PURPOSE: Buccal squamous cell carcinoma is an aggressive form of oral carcinoma with a high recurrence rate. Injury to the parotid duct is often unavoidable when surgically treating buccal squamous cell carcinoma because of the intimate anatomic relation among the buccal mucosa, Stensen duct, and parotid gland. It is often difficult to achieve negative margins and preserve the integrity of the parotid duct. Sialocele formation is a frequent and untoward complication owing to extravasation of saliva into the surgical defect, which delays healing, creates fistulas, and produces painful facial swelling. Currently, no consensus exists regarding the management of a parotid sialocele. Multiple investigators have described different modalities of treatment, such as repeated percutaneous needle aspiration, pressure dressings, antisialagogue therapy, radiotherapy, botulinum toxin, and surgical techniques, including duct repair, diversion, ligation, drain placement, and parotidectomy. MATERIALS AND METHODS: With approval from the institutional review board of the University of Texas Health Sciences Center at Houston, 3 cases of parotid sialocele and nonhealing fistulas successfully treated with Botox (onabotulinumtoxinA) after tumor extirpation, neck dissection, and reconstruction with a microvascular free flap are presented. RESULTS: At the University of Texas Health Sciences Center at Houston, the radiation oncologist prefers not to start adjunctive radiation treatment with a nonhealing wound or a drain in the field of radiation. Ideally, a standard timing of adjuvant radiotherapy is 6 to 8 weeks after surgery and 60 cGy should be completed before 7 months. CONCLUSIONS: With the use of Botox, the nonhealing wound resolved and the drain was removed at least 2 weeks before the initiation of adjunctive radiotherapy, thus minimizing the delay in adjuvant treatment.

Clinical features and treatment outcomes of immunoglobulin g4-related sclerosing sialadenitis.

Idiopathic enlargement of salivary glands used to be confusing in diagnosis until immunoglobulin G4 (IgG4)-related sclerosing sialadenitis was proposed as a possible answer. In this case series, we reported the clinical features and management outcomes in 16 patients with IgG4-related sclerosing sialadenitis. We retrospectively studied 16 patients in clinical examination, serology, pathology, and sonography features. All patients were treated by corticosteroids and followed up for at least 3 months. The results of clinical features showed that all of the patients presented persistent, symmetric bilateral swelling of the salivary glands, elevated levels of serum IgG4, and/or IgG4-positive plasmacytes infiltration and tissue fibrosis. The results of all autoantibody tests were negative. The typical sonographic manifestation revealed multiple hypoechoic foci with an irregular netlike diffuse lesion in salivary glands. Most patients showed excellent response to steroids treatment. We conclude that, for patients who present (1) symmetric swelling of bilateral salivary glands for more than 3 months, (2) elevated serum IgG4 level (>135 mg/dL), and (3) enlargement in bilateral salivary glands with multiple hypoechoic areas (irregular netlike appearance) in the sonography, the diagnosis of IgG4-related sclerosing sialadenitis should be considered. A comprehensive understanding of the medical condition and appropriate pathology examination are the key to diagnose. Steroids treatment is effective, and a treatment plan should be set up and followed in the long-term.

Candidal abscess of the parotid gland due to Candida glabrata: report of a case and literature review.

We report the case of an immunocompetent woman who developed a Candida glabrata abscess of the parotid gland and present a review of similar cases from the literature. Diagnosis was based on the isolation of C. glabrata in pure culture from the abscess pus. Examination of stained smears of the same material demonstrated small sized yeast cells, some being intra-macrophagic. Combination of a local drainage and oral fluconazole proved to be an efficient therapeutic strategy. Candidal abscesses are rare in immunocompetent patients and salivary gland localization has only been reported in five cases.

[Alpha-1-blockers (alfuzosin) for obstructive salivary gland diseases]. / Les Alpha-1-Bloquants (alfuzosine) en pathologie salivaire obstructive.

INTRODUCTION: Alpha-blockers are used in urology to treat stenosis and lithiasis. The pathophysiology is similar in salivary glands. We had for aim to assess the safety and effectiveness of an alpha-blocker (Alfuzosin) in patients with ductal stenosis, allergic pseudo-parotitis or sialolithiasis after lithotripsy. PATIENTS AND METHODS: Three hundred and fifty-two patients were included, 194 of whom presented with sialolithiasis fragmented by extracorporeal lithotripsy (112 parotidic and 82 submandibular). Sixty-nine presented with ductal stenosis, and 89 with allergic pseudo-parotitis. This retrospective study lasted 3 years (January 2005 to January 2008) with a mean follow-up of 33 months (18 months to 4 years). Male patients were given 2.5mg tid of the alpha-blocker Alfuzosin and female patients 2.5mg bid for 3 to 24 months. After 6 months and up to 2 years of treatment, patients were assessed every 3 months by US and with a questionnaire on symptoms. RESULTS: Results were similar in male and female patients. Eighty percent of patients with colic-like pain due to stenosis reported a significant improvement after treatment. 78.6% of patients with allergic pseudo-parotitis felt they had improved and noted a sharp decrease of pruritus. Sixty-seven of the patients with residual parotid lithiasis after extracorporeal lithotripsy presented with less ductal lithiasis and fragments were evacuated more rapidly in the two months following lithotripsy. Forty-two percent of the patients treated for residual submandibular lithiasis reported a significant functional improvement and faster evacuation of fragments. Twelve patients out of 352 (3.4%) reported adverse effects. The incidence of orthostatic hypotension was 2.2%. DISCUSSION: A significant improvement of symptoms was observed in patients treated with Alfuzosin for obstructive salivary gland diseases. The drug was well tolerated. These preliminary results are good in terms of effectiveness and inocuity. They should be confirmed with a prospective controlled study.

Isolation and characterization of Bartonella quintana from the parotid gland of an immunocompetent man.

We describe a case of the isolation of Bartonella quintana from the parotid gland of an apparently healthy man. Pathological examination showed intraparotid granulomatous abscessual lymphadenitis. Diagnosis was made on the basis of high titers of immunoglobulin G (IgG) and IgM antibodies and of culture isolation of a causative agent from parotid aspirate.

The use of botulinum toxin in the treatment of a parotid duct injury during Mohs surgery and review of management options.

BACKGROUND: Aggressive skin cancers on the cheeks may involve the parotid duct. For such tumors to be successfully removed, at least part of the parotid duct must be excised as well. Failure to properly address parotid duct injuries that result from Mohs micrographic surgery exposes the patient to a variety of adverse sequelae. OBJECTIVE: To discuss the various diagnostic and treatment options that should be considered when managing parotid duct injuries that result from skin cancer extirpation. MATERIALS AND METHODS: We describe a patient who sustained a parotid duct injury after Mohs micrographic surgery for treatment of squamous cell carcinoma. The patient was treated with intraparotid injections of botulinum toxin. RESULTS: Two weeks after treatment of the injury with botulinum toxin, the patient reported complete resolution of his symptoms. CONCLUSION: If a parotid duct injury is diagnosed at the time of tumor extirpation, then surgical repair of the duct should be attempted, but if surgical repair is not possible or if an injury remains unrecognized until well after tumor extirpation, then surgery is not necessary. In such cases, conservative, nonsurgical measures, such as treatment with botulinum toxin, will provide excellent results.

Sarcoidosis involving the lacrimal, submandibular, and parotid glands with panda sign.

Sarcoidosis is a granulomatous inflammation of unknown origin that varies in severity and distribution. We present a case of sarcoidosis with involvement of the skin, lacrimal, parotid, and submandibular glands. The patient had been previously misdiagnosed as having angioedema and allergic contact dermatitis; he had the rare finding of panda sign on gallium scintigraphy.

Tuberculosis of the parotid gland.

Tuberculosis (Tbc) presented as an isolated parotid mass is rare. Preoperative diagnosis is difficult and the symptomatology is nonspecific. In the majority of the cases an initial diagnosis of a parotid tumor, often a pleomorphic adenoma, is made. We present a 35-year old woman with a six months duration right parotid lump. The mass was firm and nontender without ipsilateral cervical lymphadenopathy, suggesting a parotid neoplasm. The computerized tomography scan showed an intraparotideal tumor resembling a pleomorphic adenoma and thus the patient underwent to a superficial parotidectomy. Fine needle aspiration biopsy was performed but it was not diagnostic. Histological examination revealed an intraparotideal lymph node with changes of granulomatous lymphadenopathy type, like those demonstrated in the tuberculosis and sarcoidosis. Ziehl-Nielsen staining was negative, while the tuberculin skin test (PPD, 5 IU) was positive. The patient's treatment regimen consisted of a 2-month initial phase of isoniazid, rifampin, pyrazinamide and ethambutol followed by a 7 month continuation phase of isoniazid and rifampin. Postoperatively, there was only a mild paresis of the facial nerve resolved a week after. Parotid Tbc is very rare but should be considered as a differential diagnosis of parotid lumps. Fine needle aspiration biopsy (FNAB) is of outmost importance for diagnosis, since the treatment of this entity is primarily conservative. However, surgery could be both therapeutic and diagnostic, especially when other diagnostic examinations fail.

Histological surprise of parotid tuberculosis: about two cases.

Parotid tuberculosis remains a very rare localization in the Department of Otolaryngology and Cervico-Facial Surgery (ENT) sphere. It is presented in the form of a deceptive clinical picture causing confusion with other pathologies of the parotid gland, including tumor pathology. In addition, its lack of knowledge by practitioners increases the risk of missing the diagnosis. Often, the diagnosis is a histological surprise on a piece of excision after an exploratory parotidectomy. However, its treatment is primarily medical if the positive diagnosis is well established. We report medical observation of two new cases aged 44 and 45 respectively, who consult our center for parotid swelling. Radiological examinations were in favor of intraparotid cystic lesions. Both patients benefited from an excision whose histopathological study was in favor of primary parotid tuberculosis. The subsequent evolution was favorable under antituberculous treatment.

Hydatid disease of the parotid gland: a rare case report.

A 40-year-old female suffering from hydatid disease located in the parotid gland is presented. Although Greece remains an endemic area for echinococcosis, this presentation of the disease is rare. Total excision of the cyst with partial parotidectomy was performed. The patient refused to receive general anesthesia and the operation was carried out under local anesthesia. Perioperative adjuvant medical therapy with albendazole was administered. In a two-year follow-up no recurrence has occurred.

Combined transdermal scopolamine and botulinum toxin A to treat a parotid fistula after a face-lift in a patient with siliconomas.

A parotid fistula is a rare, extremely unpleasant disease. Patients with chronic pathologies of the facial soft tissues have a high complication rate after aggressive treatments. Alternative conservative treatments have recently been reported for this condition. The case is described of a parotid fistula following a face-lift in a patient affected by facial siliconomas. A 41-year-old Caucasian who had undergone repeated facial silicone injections developed a diffuse granulomatous reaction accompanied by facial disfigurement. Thirteen surgical operations were performed to remove the siliconomas and correct the deformities, the last of which was a face-lift. After this procedure, the patient developed a parotid fistula. Conservative treatment, consisting of a combination of transdermal scopolamine and botulinum toxin A injections, was adopted. These antisialogogues gradually reduced saliva secretion, thereby preparing the wound bed for a skin graft and eventual healing. The choice of conservative therapy, as opposed to a surgical approach, was made to avoid further risks in what was already a highly complicated condition. The use of this conservative approach is recommended to treat complicated cases of parotid fistula.

Non tuberculous mycobacteria infection of the parotid region: two familiar cases.

OBJECTIVE: We review two cases of non tuberculous mycobacteria infections of the parotid region in members of the same family. The parotid region represents a peculiar location for the disease and it is exceptional to discover cases in members of the same family. METHODS: Two unusual case reports of non tuberculous mycobacteria infections in two members of the same family are presented. We discuss the diagnostic criteria and review pertinent recent literature. To our knowledge, these are the first English language reports of NTM infections in member of the same family. RESULTS: We performed surgical exeresis of the lesions in parotid region together with the skin affected by the fistula; regular check-ups for 24 months after surgery. CONCLUSIONS: Surgical exeresis of regional structures is the treatment for non tuberculous mycobacteria infections non responsive to antibiotic therapy.

[Primary tuberculosis of the parotid gland]. / Tuberculose primaire de la glande parotide.

OBJECTIVES: To report on a case of primary tuberculosis of the parotid gland in a 13-year-old child, and to stress the corresponding diagnostic pitfalls. CASE REPORT: A 13-year-old child presented with an isolated mass of the right parotid area. Radiological findings were in favour of a cystic lesion. Skin tuberculin test was positive. Bacteriological and histopathological examinations were realized after spontaneous fistulization of the mass, and allowed the diagnosis of tuberculosis of the parotid gland. Evolution was favourable under antituberculous chemotherapy. DISCUSSION: Localization of tuberculosis in salivary glands is rare. Diagnosis is difficult because there are no specific clinical, radiological or biological signs of the disease. Only bacteriological and histopathological findings can confirm the diagnosis. Fine needle aspiration cytology is very helpful, and permits to avoid abusive surgery. Treatment is based on antituberculous drugs and allows usually a favourable evolution.

[Case report: tuberculosis of parotid gland]. / Olgu sunumu: parotis bezinin tüberkülozu.

Primary tuberculosis of the parotid gland is an unusual clinical presentation. In this report a 32 years old male patient with parotid gland tuberculosis has been presented. The patient has been admitted to Ear, Nose & Throat outpatient clinic of our hospital with the complaint of left facial nodule. Histopathologic examination of the needle aspiration biopsy (NAB) specimen yielded benign necrotic lenfoid tissue, and in cervical ultrasonography cystic formations in left parotid gland were detected. Since the nodule size has increased in the follow-up period, cervical tomography was performed and heterogenous mass in the left side with lobular contour and hypodense appearance in posterior cervical region was detected. Histopathologic examination of the repeated NAB revealed chronic sialadenitis and benign lymphoid hyperplasia, and the patient has undergone left parotidectomy and lymph node dissection. Histopathologic examination of the excisional biopsy specimen revealed necrotising granuloma with diffuse caseification lesions concordant with tuberculosis. The patient was diagnosed as parotid gland tuberculosis, and anti-tuberculous therapy was started with isoniazid, rifampin, ethambutol and pyrazinamide. The history of the patient pointed out that he had used steroid for four months with a suspective diagnosis of rheumatoid arthritis, and his father had tuberculosis. In conclusion, since tuberculosis is a common infection in our country, it should be considered in the differential diagnosis of parotid nodules.