Enucleation or exenteration in two dogs with previous parotid duct transposition: parotid duct ligation versus reverse parotid duct transposition.

Two dogs with previous parotid duct transpositions presented with unrelated ocular disease. In both cases, ophthalmic examination revealed the need for enucleation or exenteration. In case 1, systemic coccidioidomycosis was diagnosed with panuveitis and secondary glaucoma of the left eye. In this case, the parotid duct was ligated at the time of enucleation to stop salivary secretions. This dog encountered morbidity in the form of a sialocele that did not resolve for 11 months. In case 2, ultrasound and computed tomography revealed a discrete mass within the left medial orbit that was suspected to arise from the nictitating membrane. A combination of exenteration and parotid duct transposition reversal was performed to avoid morbidity associated with ligation of the parotid duct. The dog encountered no complications from this novel procedure. This case report represents the first report of re-routing a transposed parotid duct from the ventral conjunctival sac back to the mouth at the time of enucleation or exenteration in the dog.

Predictors of adverse events after parotidectomy: a review of 2919 cases.

OBJECTIVE: There is a current paucity of large-scale, multi-institutional studies that explore the risk factors for major complications following parotidectomy. METHODS: The American College of Surgeons National Surgical Quality Improvement Program participant use file was reviewed to identify all patients who had undergone parotidectomy between 2006 and 2011. Risk factors that predicted adverse events were estimated by using multivariate logistic regression. RESULTS: Of 2919 included patients, 202 patients experienced adverse outcomes within the first 30 days of surgery. These included surgical complications in 76 (2.6%) patients; medical complications in 90 (3.1%) patients; death in 7 (0.2%) patients; and reoperation in 77 (2.6%) patients. Predictors of any complication included disseminated cancer (odds ratio [OR] = 2.28; 95% confidence interval [CI], 1.05-4.95; P = .036) and increasing total relative value units (OR = 1.01; 95% CI, 1.00-1.02; P = .027). Active smoking was a major risk factor for surgical complications (OR = 1.81; 95% CI, 1.08-3.05; P = .025). Dyspnea (OR = 2.93; 95% CI, 1.37-6.27; P = .006) significantly predicted medical complications. CONCLUSION: Although complication rates after parotidectomy are generally low, avoidance of specific and nonspecific postoperative complications still remains an area for improvement. Future outcomes databases should include procedure-specific complications, including facial nerve injury.

Benign Lymphoepithelial Cyst of Parotid Glands in HIV-Positive Patient.

Parotid enlargement mostly results from benign lymphoepithelial cysts (BLCs) in HIV-positive patients, as this can often be the first indication of human immunodeficiency virus infection. BLCs develop secondary to a benign lymphoproliferative disease that is not a tumor but HIV-related reaction, yet pathophysiology was still unclear FNA cytology is considered the basic and minimal invasive diagnostic tool. BLCs can expand and distort the patient's facial appearance. This is a cosmetically deforming disease entity as well as the many treatments that accompany it. Choices of treatment are anti-retroviral therapy, repeated fine-needle aspiration and drainage, radiotherapy, sclerotherapy and surgery. The patient presented in this paper is a surgical case control for our findings upon review of the literature. Based on this case control and our review of the literature, it is concluded that surgical intervention offers the best complete response to the disease and cosmetic result for these patients.

A rare cause of unilateral parotid gland swelling: compensatory hypertrophy due to the aplasia of the contralateral parotid gland.

In this clinical report, 3 cases, admitted to the ears, nose, throat outpatient clinic with the complaints of unilateral swelling in the parotid region and facial asymmetry, are presented. In the etiology, contralateral parotid gland aplasia with compensatory hypertrophy and sialosis was detected. With this rare condition, clinical and radiological features of this anomaly are discussed.

Cavernous hemangioma with large phlebolith of the parotid gland.

Hemangiomas are vascular anomalies characterized by increased proliferation and turnover of endothelial cells. Hemangiomas of the parotid region are relatively uncommon in adult population, and there are a few reports of hemangioma with large phlebolith within the parotid gland. We herein report a case of it. Sialography may be a useful investigation method in the evaluation of radiopaque lesions localized intraglandularly in the parotid area to rule out the sialolith. Cavernous hemangioma with phleboliths should be included in the differential diagnosis of a swelling in the mandibular area.

Parotid gland enlargement in pediatric HIV population.

OBJECTIVES: To establish the significance of parotid enlargement, state frequency, cytological features and effect of antiretroviral therapy (ART) on parotid enlargement among a pediatric HIV population. STUDY DESIGN: A 6 month cross sectional survey that utilised clinical features, serial immunological indices and fine needle aspiration cytology. RESULTS: 287 HIV positive children were seen at special paediatric clinic of the University College Hospital, Ibadan, Nigeria, 114 (39.7%) had oral features and among these 24 (8.4%) had parotid involvement comprising of 10 males and 14 females. The overall mean age was 43.4 + 39.7 months compared with 59.6 + 36.5 months in the parotid enlargement group (p = 0.03). Mean ages of parotid enlargement and non enlargement group was significantly different (p = 0.03). The mode of transmission was vertical in (91.7%), 87.5% was bilateral (87.5%) and (75%) presented as a syndrome state with generalised lymphadenopathy. The predominant cytology was lymphoid hyperplasia (62.5%). ART resulted in marked clinical reduction in all the cases and statistically significant improvement in serum indices of CD4 count, CD4% and viral load (p = 0.001, 0.000 & 0.009 respectively). CONCLUSION: HIV positive children often present with bilateral parotid enlargement and the syndrome state with classical clinical and cytological features of lymphoid hyperplasia predominated. ART resulted in satisfactory reduction of the swellings in most of the cases with no need for further intervention.

[Intraparotid first branchial arch cyst: complex diagnostic and therapeutic process]. / Quiste de primer arco branquial intraparotídeo: complejo proceso diagnóstico y terapéutico.

First branchial arch cysts are uncommon. Therefore, together with its variable clinical and age presentation they are often misdiagnosed at first. The treatment is surgical, requiring a correct procedure to avoid future recurrences. In this paper we describe a typical case of first branchial arch cyst in which as described in other reports, we first made several misdiagnoses and therefore an inadequate treatment and lastly, with the correct diagnosis, we performed a meticulous complete excision under facial nerve monitoring.

Parotid tuberculosis associated with cutaneous tuberculosis on a medial epicanthus.

An 83-year-old woman presented with a 2-month history of a gradually enlarging, reddish, crusted papule on her left medial epicanthus. Her medical history did not reveal any systemic disease. She gave no personal history of tuberculosis or any systemic symptoms, such as night sweat, weight loss, and pulmonary abnormalities. Her husband had been treated for pulmonary tuberculosis 30 years ago. A dermatologic examination revealed a 2.5 x 1.2-cm nontender, erythematous plaque with fine, white adherent scales on the left medial epicanthus (figure 1A). All laboratory values were within the normal range. Results from a tuberculin skin test were initially negative. A skin biopsy was performed, and a pathological examination demonstrated multiple noncaseating granulomas with various diameters in the reticular dermis and an infiltrate of neutrophils and lymphocytes in the surrounding dermis (figure 2). Periodic acid-Schiff, Ziehl-Nilsen, gram, and giemsa stains were negative for any microorganism. Leishman-Donovan-like bodies were observed within the epitheloid histiocytes that formed the granulomas. The pathological diagnosis was granulomatous dermatitis. The patient was diagnosed with cutaneous leishmaniasis (CL) based on her clinical appearance and histopathological findings, although the parasite was not detected in the tissue specimens. Treatment with intralesional glucantime for 5 consecutive weeks did not improve her condition. By the end of the fifth week, the patient developed asymptomatic facial swelling and a 1.5 x 1.2-cm erythematous plaque in the left parotid area (figure 1B). An ultrasonographic examination demonstrated a 13 x 11 x 17-mm hypoechoic mass, which suggested pleomorphic adenoma. In addition, lymph nodes, the largest of which were 9 x 10 mm, were noted in the left cervical area. A skin biopsy from the erythematous plaque of the left parotid area demonstrated diffuse neutrophilic infiltration with formation of focal granulomas. Tuberculosis was suspected, and mycobacterium tuberculosis (MT) was isolated from the culture. A tuberculin skin test was performed again, which was positive (12 mm). The erythrocyte sedimentation rate was 35 mm/h, and all other laboratory tests were within normal limits. Pulmonary radiography and thoracic computerized tomography findings were normal. Fine needle aspiration biopsy and ultrasonographic examination of the parotid mass were performed, which revealed necrotic material with neutrophils and lymphocytes (figure 3). We treated the patient with a standard antituberculous regimen, comprising isoniazid 300 mg/d, rifampin 600 mg/d, ethambutol 1200 mg/d, and pyrazinamide 1500 mg/d. By the end of the second month of treatment, the patient improved considerably. There was a marked reduction in facial swelling, and the lesion on the left medial epicanthus regressed dramatically (Figure 4A and Figure 4B). No adverse effects of the medication occurred. An additional 7 months of therapy with isoniazid and rifampin was planned.

Viruses and salivary gland disease (SGD): lessons from HIV SGD.

Viral infections are often associated with salivary gland pathology. Here we review the pathogenesis of HIV-associated salivary gland disease (HIV-SGD), a hallmark of diffuse infiltrative lymphocytosis syndrome. We investigate the presence and contributions of viral diseases to the pathogenesis of salivary gland diseases, particularly HIV-SGD. We have detected BK viral shedding in the saliva of HIV-SGD patients consistent with viral infection and replication, suggesting a role for oral transmission. For further investigation of BKV pathogenesis in salivary glands, an in vitro model of BKV infection is described. Submandibular (HSG) and parotid (HSY) gland salivary cell lines were capable of permissive BKV infection, as determined by BKV gene expression and replication. Analysis of these data collectively suggests the potential for a BKV oral route of transmission and salivary gland pathogenesis within HIV-SGD.

Chronic periaortitis associated with membranous nephropathy: clues to common pathogenetic mechanisms.

Chronic periaortitis (CP) is a rare disease hallmarked by the presence of a periaortic retroperitoneal fibro-inflammatory tissue which can often cause obstructive uropathy. CP is isolated in most cases but it may also be associated with other sclerosing inflammatory and immune-mediated diseases. We here present the case of a patient who was initially diagnosed as having CP and subsequently developed membranous nephropathy and chronic sclerosing sialoadenitis of the right parotid gland. As these conditions were all characterized by either pronounced infiltration of IgG4-positive plasma cells or marked IgG4 tissue deposition, we hypothesize that they are part of the same disease spectrum, and discuss the immune-mediated pathogenetic mechanisms potentially shared by these conditions. In particular, we consider the role of Th2-mediated immune reactions and of immunogenetic factors such as HLA genotype as common determinants of these disorders.

Parotid abscess: an unusual cause of facial nerve palsy.

Facial nerve palsy with a parotid mass is usually associated with malignant neoplasm of parotid gland. Its occurrence as a complication of parotid abscess is extremely rare. A literature review revealed only 16 cases of facial nerve palsy associated with suppurative parotitis or parotid abscess were reported. We present a case of deep parotid abscess which is complicated by facial nerve dysfunction. Underlying neoplasia was excluded.

CT and MR imaging findings of non-neoplastic cystic lesions of the parotid gland.

A variety of neoplastic and non-neoplastic lesions of the parotid gland can present with a predominantly cystic architecture, and although radiologists frequently encounter cystic parotid tumors, other non-neoplastic lesions should also be included in the differential diagnoses of cystic parotid lesions. Non-neoplastic cystic lesions are usually classified as either congenital/acquired cystic lesions or inflammatory/infectious lesions. Adequate knowledge about these rare conditions is essential for appropriate diagnosis and optimal treatment strategy. This review article describes CT and MR imaging features of non-neoplastic cystic lesions of the parotid gland and provides helpful suggestions on the differential diagnoses for cystic parotid lesions.

Facial paralysis due to an occult parotid abscess.

Facial paralysis associated with benign diseases of the parotid gland is very rare. It has been reported in approximately 16 cases of acute suppurative parotitis or parotid abscess. We presented a 45-year-old woman who developed facial paralysis secondary to an occult parotid abscess. Initially, there was no facial paralysis and the signs and symptoms were suggestive of acute parotitis, for which medical treatment was initiated. Three days later, left-sided facial palsy of HB (House-Brackmann) grade 5 developed. Ultrasonography revealed a pretragal, hypoechoic mass, 10x8 mm in size, causing inflammation in the surrounding tissue. Fine needle aspiration biopsy obtained from the mass revealed polymorphonuclear leukocytes and lymphocytes. No malignant cells were observed. The lesion was diagnosed as an occult parotid abscess. After a week, the mass disappeared and facial paralysis improved to HB grade 4. At the end of the first month, facial paralysis improved to HB grade 1. At three months, facial nerve function was nearly normal.

Parotid abscess at a single institute in Korea.

OBJECTIVE: To investigate clinical features, treatment modality, and outcomes of patients with parotid abscess. METHODS: A retrospective chart review was conducted at Chonnam National University Hwasun Hospital January, 2006 to July, 2017. RESULTS: Among 13 patients, 4 patients had immunocompromised disease, and 3 patients had been diagnosed with pre-existing parotid tumor. Patients were treated with empirical intravenous broad-spectrum antibiotics. Among 13 patients, 7 patients (53.8%) had surgical incision, and drainage was conducted. There was no recurrence or death associated with parotid abscess; however, 1 patient with parotid abscess developed facial nerve palsy that persists, despite adequate treatment. CONCLUSION: After adequate treatment, including antibiotics and surgical drainage, the prognosis of parotid gland is good. In the case of parotid abscess of immunocompromised patients, we suggest rapid surgical procedure for speedy recovery and minimizing adverse effects.

Do you know this syndrome? Heerfordt-Waldenström syndrome.

Heerfordt-Waldenström syndrome is a rare subacute variant of sarcoidosis, characterized by enlargement of the parotid or salivary glands, facial nerve paralysis and anterior uveitis. Granulomas with a peripheral lymphocyte deficit are found in the anatomic pathology of affected organs. It is normally self-limiting, with cure achieved between 12 and 36 months, but some prolonged cases have been reported. Diagnosis of the syndrome is clinical, and treatment depends on the degree of systemic impairment. Oral corticosteroids represent the first line treatment option. The mortality rate ranges between 1 and 5% of cases.

HIV-associated cystic lesions of the parotid gland.

We present two cases of an HIV-associated parotid gland cyst. One case was a 36-year-old HIV infected woman. She was diagnosed with HIV infection and presented with slowly enlarged parotid gland cysts together with elevation of HIV viral RNA copies/mL in her serum. She was performed parotid gland biopsy under the general anesthesia. The histopathologic analysis revealed negative HIV p24-antigen in her parotid gland tissue. The other case was a 43-year-old man found his parotid gland swelling shortly after highly active antiretroviral therapy (HAART). He was diagnosed with HIV infection 2 years previously. He had started HAART several days before. He showed exceeding elevation of IgE in his serum. We treated him with medication using anti-histamic drugs for his cyst. A computed tomography scan revealed a complete response of his parotid gland cyst 4 weeks after the medication. His serum IgE level was decreased to half of the level before the medication. These findings suggested that the parotid gland swelling associated with HIV was due to various factors including immune reconstitution inflammatory syndrome (IRIS). In case such a parotid gland swelling, we could avoid invasive treatments.

Pulmonary and parotid hydatid cyst: an unusual double localization.

We described a rare case of pulmonary and parotid cyst for echinococcus granulosus in an eighty-one-year-old patient. Lesion was discovered in the lung owing to a clinical presentation. A swelling was the only sign in the parotid gland. Time between lung and parotid excision was 14 days. Time of hospitalizations was 4+/-1 day.