Lymphoma presenting as preauricular tumor in unilateral parotid gland agenesis: a case report and review of literature.

BACKGROUND: Parotid gland agenesis is a rare, congenital, usually asymptomatic disorder. Until now, only 24 cases with unilateral, incidentally found, parotid gland agenesis have been described. Here, we present the first reported case of an ipsilateral preauricular neoplasm in a patient with unilateral parotid gland agenesis. During surgery, the position of the greater auricular- and facial nerves was documented. Furthermore, we performed the first sialendoscopy for this rare disorder to assess the number of duct branches, which might be indicative of the abundance of parotid tissue. Moreover, we looked for sialendoscopic characteristic features that could aid in identifying these patients in the ambulatory setting. CASE PRESENTATION: A 50-year-old Greek man presented with a painless, slowly enlarging mass in the right parotid space. Magnetic resonance imaging revealed a complete absence of the right parotid gland without accessory parotid tissue. The right parotid gland was replaced by fatty tissue and the radiologist suggested a benign parotid tumor. Fine needle aspiration was indicative of a reactive lymph node. Sialendoscopy revealed only two branches within the right parotid duct. Surgical resection was performed through a conventional lateral parotidectomy. This revealed typical anatomic position of the greater auricular- and facial nerves despite the parotid tissue agenesis. Histopathology revealed a small lymphocytic lymphoma. CONCLUSIONS: Surgeons should feel confident to resect tumors of the parotid space in patients with parotid gland agenesis. Reduced branching observed during sialendoscopy might indicate parotid gland agenesis. Physicians should be even more cautious than usual with the watch and wait strategy in patients with tumors of parotid gland agenesis, since the probability of a tumor being a benign salivary gland tumor might be lower than usual.

Bilateral variation of the parotid gland in cadaver: a case report.

Bilateral variation of the parotid gland is an anatomically rare entity. In this study, we present a 91-year-old female cadaver with aplasia of the parotid gland on the left side of the face and hypoplasia of the parotid gland on the right side of the face. The accessory parotid glands on both sides were of normal size, while bilateral submandibular glands were found to be larger than normal. The surgical anatomy of the parotid gland is very important because this region of the face is a complex structure intertwined with important vessels and nerves. Patients with aplasia, atresia, agenesis, or hypoplasia of the parotid gland should be diagnosed early and proper treatment must be planned. Consequently, this case was found to be remarkable in terms of the coexistence of parotid gland aplasia and hypoplasia.

Parotid Gland Venolymphatic Malformation Presentation As Macroglossia.

Venolymphatic malformations (VLM) are the rare congenital disorders but the parotid gland VLMs are the rarest. Most of the parotid lesions present with unilateral swellings. Aetiology is unknown. Interestingly, this case came in OPD with the macroglossia and only complaint was cosmetic problem. Diagnosis was confirmed on the basis of Magnetic resonance imaging which is gold standard. Doppler ultrasonography showed low flow. Intra lesion electro cautery was done. There is need to focus on malformations and work to find out the causes.

Ectopic tooth buds and parotid aplasia are diagnostic features of partial facial duplication on pre- and postnatal MRI: Case report and literature review.

Craniofacial duplication is a rare congenital anomaly. A case of hemi-mandibular duplication with an accessory oral cavity is presented with along with first-time reported pre- and postnatal MRI, surgical approach and a literature review. MRI clearly depicts the ectopic tooth buds and parotid aplasia in this condition, features that are diagnostic of partial facial duplication. MRI is diagnostic for this condition and can be useful to avoid misdiagnosis of a facial mass.

Imaging Evaluation of Pediatric Parotid Gland Abnormalities.

Parotid gland lesions in children can be divided into benign or malignant. The age of the patient helps narrow the differential diagnosis, with vascular and congenital lesions being more frequent in the 1st year of life, while solid tumors are more frequent in older children. Inflammatory disease usually has rapid onset in comparison with that of neoplastic or congenital processes, which have more gradual clinical evolution. Currently, multiple imaging techniques are available to study the parotid region, such as US, CT, and MRI. However, it is still a challenge to distinguish nonmalignant lesions from malignant ones. US is the first-line diagnostic approach in children to characterize the morphology and vascularity of these lesions. CT in children may be indicated for evaluation of abscesses or sialolithiasis. MRI is the imaging modality of choice for investigating the nature of the lesion and its extent. In addition to complete and detailed clinical information, knowledge of parotid gland anatomy and characteristic radiologic features of parotid disorders is essential for optimal radiologic evaluation and avoiding unnecessary interventional diagnostic procedures or treatment. This article illustrates a variety of entities (congenital, inflammatory, vascular, neoplastic) that can occur in the parotid gland, highlighting the most frequent radiologic patterns of manifestation and correlating them with clinical, surgical, and pathologic findings. ©RSNA, 2018.

Salivary glands abnormalities in oculo-auriculo-vertebral spectrum.

BACKGROUND: Feeding and swallowing impairment are present in up to 80% of oculo-auriculo-vertebral spectrum (OAVS) patients. Salivary gland abnormalities have been reported in OAVS patients but their rate, features, and relationship with phenotype severity have yet to be defined. MATERIAL AND METHODS: Parotid and submandibular salivary gland hypo/aplasia was evaluated on head MRI of 25 OAVS patients (16 with severe phenotype, Goldenhar syndrome) and 11 controls. RESULTS: All controls disclosed normal salivary glands. Abnormal parotid glands were found exclusively ipsilateral to facial microsomia in 21/25 OAVS patients (84%, aplasia in six patients) and showed no association with phenotype severity (14/16 patients with Goldenhar phenotype vs 7/9 patients with milder phenotype, p = 0.6). Submandibular salivary gland hypoplasia was detected in six OAVS patients, all with concomitant ipsilateral severe involvement of the parotid gland (p < 0.001). Submandibular salivary gland hypoplasia was associated to Goldenhar phenotype (p < 0.05). Parotid gland abnormalities were associated with ipsilateral fifth (p < 0.001) and seventh cranial nerve (p = 0.001) abnormalities. No association was found between parotid gland anomaly and ipsilateral internal carotid artery, inner ear, brain, eye, or spine abnormalities (p > 0.6). CONCLUSIONS: Salivary gland abnormalities are strikingly common in OAVS. Their detection might help the management of OAVS-associated swallowing and feeding impairment.

The ectopic accessory parotid system: A new patient, studied through magnetic resonance imaging.

The ectopic accessory parotid system (EAPS) connotes an extra parotid tissue with its ductal outlet that is morphologically distinct from the main parotid gland and its drainage system. Clinically presenting as a saliva-draining cheek fistula near the oral commissure, this rare congenital anomaly is almost always associated with ipsilateral preauricular appendages and occasional mandibular hypoplasia, and is considered a variant of the oculo-auriculo-vertebral spectrum. This report discusses the embryology, clinical details, and management aspects in a new patient, highlighting the role of magnetic resonance imaging in, for the first time, tracking the ectopic salivary system, and establishing its independent existence.

Sialolitíase em equino: relato de caso / Sialolithiasis in equine: case report

Sialolitíase é uma afecção que afeta as glândulas salivares ou seus ductos, caracterizada pela presença de estruturas calcificadas, denominadas de sialolitos, com crescimento lento e gradual, geralmente assintomático, dificultando ou impedindo o fluxo normal de saliva. Devido à ausência de relatos na literatura nacional, descreve-se o caso de uma égua de 15 anos, que apresentava um sialolito de 13cm no ducto parotídico havia mais de dois anos, próximo à crista facial. O diagnóstico foi realizado por meio do exame clínico: visualização do aumento de volume, palpação do sialolito, avaliação odontológica; e de exames complementares: radiografia e ultrassonografia. Optou-se pelo tratamento cirúrgico, através do acesso percutâneo, pois é o mais indicado para cálculos grandes, realizando-se sutura do ducto de Stenon, sem presença de fístulas no pós-operatório. Foi de extrema importância a avaliação e os cuidados odontológicos durante a realização do procedimento, pois as pontas dentárias facilitam a formação dos cálculos.(AU)

Sialolithiasis is a condition that affects the salivary glands or their ducts, characterized by the presence of calcified structures, called sialolites, with slow and gradual growth, usually asymptomatic, hindering or impeding the normal flow of saliva. Due to the absence of reports in the national literature, the case of a 15-year-old mare who had a 13cm sialolite in the parotid duct near the face ridge for more than 2 years is described. The diagnosis was made through clinical examination: with visualization and palpation of the sialolite, dental evaluation; and complementary exams: radiography and ultrasonography. We chose surgical treatment through percutaneous access, which is the most appropriate for large stones, and Stenon's duct suture was performed, without postoperative fistulas. The assessment and dental care during the procedure was extremely important, since the dental tips facilitate the formation of the stones.(AU)

Parotid gland adenocarcinoma in a cow: case report / Adenocarcinoma de glândula parótida em vaca: relato de caso

A 9-year-old Girolando dairy cow, weighing 400kg, with a history of increased volume in the right parotid region, which extended to the submandibular region, was assisted. Fine needle aspiration cytology was performed, and the cytological findings were consistent with malignant neoplasm of epithelial origin (carcinoma). Because of the unfavorable prognosis, the animal was euthanized and submitted to an anatomopathological examination. Samples of the increased parotid and affected lymph nodes were collected for histopathological evaluation. The microscopic changes were accentuated features of anaplasia, moderate cell proliferation, atypical mitotic figures, and necrosis. Stroma ranged from delicate to scirrhous, and the tumor boundaries were not distinct. These findings substantiated the preliminary histomorphological diagnosis of undifferentiated carcinoma with metastasis in lymph nodes. Immunohistochemical tests were performed with anti-CK Pan (clone AE1AE3), anti-CK HMW (clone 34ßE12), anti-CK19 (clone RCK108), anti-vimentin (clone V9), anti-S100 (polyclonal), and anti-androgen (polyclonal) antibodies. The immunophenotype favored the diagnosis of salivary gland adenocarcinoma. Despite the rareness in cattle, salivary gland adenocarcinoma should be considered in the differential diagnosis of diseases that occur with increased volume in the head, lymphadenopathy, drooling, dysphagia, and progressive weight loss.(AU)

Foi atendida uma vaca da raça Girolando, de nove anos de idade, de aptidão leiteira, pesando aproximadamente 400kg e com histórico de aumento de volume na região parotídea e submandibular direita. Diante do prognóstico desfavorável, o animal foi submetido à eutanásia e encaminhado para exame anatomopatológico. Fragmentos da glândula parótida e dos linfonodos alterados foram colhidos e encaminhados para exame histopatológico. À avaliação microscópica, observaram-se acentuada anaplasia, moderada proliferação celular, figuras de mitose atípicas e focos de necrose. O estroma variava de delicado a esquirroso e os limites do tumor eram imprecisos. Esses achados fundamentaram o diagnóstico de carcinoma indiferenciado com metástase em linfonodos. No exame imuno-histoquímico, foram utilizados anticorpos primários monoclonais anti-CK Pan (clone AE1AE3), anti-CK alto peso molecular (clone 34ßE12), anti-CK19 (clone RCK108), antivimentina (clone V9), anti-S100 (policlonal) e antirreceptor de andrógenos (policlonal). As células neoplásicas apresentaram imunomarcação para todos os anticorpos testados, resultado que favorece o diagnóstico de adenocarcinoma de glândula salivar. Embora raro em bovinos, o adenocarcinoma de glândula salivar deve ser considerado no diagnóstico diferencial de doenças que cursam com aumento de volume na cabeça, linfadenopatia salivação, disfagia e emagrecimento progressivo.(AU)

Accessory parotid gland tumors: A series of 4 cases.

Accessory parotid gland tumors are clinically rare, and their management remains unclear. In this article, we describe our experience with 4 patients-2 males and 2 females, aged 13 to 66 years-who were diagnosed with an accessory parotid gland tumor. All patients presented with an asymptomatic midcheek swelling, and all underwent fine-needle aspiration biopsy, ultrasonography, computed tomography, and magnetic resonance imaging. A standard parotidectomy was performed on all patients. Postoperatively, 2 patients were found to have a malignant tumor, while the other 2 had a pleomorphic adenoma. No patient experienced any obvious facial nerve injuries postoperatively, and no recurrences were observed. We discuss the preoperative evaluation, treatment, and prognosis of these tumors, and we briefly describe the literature. The first choice of treatment for accessory parotid gland tumors is surgical resection. In our experience, a standard parotidectomy approach is safe and cosmetically appealing.

Sialolithiasis of an accessory parotid gland: an unusual case.

We report a rare case of sialolithiasis of an accessory parotid gland, which was located anteromedial to the masseter muscle and isolated from the main parotid gland. The calculus developed from this accessory gland, and the main gland was free of lithiasis and inflammation. To our knowledge, there is no reported case of 14 stones in an accessory parotid salivary gland. The calculus was removed through a standard incision without injury to the facial nerve or a salivary fistula.

Unilateral duplication of the parotid duct, its embryological basis and clinical significance: a rare cadaveric case report.

The parotid gland is the largest salivary gland in humans, and produces mainly serous secretions. The secretion of this gland reaches the oral cavity through single parotid duct (Stensen's duct). The parotid duct begins at the anterior border of the gland, crosses the masseter, and then pierces the buccinator and open the mouth. The present study reports a rare variation of a unilateral double parotid duct that was observed in the right side of the face of a 75-year-old male cadaver during dissection. The embryological basis of this variation can be explained as follows. A sprout originates from epithelium lining the primitive oral cavity, grows dorsally, and bifurcates. The end parts of these branches invaginate into the adjacent mesenchyme separately, proliferate, and make the parotid gland, while their proximal parts later form communicating ducts (D1 and D2) connecting the gland to the mouth. Furthermore, the clinical importance of this variation was discussed.

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.

[Pneumoparotid: a rare cause of recurrent parotid swelling]. / Pneumoparotide : une étiologie rare de tuméfaction parotidienne récidivante.

INTRODUCTION: Pneumoparotid is a rare cause of recurrent parotid swelling. It is often fortuitous, caused by an action inducing intraoral pressure, increased or self-induced. OBSERVATION: An 8-year-old boy presented with recurrent right unilateral parotid swelling for 2 years. A CT-scan was performed, outside of the acute phase, which revealed the presence of intraparotid air bubbles. DISCUSSION: Pneumoparotitis results from air flowing back into Stensen's duct, due to an anatomical abnormality and a significant increase of intraoral pressure. The diagnosis is made on clinical examination, often completed by a morphological examination (cervicofacial CT-scan or parotid ultrasound investigation). The outcome is most often favorable, with symptomatic treatment, and sometimes antibiotic prophylaxis. Patient education is the best means to prevent recurrence.

Lateral facial cleft associated with accessory mandible having teeth, absent parotid gland and peripheral facial weakness.

Transverse facial cleft is a very rare malformation. The Tessier no. 7 cleft is a lateral facial cleft which emanates from oral cavity and extends towards the tragus, involving both soft tissue and skeletal components. Here, we present a case having transverse facial cleft, accessory mandible having teeth, absent parotid gland and ipsilateral peripheral facial nerve weakness. After surgical repair of the cleft in 2-month of age, improvement of the facial nerve function was detected in 3-year of age. Resection of the accessory mandible was planned in 5-6 years of age.

Angiossarcoma pouco diferenciado primário de glândula salivar parótida: relato de caso / Primary poorly differentiated angiosarcoma of the parotid gland

As neoplasias mesenquimais primárias das glândulas salivares são raras. Os autores descrevem um caso de angiossarcoma primário da glândula parótida em um homem com 84 anos (AU)

Primary mesenchymal neoplasms of the salivary glands are rare. The authors report a case of primary angiosarcoma of the parotid gland in a 84-year old male (AU)

Complete agenesis of major salivary glands.

A 4 year-old female patient was treated for persistent right-sided dacryocystitis and xerostomia. MRI was performed to screen for a dry syndrome; which resulted in the diagnosis of agenesis of the parotid and submandibular glands as well as lacrimal duct malformation. An MRI of each parent was normal. The mother's history revealed 4 days of pyrexia during the 8th week of amenorrhea. This was an isolated case, with no family history, characterized by a febrile episode during pregnancy at the period of main salivary gland genesis. Epigenetic mechanisms could be implicated.