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.

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.

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.

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.

Do you know this syndrome? Heerfordt-Waldenström syndrome

Abstract: 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.

Síndrome de Sjögren y halitosis: descripción de un caso clínico / Sjögren's syndrome and halitosis: a case report

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Tuberculosis de la glándula parótida / Tuberculosis of parotid gland

Hoy en día la tuberculosis es una de las más importantes infecciones reemergentes en el mundo. Hasta un 20% de las formas de presentación son extratorácicas. Sin embargo, la presencia de tuberculosis a nivel parotídeo es infrecuente incluso en países subdesarrollados, donde la incidencia de esta enfermedad es mayor. Presentamos un paciente de 83 años que acude por tumoración en región parotídea de 4 semanas de evolución sin antecedentes personales. La exploración clínica revela una masa en cola de parótida izquierda de aproximadamente 3 × 2 cm, no dolorosa a la palpación y sin evidencia de adenopatías a nivel cervical. Tras el estudio radiológico y punción con aguja fina, no se obtienen datos concluyentes, por lo que se procede a realizar exéresis. Se envía muestra para estudio de PCR, se confirma diagnóstico de tuberculosis parotídea. Tras recibir quimioterapia antituberculosa complementaria, el paciente es dado de alta por remisión de la enfermedad (AU)

Tuberculosis is currently one of the most important re-emerging infections worldwide. Up to 20% of cases are extra-thoracic. However, the presence of parotid tuberculosis is uncommon even in developing countries where the incidence of this disease is higher. The case of an 83 year-old patient is presented who had a tumour in the parotid region of 4 weeks onset, and with no previous personal history. Clinical examination revealed a mass of approximately 3 × 2 cm in the left parotid. It was not painful on palpation and there was no evidence of cervical lymph node involvement. After inconclusive radiological examination and fine needle aspiration, an excision of the lesion was performed, and the specimen sent for a PCR study. This confirmed the diagnosis of parotid tuberculosis, and after receiving additional tuberculosis treatment the patient was discharged due to remission of the disease (AU)

Parotidectomy for the treatment of parotid sialocoele in 14 dogs.

OBJECTIVES: To describe the presentation, diagnosis, cause, complications and outcome in 14 dogs that presented with a parotid sialocoele and that were treated by complete parotidectomy. MATERIAL AND METHODS: Multi-institutional retrospective study. RESULTS: Each dog presented with a non-painful, fluctuant, soft tissue mass over the lateral aspect of the face in the region of the parotid salivary gland. Diagnosis was made by sialoradiography (3/14), CT (3/14), ultrasound (11/14) and MRI (2/14). The cause of the sialocoele could be determined in 8 of 14 patients and included: foreign body (2/14), sialolithiasis (1/14), neoplasia (3/14), salivary gland lipomatosis (1/14) and trauma (1/14). Treatment incurred one anaesthetic complication (regurgitation) and seven postoperative surgical complications [self-limiting seroma formation (2/14), haemorrhage (1/14), wound dehiscence (1/14), abscessation 7 months postoperatively (1/14) and facial nerve paralysis (2/14)]. Sialocoele did not recur in any dog during a median follow-up time of 14 months. CLINICAL SIGNIFICANCE: Parotidectomy has been considered a technically challenging procedure but can have a good success rate with long-term resolution of the clinical symptoms. Intra- and postoperative complications are reasonably common.

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.

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.

Clinical associations of incidentally detected parotid gland calcification on CT.

OBJECTIVES/HYPOTHESIS: Parotid gland calcifications can be incidental findings on computed tomography (CT) and have been reported to be associated with chronic inflammatory conditions. Associations between parotid gland calcification and other common medical conditions have not been reported. METHODS: Following institutional review board approval, 1,571 patients who underwent noncontrast head CT with 1.25-mm slice thickness on a 64-detector row CT between January 2011 and July 2011 were retrospectively reviewed for parotid gland calcifications. Medical records were reviewed for chronic kidney disease, alcoholism, autoimmune conditions, endocrine disorders, elevated alkaline phosphatase, and HIV (human immunodeficiency virus) status. Statistical analyses were performed using Fisher's exact test and multiple logistic regression. RESULTS: Sixty-three of 1,571 (4%) patients had parotid gland calcifications. Significant associations were observed between parotid gland calcifications and HIV infection (P = 0.002), chronic kidney disease (P < 0.0001), alcoholism (P < 0.0001), elevated alkaline phosphatase (P = 0.003), and autoimmune disease (P = 0.02). CONCLUSION: Parotid gland calcifications were associated with HIV, alcoholism, chronic kidney disease, autoimmune disease, and elevated alkaline phosphatase. LEVEL OF EVIDENCE: 4.

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.

Invasive carcinoma arising from sclerosing polycystic adenosis of the salivary gland.

Sclerosing polycystic adenosis is a rare salivary gland lesion. Recently, this entity has been regarded as a neoplastic lesion of low-grade malignant potential but, to date, no invasive carcinoma, metastases, or associated mortality have been reported. We report the first case of an invasive carcinoma component in a recurrent sclerosing polycystic adenosis lesion.

Ocular and parotid sarcoidosis - panda sign.

Sarcoidosis is a multisystem disease with ocular involvement in 25-50% of patients, parotid and other salivary glands involvement in 6%, resulting in this characteristic panda sign in Gallium-67 scan, present in a 16 year old male with a history of bilateral recurrent uveitis.

Deep lobe parotid abscess with facial nerve palsy: a case report / Absceso del lóbulo profundo de la parótida con parálisis del nervio facial: un reporte de caso

Acute suppurative sialadenitis mostly occurs in the parotid gland, while parotid abscesses principally arise in the superficial lobe. However, facial nerve palsy, secondary to parotid abscess, is rare. Predisposing factors for the ductally ascending infection are dehydration, xerogenic drugs and salivary gland diseases associated with ductal obstruction or reduced saliva secretion. Obstruction of Stensen's duct and diminished production of saliva are regarded as the promoting factors. Painful swelling of the preauricular region and cheek is the most familiar symptom of acute suppurative parotitis. The most common pathogens associated with acute bacterial infection are Staphylococcus aureus and anaerobes. We report a rare case of deep lobe parotid abscess with facial nerve palsy. Aside from adequate fluid hydration, good oral hygiene and treatment with empiric parenteral antibiotics, surgical treatment with drainage can provide a remedy for this disease.

La sialoadenitis aguda supurativa aguda ocurre sobre todo en la glándula parótida, mientras que los abscesos parotídeos se producen principalmente en el lóbulo superficial. Sin embargo, la parálisis del nervio facial, secundaria al absceso parotídeo, es rara. Los factores predisponentes para la infección ascendente ductal son la deshidratación, los medicamentos xerogénicos, y las enfermedades de las glándulas salivales asociadas con obstrucción ductal o reducción de la secreción salival. La obstrucción del conducto de Stensen y la disminución de la producción de saliva, se consideran los factores promotores. Una inflamación dolorosa de la región preauricular y la mejilla es el síntoma más conocido de la parotiditis supurativa aguda. Los patógenos más comunes asociados con la infección bacteriana aguda son los anaerobios y el estafilococo dorado. Reportamos un caso raro de absceso del lóbulo parotídeo profundo con parálisis del nervio facial. Además de una hidratación fluida, una buena higiene oral y tratamiento con antibióticos parenterales empíricos, el tratamiento quirúrgico con drenaje puede proveer un remedio para esta enfermedad.