Spontaneous cutaneous-parotid fistula of the cheek caused by sialolithiasis in a child: a case report.

INTRODUCTION: Cheek fistulas of salivary origin in children are very rare, predominantly of congenital or traumatic origin but rarely caused by parotid sialolithiasis given its low prevalence in paediatric populations. CASE PRESENTATION: A 3-year-old child with no history other than substantial left-cheek swelling for 2 months was referred. We identified a cutaneous fistula with seropurulent discharge. At this time, we only observed mild inflammation of the left parotid duct papilla with no visible calculi. A first ultrasound scan only detected acute inflammation of the parotid duct that was treated with antibiotics. The discharge subsided but the fistula persisted. Two more episodes of infection occurred at 6-month intervals that were both treated by antibiotics. After this second treatment, a second ultrasound scan showed dilatation of the left parotid duct upstream of the cheek fistula with the presence of a calcification. We performed sialoendoscopy under general anaesthesia 10 days later. Before introduction of the sialoendoscope, we noticed a whitish calculus within the papilla that was removed by intraoral incision and digital pressure alone. Sialoendoscopy went on to detect a dilated parotid duct that was highly inflamed and bled upon contact at the site of the cheek fistula. No other sialoliths were detected. The fistula had healed four months later without any recurrence of parotitis or discharge. CONCLUSION: Sialolithiasis should be considered for spontaneous cheek fistulas in children. Sialoendoscopic-assisted diagnosis and treatment can result in complete resolution of cutaneous-parotid fistulas without the need for more aggressive surgery.

Our experience with respiratory epithelial adenomatoid hamartomas of the olfactory cleft.

Respiratory epithelial adenomatoid hamartoma (REAH) is a relatively recent diagnosis that is gaining more interest in sinus surgery. REAH of the olfactory cleft was often misdiagnosed, and interpreted as nasal polyposis (NP). We present a retrospective case series of 27 patients who were diagnosed and treated for REAH of the olfactory cleft, in the past 7 years, in our department. The aim of this study is to present the diagnostic modalities and the results and follow-up after surgery. The male to female ratio was 2.9:1, with a mean age of 56 years. Almost half of these patients were operated at least once before on their sinuses. The most common presenting symptoms of isolated REAH are olfactory disorders. All cases were treated surgically with endoscopic sinus surgery, without recurrences in the follow-up period. Knowledge and identification of REAH of the olfactory cleft are fundamental. Knowledge, identification, and adequate treatment of these lesions are fundamental, as they limit the number of recurrences.

UMSARS Versus Laryngoscopy-Based Assessment of Dysphagia.

Background: Multiple System Atrophy (MSA) dysphagia is routinely assessed by the Unified Multiple System Atrophy Rating Scale (UMSARS) part I-item 2. Objective: To compare the UMSARS part I-item 2 with an ear/nose/throat (ENT) expert physician assessment. Methods: We retrospectively analyzed the data of MSA patients who underwent an ENT assessment (nasofibroscopic and radioscopic exam) and an annual UMSARS assessment. Deglutition Handicap Index (DHI) and pulmonary/nutrition complications were collected. Results: Seventy-five MSA patients were included. The ENT assessment revealed more severe dysphagia compared to the UMSARS part I-item 2 score (P = 0.003). A higher proportion of patients with impaired protective mechanisms showed severe UMSARS-based dysphagia (P = 0.005). Patients with choking and oral/pharyngeal transit defects and nutritional complications were equally distributed across UMSARS part I-item 2 scores. Worse UMSARS part I-item 2 scores had worse DHI scores. Conclusions: The UMSARS-based assessment of dysphagia does not capture key aspects of pharyngo-laryngeal dysfunction reflecting swallowing efficiency.