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Schwannomas are benign tumors which arise from Schwann cells and take place along peripheral nerves. Extra-temporal facial nerve schwannomas are infrequent and present as painless masses in the parotid region, slow-growing and involvement of the facial nerve. Although rare, they should be taken into account as a differential diagnosis in parotid masses in children. Surgical strategies include superficial parotidectomy and surgical tumor resection with electrical nerve stimulation and nerve preservation. The following case describes a paediatric patient treated with the previously mentioned nerve sparing surgical technique.

Background Superficial parotidectomy is standard surgical procedure for parotid gland tumor, and Frey syndrome and depressed deformity of the region are often seen as complications. In this study, we performed prevention of Frey syndrome by covering the residual parotid gland defect with the parotid gland fascia flap. Method The subjects were 5 patients with parotid gland tumor. Tumor was localized in the inferior and superior poles of the parotid gland in 3 and 2 patients, respectively, and it was confirmed on preoperative diagnostic imaging that the tumor and parotid gland fascia were not present in close proximity. Through Lazy-S incision, main trunk of facial nerve was identified and conserved following the surgical procedure of normal superficial parotidectomy, and the superficial parotid gland containing tumor was elevated. A parotid gland fascia flap with a pedicle on the nasal side was prepared and the defect after superficial parotidectomy was covered with it. Results The facial nerve and resected parotid gland stump could be sufficiently covered with the parotid gland fascia flap in all patients. The mean duration of postoperative follow-up was 36 months (10 months-4 years and 5 months), and there were no complications such as tumor recurrence, Frey syndrome, salivary gland fistula, or severe concavity in the parotid region. Conclusion Although application of the present procedure is limited to patients in whom the parotid gland fascia and tumor are not located in close proximity, it may be useful to prevent Frey syndrome because extension of incision is not necessary, the surrounding tissue is not sacrificed, the flap can be easily elevated, and the parotid gland stump can be sufficiently covered.

Key Clinical Message Undifferentiated high‐grade pleomorphic sarcoma is a slow‐growing tumor rarely localized in the head and neck region. The treatment of UHPS should be based on large surgical resections in free margins associated with neck dissection. Postoperative radiotherapy improves local control of the disease and the prognosis quod vitam.

Salivary duct injury can be idiopathic, iatrogenic, or post-trauma and may result in sialocele or fistula. Most injuries regress spontaneously and botulinum toxin A is one of several therapeutic possibilities. We report a case of iatrogenic injury to the parotid duct after Mohs' micographic surgery for a squamous cell carcinoma excision in the left jaw region, treated by injection of botulinum toxin type A. Although the fistula by duct injury can be self-limiting, botulinum toxin injection by promoting the inactivity of the salivary gland allows rapid healing of the fistula.

Pilomatricoma is a benign skin tumor originating from the matrix cells of the hair follicles. Sometimes, its diagnosis can be difficult, especially in the preauricular region, where in the differential diagnosis, in addition to other dermal and subcutaneous masses, primary and secondary parotid gland tumor lesions must be also considered. A 34-year-old female was referred to our Institution with a right preauricular swelling over 12 months, which enlarged in the last two months. The ultrasonography confirms the origin of the tumoral mass in the skin of the preauricular region and not from the superficial lobe of the right parotid gland. The patient underwent complete tumor excision and the histopathology and immunohistochemical exams confirmed the diagnosis of a conventional pilomatricoma evolving to a late regressive lesion. She was discharged considered as cured and no recurrences were reported within a period of eight months of follow-up. This is the first reported case in the last 30 years, in this location, in the Department of Oral and Maxillofacial Surgery our Institution. Regarding the rarity of these tumors, especially in this location, we must keep in mind to consider a broader differential diagnosis that includes both tumoral and non-tumoral skin lesion and also parotid gland lesions.

The tumours of the parotid accessory lobe may present with significant challenges to the clinicians due to their rarity, presenting with diagnostic difficulties as well as difficult decision-making in terms of surgical approach. We retrospectively analysed 8 cases of accessory parotid lobe tumours treated in our unit. The presenting symptom was a mass in all cases present in the peri-parotid region with duration ranging from 6 weeks to 2 years. All cases were investigated with ultrasound-guided fine needle aspiration cytology (FNAC). Various surgical approaches were adopted that included standard cervico-facial (n = 4), trans-oral (n = 3) and cervical (n = 1) incision approach. The rate of early post-operative facial nerve weakness was 37.5% (n = 3). There were no cases of tumour recurrence. Any lump not typical of a parotid lump but close to the parotid region should be treated with a high degree of suspicion to exclude an accessory lobe tumour. A full work up with US-guided FNAC is recommended prior to definitive treatment. Although a standard cervico-facial incision approach is recommended in most cases, other direct approaches may also be considered depending on the location of the tumour. We present our experience of these tumours providing practical tips on diagnosis and surgical management.

A 67-year-old man with a high position carotid plaque presented with severe pain in ipsilateral parotid region several days after carotid endarterectomy (CEA). The pain occurred at the first bite of each meal and resolved as further bite. We diagnosed the pain as first bite syndrome (FBS). FBS is infrequent but known as a complication associated with parapharyngeal space surgery. The pain is characterized by sharp pain in the parotid region associated with mastication. The cause is unclear but thought to the result from sympathetic denervation of the parotid gland, followed by parasympathetic nerve hypersensitivity. Only five cases associated with carotid endarterectomy (CEA) have been reported. We should be in mind that CEA for high position plaque is one of the risk factors to cause FBS associated with CEA. Neurologists and vascular surgeons as well as otolaryngologists should all be informed FBS as one of the complications after carotid endarterectomy.

Overall salivary gland tumours are rare, comprising of less than 3% of overall head and neck neoplasms. Parotid gland is the most common site for the benign salivary gland neoplasm. Usually they are painless slow growing lesion involving the superficial or deep part of the gland and can severely affect the facial nerve functioning. Treatment mainly comprises of surgical excision with preservation of the facial nerve. A 28 year old female presented with painless swelling in the left parotid region since 2 years. The C.T. scan shows a hyperdense circumscribed mass involving the left parotid gland. On surgical exploration the neoplasm was resected and histopathologically diagnosed as Pleomorphic adenoma of parotid. It is of clinical significance to rule out other different benign and malignant neoplasm present in the parotid region for the proper diagnosis and management of these types of lesion encountered in routine dental practice.

The aim of the present study was to assess the efficacy and safety of topical timolol maleate combined with oral propranolol for parotid infantile hemangiomas. Between October 2012 and April 2014, propranolol was administered orally at a dose of 1.0–1.5 mg/kg/day to 22 infants with proliferating hemangiomas in the Department of Oral and Maxillofacial Surgery (Hospital of Stomatology, China Medical University, Shenyang, Liaoning, China). A small amount of 0.5% timolol maleate eye drop solution was topically applied with medical cotton swabs to the area of the lesion twice a day, every 12 h. The study group consisted of 9 males and 13 females, aged 2–9 months, with a median age of 4.7 months. The lesions were all located in the parotid region, and measured between 3.5×4×0.5 and 7×8×3 cm in volume. The planned duration of therapy was 6–8 months, or the two drugs were stopped when complete regression of the lesions was obtained. The therapeutic outcomes and safety were assessed by the change in the size and color of the tumor, and the presence of adverse effects throughout the course of treatment. The mean duration of therapy was 21.1 weeks and ranged from 3 to 8 months. Of the 22 patients, 16 demonstrated an excellent response, 6 showed a good response and 2 displayed a moderate response. No major collateral effects were observed. Overall, oral propranolol combined with topical timolol maleate may be used as the first-line therapeutic choice in the treatment of infantile parotid mixed hemangioma.

Objectives/Hypothesis The treatment for most advanced head and neck cancers (stage III and IV) usually includes radiation, and the most common side effect of this treatment modality is a permanent decrease in salivary production. Xerostomia is a devastating complication that significantly affects patients' quality of life by interfering with functions of taste, mastication, deglutition, and speech production. Treatment of xerostomia is varied, but one of the strategies developed by our group was to preserve one submandibular gland by surgically transferring it to the submental space and shielding it from the full dose of radiation. This procedure is proven to reduce the rate of radiation-induced xerostomia, but its main disadvantage is that it is contraindicated in oral cavity cancer. This study describes and evaluates a modification of the submandibular gland transfer (SGT) procedure, where the submandibular gland contralateral to the disease process is relocated to the parotid region. This modification has the potential of expanding the benefits of submandibular gland transfer procedures to patients with oral cavity cancers. Study Design Prospective feasibility study. Methods This study involved nine patients with a new diagnosis of advanced head and neck cancer undergoing major head and neck cancer resection with postoperative adjuvant radiation therapy. The new modified salivary gland transfer procedure was performed on all nine patients, and the glands total dose received with radiation therapy was assessed. Results All the modified SGT procedures were successful with no post-operative complications. The radiation oncology team has been able to successfully localize the transferred submandibular glands and shield them from the radiation beam postoperatively. Conclusions We have successfully demonstrated that surgical transfer of a submandibular salivary gland to the parotid region is feasible, surgically viable, oncologically sound, and does not interfere with radiation therapy. Level of Evidence 4 Laryngoscope, 2016

Salivary gland neoplasms are extremely rare in children and comprise less than 1% of all pediatric neoplasms. Benign neoplasms account for 60% of these salivary tumors in children. They are most commonly vascular in origin with parotid glands being affected commonly. Pleomorphic adenoma is common in adults; it is extremely rare in pediatric age group. We report a 9 year old girl with a parotid region swelling; suspected to be a pleomorphic adenoma of the superficial lobe of parotid. However, it was arising from the deep lobe & hence was managed with an enucleation of the tumor with no evidence of recurrence after 3 years of follow up.

To present a patient with an atypical recurrent parotid swelling due to masseter muscle hypertrophy and the diagnostic/therapeutic assessment to treat this condition.A patient referring recurrent right facial swelling underwent a complete multidisciplinary assessment of the parotid region that revealed masseter muscle hypertrophy, confirmed by means of clinical (otolaryngological and gnathological evaluation), radiological (utrasonography, dynamic magnetic resonance imaging, and cone beam computed tomography), instrumental (electromyography to evaluate the right masseter muscle function and kinesiography to evaluate maximum right deflection - MaxRDefl and maximum opening - MaxMO) and sialendoscopy assessment where T0 indicates the pre-treatment values. All electromyographic and kinesiographic parameters were evaluated six months after the orthodontic application of a neuromuscular orthosis at T1. At T1, the effectiveness of the orthodontic therapy was demonstrated by the complete resolution of symptoms, and instrumental results documented more efficient muscle activity at rest and during clenching and a better mandibular position. At EMG T1, the resting and post-TENS values were, respectively, 1.2 and 1.8 microV. At kinesiography, MaxRDefl increased from 10.2 (T0) to 10.5 mm (T1); maxMO increased from 41.2 (T0) to 48 mm (T1).The proposed multidisciplinary assessment based on otolaryngological, gnathological, and radiological evaluation may be useful in the case of recurrent parotid swelling secondary to masseter muscle hypertrophy to plan an appropriate management with a removable neuromuscular orthosis.

First bite syndrome (FBS) refers to intense pain in the parotid region, which coincides with the first bite of every meal, gradually subsides over the next several bites, but returns with the first bite of the next meal. The definitive diagnosis can be readily established by the characteristic onset of pain after the first bite of every meal. Pain is typically most intense at the first meal of the day, although some patients experience symptoms when thinking of food or salivating. FBS is a recognized complication of surgery within the parapharyngeal space; however, other surgical procedures involving the upper neck have been associated with this syndrome. The extreme rarity of FBS complicates a thorough understanding of its pathophysiology. Various medical agents have been used, with variable success, for the management of patients with FBS. Although proved effective, more radical treatment modalities are commonly reserved for persistent or refractory cases, because there is potential of spontaneous decrease in the severity of symptoms with time. This report describes the case of a patient presenting with symptoms of FBS after bilateral temporomandibular joint replacement. To the authors' knowledge, this is the first case of FBS in the literature occurring after temporomandibular joint replacement.

Background: The majority of parotid masses are benign pleomorphic adenomas that rarely recur, leaving a large group of patients healthy after their parotid surgery. Nearly, 80–90% of salivary gland tumors occur in the superficial lobe of the parotid gland, and the vast majority of them are benign. The optimal treatment for benign parotid tumors, of which pleomorphic adenomas is the most common is superficial parotidectomy with dissection and preservation of the facial nerve. Aims and Objectives: The aim of this study was to evaluate the postoperative complications and tumor recurrence following superficial parotidectomy for benign parotid tumors. Settings and Design: This was a retrospective study conducted of all patients who underwent superficial parotidectomy in a General Surgical Unit of the Goa Medical College, Bambolim, Goa, between December 2013 and December 2014. Materials and Methods: The records of 17 patients were analyzed in detail with regard to the complications and tumor recurrence that followed the operation of superficial parotidectomy. Data regarding age, gender and histology were also included in the study. Patients had all been chosen from the out-patient department on the basis of clinical presentation of swelling over the parotid region. The location of the tumor and diagnosis was confirmed in every case by advising ultrasound of the parotid region and/or computed tomography scan along with fine needle aspiration cytology of the swelling. All data were meticulously entered in a previously prepared proforma for this purpose. Patients were followed up for 1 year. Results: Twelve (70.5%) patients were male and 5 (29.5%) female, with ages ranging from 21 to 65 with a mean age of 38.2. There were 16 pleomorphic adenomas 94.1% and 1 adenolymphoma. Partial or temporary facial nerve damage was seen in six patients at 35.3%. At 6 months follow-up, however, recovery was complete, and we had no permanent facial nerve damage. Of 17 patients, 10 (58.9%) complained of numbness of the ear lobule which gradually improved with time. None of our patients had an infection, permanent facial weakness, or tumor recurrence. However, it should be stressed that Goa is a small state and due to the small number of cases in the study, it could be labeled more as a personal one. Conclusions: Superficial parotidectomy is a safe operation if performed with attention to detail, meticulous gentle dissection and avoidance of direct trauma or stretches to the nerve to prevent facial weakness.

Background and purpose: An adequa- te diagnosis of a parotid gland enlargement is crucial for an appropriate treatment. The aim of the study was to evaluate effectiveness and minimal invasiveness of diagnostic procedures of core-needle biopsy. Materials and Methods: This study involved 67 patients, aged 40 to 90 years, with a tumor mass in the submandibular and parotid region. Method used for tak- ing samples of pathological masses was BD Disposable guillotine spring-loaded needle for biopsies on soft tis- sues. Final diagnoses were established on the basis of surgical-pathological results in 67 cases, and on the ba- sis of histopathological analysis of core-biopsy samples. Results: Compared with results of surgical bi- opsy, core-needle biopsy had sensitivity of 100% in differentiating benign from malignant lesions and in setting up an adequate diagnosis. Its positive predictive values were 100% in diagnosing malignancy. There were found 28 non-malignant and 39 malignant lesions with fewer disadvantages for patients.

This study aims to report 2 pleomorphic adenoma (PA) cases. The patient had pain complaint in mouth opening. Clinical observation found a hardened increase volume, smooth, fixed, without inflammation at the left side of the face. Computed tomography (CT) scans show a 3 cm in diameter, well-circumscribed lesion, with areas of calcification, located in the parotid region (upper lobe). The mass was surgically removed, the histopathologic examination confirmed the initial suggestion of PA, and up to the 10th month no recurrence was observed. The second patient reported a volume increase at the right submandibular. CT scans show a well delimited, lobular lesion without signs of calcification. Surgical resection was the chosen approach, and at 6-month follow-up no recurrence or motor deficit of the facial nerve was observed.

First bite syndrome (FBS) is a condition that classically presents as severe pain in the preauricular region, initiated on the first bite of a meal. In most of the cases reported, it is associated with a history of upper neck surgery or tumor of the parotid salivary gland or parapharyngeal space (PPS). Some propose that FBS arises due to damage to the cervical sympathetic trunk leading to the loss of sympathetic innervations to the parotid salivary gland. Literature also showed occurrence of this syndrome in individuals who had no history of parotid tumor, PPS tumor or surgery of the upper neck, and such cases are referred to as idiopathic FBS (IFBS). There are very few case reports reported on IFBS. We report the one such rare case of IFBS in a 35-year-old male, referred to the outpatient department, with a 5-month history of severe, sharp pain and bilateral swelling in the parotid region occurring only on the first bite of eating and would diminish over few minutes.

Arteriovenous malformation (AVM) of the parotid gland is an extremely rare condition with very few cases reported in the literature. Majority of the swellings in the parotid region are usually due to sialadenitis, tumour etc., therefore making the initial diagnosis of vascular malformation may be difficult if there is no evident Turkey-wattle sign. Here, we present a case of AVM of parotid gland with its clinical features, radiographic features and its management. The lesion, being a high flow one, was managed with sclerosing agents to regress its size.

To investigate the clinical features, diagnosis, and treatment, as well as prognosis of neurinoma in parotid region, in order to provide references for clinical treatment.Fifty-two cases of neurinoma in parotid region treated between June 2000 to December 2013 were retrospectively investigated, including their clinical characteristics, imaging examination, diagnosis, therapies and prognosis. SPSS13.0 software package was used for Fisher's exact test.Nine cases (17.31%) in all had facial paralysis, discomfort and other neural symptoms before operation. Eleven cases(21.15%) was preoperatively diagnosed. All patients were treated with surgery, pathologically diagnosed and followed up for 42 months to 206 months. No recurrence and malignant transformation were found. Twenty-eight cases (53.85%) had symptoms of facial nerve injury postoperatively, but 18 cases (64.29%) were improved functionally. When there was no obvious correlation between the tumor and facial nerve, no facial nerve paralysis was found. When the tumor was located on the facial nerve, the rate of preserving facial nerve function was 22.22%, the rate of intracapsular enucleation of the neurinoma was 85.71%, and the effective rate of excision followed by facial nerve reconstruction was 85.71%.The diagnosis of neurinoma in parotid region is difficult and needed to be confirmed by postoperative pathology. The preservation of facial nerve function should be the utmost procedure during operation while intracapsular enucleation is the first choice. However, in order to restore the function of facial nerve, nerve reconstruction should be performed as soon as possible.

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.

Introduction: The high-pressure water jet is used for cleaning in various business lines. However, these technological devices occasionally cause severe penetrating injuries in the head and neck region due to high-pressure water. Such high-pressure water injuries to the parotid region are rare. Case Report: After high-pressure water jet injury, facial paralysis was present in a 37-year-old male patient who applied to the emergency department with an incision about 15-20 cm including skin, subcutaneous tissue, parotid gland and masseter muscle on the raght side of the neck. In Magnetic Resonance Imaging (MRI), there was no pathology showing deep veins, trachea, larynx, and oropharynx. For facial paralysis, prednisolone treatment was given intravenously (iv) and antibiotic therapy was started in response to the possibilit of infection. Conclusion: As the daily use of water jets becomes increasingly widespread, the prominence of these injuries is increasing. Early tissue repair is useful in reducing post-injury complications. We found it appropriate to present this issue in order to take attention to the public awareness of such head and neck injuries due to high-pressure water pumps.

Background Lengthening temporalis myoplasty is a faster and less invasive alternative to free muscle transfer for smile reconstruction. However, it requires a nasolabial fold incision, which leaves a midfacial scar. Based on esthetic considerations, a modified approach, involving an extended lazy-S (parotidectomy) incision instead of a nasolabial fold incision, was developed. Methods A cadaveric study involving 10 hemifaces was conducted. From February 2013 to March 2016, the modified lengthening temporalis myoplasty procedure was employed in 10 patients. The results were graded from 1 (poor) to 5 (excellent) according to the Terzis grading system. The excursion of the oral commissure was also measured. Results The extended lazy-S incision provides easy and safe access to the coronoid process and good visibility. The patients' mean age was 56.5 years, and the mean duration of the postoperative follow-up period was 22.2 months. The patients' underlying conditions included acoustic neuroma (n = 2), Bell palsy (n = 3), congenital conditions (n = 2), brain infarction (n = 1), Ramsay Hunt syndrome (n = 1), and malignant parotid lymphoma (n = 1). One patient suffered a surgical site infection, which was successfully treated with irrigation. All the patients achieved improvements in smile symmetry: 2, 5, and 3 patients obtained excellent, good, and moderate results, respectively. The excursion of the oral commissure ranged from 5 to 10 mm. Conclusion The modified lengthening temporalis myoplasty procedure provides satisfactory functional outcomes without causing significant complications. It does not leave a facial scar and is a preferable option, especially for young and female patients, and patients who have undergone ablative surgery involving the parotid region.

Lipomas localization in the parotid region is very rare. We here report a new case of a 55-year old patient, presenting with a mass in the parotid region that had progressed over the past 4 years and a literature review. A soft, mobile and painless mass was detected on palpation. The patient underwent imaging examinations (ultrasound and MRI), that enabled to retain the diagnosis of parotid lipoma. The patient decided to have conservative treatment.

Objective. First bite syndrome, characterized by pain in the parotid region after the first bite of each meal, predominantly develops in patients who have had head and neck surgery. Idiopathic parotid pain (IPP) that mimics first bite syndrome may present in patients without a history of surgery or evidence of an underlying tumor, but its clinical features are unclear. This study characterized the clinical characteristics of IPP in patients with diabetes. Study Design. A retrospective case review involving the clinical findings and pain characteristics of nine patients with IPP and diabetes who presented to our department between 2013 and 2016. Results. All the patients were men diagnosed with type 2 diabetes (median age, 43 years). IPP developed unilaterally in seven patients and bilaterally in two. The median intensity of the first bite pain was 8 on a numerical rating scale of 0–10. The trigger factor was gustatory stimuli, and the trigger area was the posterior section of the tongue. Postprandial pain occurred within 1–10 min after meals in six patients. Conclusions. IPP may be considered a separate disorder, in which the pain characteristics are similar to those of first bite syndrome but the clinical features and pathophysiology are different.

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children and adolescents. Most patients present with a mass in the head and neck region, urogenital region, or with distal extremity involvement. The authors describe a challenging case of a 6-year-old male patient presenting with mandibular RMS. The clinical/radiographic/tomographic evaluations classified the tumor as an advanced stage (stage IV), with a mass of 6.0 cm involving the left side of the mandible and parotid region. The biopsy revealed round, spindled, and pleomorphic cells with hyperchromatic nuclei and rare larger rhabdomyoblasts with eosinophilic cytoplasm. The diagnosis was of embryonal RMS. The patient was referred for treatment with cycles of chemotherapy; however, pulmonary and bone marrow metastasis were identified. Radiotherapy and local surgery with microvascular reconstruction were performed later; however, the patient died after a few months. Early diagnosis is critical for a good prognosis and cure of patients with RMS. Correct diagnosis considering also the histological subtype is important for adequate treatment, which according to the literature is not uniform probably because of the rarity of this neoplasm.

Salivary duct injury can be idiopathic, iatrogenic, or post-trauma and may result in sialocele or fistula. Most injuries regress spontaneously and botulinum toxin A is one of several therapeutic possibilities. We report a case of iatrogenic injury to the parotid duct after Mohs' micographic surgery for a squamous cell carcinoma excision in the left jaw region, treated by injection of botulinum toxin type A. Although the fistula by duct injury can be self-limiting, botulinum toxin injection by promoting the inactivity of the salivary gland allows rapid healing of the fistula.

Objectives/Hypothesis First bite syndrome is the sudden onset of acute and severe pain in the parotid region at the initiation of mastication. Although it generally lasts less than a minute, it is disabling for these individuals and leads to a fear of oral intake. It is typically seen after parapharyngeal or deep parotid space surgery. Intraparotid injection of botulinum toxin A (BTA) has been suggested as a treatment for this condition, but there is little supporting literature to this effect. The purpose of this study is to document our experience using this treatment method for first bite syndrome. Study Design Retrospective case review. Methods Five patients with first bite syndrome, developed after parapharyngeal space surgery, were treated by multisite injection of BTA into the parotid gland. Between 17.5 and 50 total U of BTA were injected into four or more sites in the parotid region. The patients were then followed up every 4 months. Results Three of five patients reported a significant improvement in symptoms at the 4-month follow-up visit, although complete resolution was not reported. One patient reported only moderate improvement, and despite two series of injections there was no improvement in one patient, leading us to question our initial diagnosis. Conclusions Unilateral BTA injection into the affected parotid gland produces a decrease in the severity of symptoms. It is a safe and viable noninvasive treatment for this difficult to treat condition and may lead to permanent resolution of symptoms in some patients. Level of Evidence 4 Laryngoscope, 126:104–107, 2016

Parotid gland tuberculosis is an extremely rare form of extrapulmonary tuberculosis, even in countries where tuberculosis is endemic like India; however, it should be included as one of the differentials of discrete parotid swelling as it generally presents as a slow-growing mass indistinguishable from a malignancy and even imaging too, can’t differentiate these clearly. The majority of the previously reported cases were mostly unilateral and diagnosed by histopathological examination of post parotidectomy specimens. Here we are describing a case of tuberculosis of both parotid glands in a 25 year-old male who was referred to us with bilateral parotid region swelling of two month duration. Tubercular parotiditis was confirmed by demonstration of epithelioid granuloma and caseous necrosis compatible with TB on fine needle aspiration cytology (FNAC). He was treated with four drug anti-TB regimen (2HERZ + 4HR) leading to full recovery and complete disappearance of swelling and symptoms with no recurrence till one year of follow up. Apart from rarity due to bilateral involvement, this case report highlights the clinical presentation, ultrasonography and other imaging findings, and significance of FNAC in diagnosis of this uncommon entity reinforcing the fact that the diagnosis of parotid gland tuberculosis requires a high degree of clinical suspicion.

Pilomatrix carcinoma (PC) is a rare neoplasm, particularly in the parotid region. Thus, it is easily misdiagnosed and an optimal treatment regimen has not yet been established. The present study reports the case of a 43-year-old female who presented with a PC of the parotid region and reviews the associated published literature. The patient underwent three surgical excisions prior to the tumor being completely removed, and was misdiagnosed four times prior to the correct diagnosis. Once the tumor was completely removed, the patient received radiation therapy (RT). At the 2-year follow-up, the patient remained free of local recurrence and metastasis. To the best of our knowledge, only 3 cases of PC on the parotid region have been reported. Although an optimal treatment regimen has not been established, surgery with wide margins is recommended, with RT and chemotherapy producing mixed results.

Introduction Parotid gland incidentalomas (PGIs) are unexpected hypermetabolic foci in the parotid region that can be found when scanning with whole-body positron emission/computed tomography (PET/CT). These deposits are most commonly due to benign lesions such as Warthin tumor.Objective The aim of this study was to determine the prevalence of PGIs identified in PET/CT scans and to assess the role of smoking in their etiology.Methods We retrospectively reviewed all PET/CT scans performed at our center in search of PGIs and identified smoking status and standardized uptake value (SUVmax) in each case. We also analyzed the database of parotidectomies performed in our department in the previous 10 years and focused on the pathologic diagnosis and the presence or absence of smoking in each case.Results Sixteen cases of PGIs were found in 4,250 PET/CT scans, accounting for 0.4% . The average SUVmax was 6.5 (range 2.8 to 16). Cytology was performed in five patients; it was benign in four cases and inconclusive in one case. Thirteen patients had a history of smoking. Of the parotidectomies performed in our center with a diagnosis of Warthin tumor, we identified a history of smoking in 93.8% of those patients.Conclusions The prevalence of PGIs on PET/CT was similar to that reported by other authors. Warthin tumor is frequently diagnosed among PGIs on PET/CT, and it has a strong relationship with smoking. We suggest that a diagnosis other than Warthin tumor should be considered for PGIs in nonsmokers.

Objective The pathology of the salivary glands focuses on that of the parotid gland. The purpose of this study is to clarify and explain the epidemiological features of parotid tumors in a Senegalese context, to highlight the importance of clinical examination when access to complementary investigations is limited, to discuss respective indications and finally to describe certain aspects of treatment in our context. Materials and methods This retrospective study of 114 cases of parotidectomy spans 16 years, from 1992 to 2007. It was performed in the ENT department of University Hospital of Fann, Senegal. All patients operated on for chronic mass of the parotid region for whom histological results were available when initially included. Benign swellings were subsequently excluded. The study parameters were epidemiological, clinical, paraclinical and surgical. Results The 114 parotidectomies showed a predominance of benign tumours: 63 procedures (55.26%) essentially concerned pleomorphic adenoma; 30 cases (26.31%) concerned malignant tumours, mainly parotid adenocarcinoma. There were 21 cases of benign swelling (18.4%). The study focused on the series of 93 cases of benign and malignant tumours of the parotid gland. Both sexes were affected similarly. All age groups were concerned, from 5 to 89 years. A total of 97% of patients underwent surgery: conservative total parotidectomy in 75.51% of cases. Conclusion Although there are features specific to the local context, the epidemiological profile of parotid tumours is well-known. Indications for complementary investigations are discussed, as availability in Senegal is restricted, highlighting the important role of clinical examination in the management of parotid tumours.

Objective Chronic recurrent multifocal osteomyelitis (CRMO) is an aseptic inflammatory disorder of unknown etiology. CRMO involving the mandible is a diagnostic challenge due to a propensity for solitary involvement and lack of definitive radiologic or pathologic diagnosis. The purpose of this study is to report clinical and imaging findings in cohort of children with CRMO of the mandible. Materials and methods A retrospective search of the Picture Archiving Communication System (PACS) and accompanying reports was performed for studies with suspected osteomyelitis of the mandible. The electronic medical record, histopathology results, and imaging findings were also reviewed. Inclusion criteria included presentation and course as well as surgical biopsy consistent with CRMO. Four children satisfied our inclusion criteria. Mean age was 9.1 years (range 3.5–12). M:F ratio = 1:3. Results Patients presented with mild pain and swelling in the parotid region ( n = 4), mildly elevated sedimentation rate ( n = 3), and negative biopsy culture ( n = 4). A positive response to non-steroidal anti-inflammatory medication was noted in all patients. Imaging demonstrated a predominately sclerotic lesion in the posterior mandible associated with solid periosteal reaction in all patients. Cortical expansion ( n = 3) was commonly present. The clinical course was prolonged in the patients in whom a diagnosis of CRMO was not initially entertained. Conclusions Parotid mass or swelling is a common presentation of CRMO involving the mandible. The possibility of this diagnosis should be raised when typical clinical and imaging features are present. Whole body imaging may be helpful to evaluate for additional lesions. While biopsy is necessary with isolated mandibular involvement, repeated biopsies and prolonged antibiotic therapy should be avoided.

Patient: Male, 34 Final Diagnosis: Intramuscular hemangioma of the masseter muscle Symptoms: Swelling over parotid region Medication: — Clinical Procedure: Clinical-Radiological work-up Specialty: Radiology Objective: Rare disease Background: Hemangioma is a benign vascular proliferation. Intramuscular hemangiomas are rare, accounting for less than 1% of all hemangiomas, and occur normally in the trunk and extremities. Approximately 10–20% of intramuscular hemangiomas are found in the head and neck region, most often in the masseter muscles. The typical clinical characteristic is a painful soft tissue mass without cutaneous changes. Currently, MRI is the standard imaging technique for diagnosing soft-tissue hemangioma. The optimal management is the surgical resection. Case Report: We report a case of 34-year-old male patient consulted for a swelling of 1 year evolution, around the parotid region. On physical examination, a soft, well-contoured lesion of about 2 cm on its long axis was found. MRI showed a space-occupying lesion in the left masseter muscle, with intermediate signal intensity on T1-weighted images and hyperignal intensity on T2-weighted images, containing nodular hypointense foci corresponding to calcification. The presumptive diagnosis of an intramasseteric hemangioma with phlebolith was made based on these findings. The patient was informed about her condition, and treatment options were discussed; however, the patient elected to forgo treatment at that time. Conclusions: The possibility of an IMH should be included in the differential diagnosis of any intra-masseteric lesion. The appropriate radiologic examinations especially MRI can enhance accurate preoperative diagnosis; the treatment of choice should be individualized in view of the clinical status of the patient.

Giant cell tumour (GCT) in the parotid region is a rare lesion whose origin can be divided into three compartments: giant cell tumour of the salivary gland (GCT-SG), giant cell tumour of the bone (GCT-bone) and giant cell tumour of the soft tissue (GCT-ST). A low risk of malignancy has been observed, in which all of them were GCT-SG. We present a case of GCT in the parotid region and review the features of GCT in origin, immunohistochemical characteristics, treatment of choice and disease outcome.

Tuberculosis is a potentially fatal infectious disease caused by Mycobacterium Tuberculosis. It most commonly involves the lungs (Pulmonary Tuberculosis), although it can involve any organ system in the body. However even in a country like India which has high burden of this disease, the tubercular invasion of parotid gland is extremely rare. Here we describe two such cases. Both patients were immune competent and presented with fever and swelling in the parotid region. They were diagnosed as tuberculosis of parotid gland by ultrasound guided fine needle aspiration and confirmed bacteriologically.

ResumenHoy 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 3×2cm, 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.AbstractTuberculosis 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 3×2cm 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.

Pilomatrixoma in the head and neck region usually occur in the immediate subcutaneous tissue. Pilamatrixoma of the parotid region are rare. We present a case of pilomatrixoma in the parotid region mimicking mucoepidermoid carcinoma on aspiration cytology. A 21 year old female presented in our hospital with a painless swelling in the left parotid region simulating a parotid gland tumor. The relative rarity of such a tumor in this location, presenting features and management strategies were considered worth presentation.

BACKGROUND Pseudoaneurysm is very rare in Head Neck region. Psedoaneurysm or false aneurysm develops only from adventitia, lacking one or more of the layers of the vascular wall. Correct clinical diagnosis and management is challenging. CASE REPORT 19 years old male patient presented with a swelling in the left parotid region following trauma in the same region with the sharp end of a scissor. USG and Colour Doppler were suggestive of a A-V malformation. MRI and MR Angiogram showed it to be a pseudoaneurysm arising from superficial temporal artery. Superficial parotidectomy was done followed by ligation of superficial temporal artery. Aneurysm was subsequently excised. DISCUSSION Pseudoaneurysms are relatively rare in the external carotid system. It is most commonly seen in association with superficial temporal artery in external carotid system. Several anatomical factors predispose to such propensity. Imaging studies followed by surgical excision remains the treatment of choice. CONCLUSION Penetrative trauma in the head–neck region is not uncommon. Their exterior entrance may appear benign but deeper part may have significant and dangerous injuries. Any pulsatile mass that follows trauma in the head and neck regions might be a case of pseudoaneurysm.

Squamous cell carcinoma (SCC) is the second-most common malignant cutaneous cancer, with 60% occurring in the head and neck region. Metastases are uncommon and imply a more conservative prognosis. This report describes a case of parotid-invasive, facial squamous cell carcinoma, highlighting the importance of its prognostic and therapeutic management. The patient is an 81-year-old female, exhibiting extensive tumoral lesions in the pre-auricular region, affecting the parotid parenchyma and implying the metastatic involvement of the intra-parotid lymph node. Parotid involvement caused by SCC in specificity tumors is discussed herein. Parotid invasion is currently recognized as an isolated variable. It affects survival rates and determines certain changes in case management, such as the broadening of resection areas and adjuvant radiotherapy.

Lipomas are common benign soft tissue tumours, they are found in every body part where the fat is normally present but they are rarely found in the head and neck region. There are few reports of parotid lipoma and till date only one case report of bilobe lipoma has been reported earlier. They compromise 0.6%-4.4% of all parotid tumour. A 60 year old male presented with a large swelling in left parotid region extending from left pre-auricular region to submandibular region from 6 years. Examination of the facial nerve was normal. Ultrasound of the region suggested of lipoma. Fine needle aspiration cytology was done which supported the ultrasounds diagnosis. Patient underwent tumour excision with facial nerve preservation. Lipoma of size 10 x 8 cm which is the largest reported bilobe parotid lipoma reported till date. Literature review has suggested lipomas of parotid region are rare hence should be kept in one of the differential diagnosis. Surgical intervention is challenging because of the probability of injuring the facial nerve, thus knowledge of the anatomy and meticulous surgical technique is essential.

Parotid abscess is a rare complication of acute parotitis in children. Acute parotitis occurs due to infection of intra-parotid or para-parotid lymph nodes or glandular parenchyma of the parotid gland which may progress to parotid abscess. Objectives To document the causative organism, clinical behaviour and response to treatment in paediatric parotid abscess. Materials and methods A retrospective study was done in our tertiary rural hospital from May 2007 to May 2015 to identify and analyse paediatric parotid abscess in 80 unilateral parotitis cases. Results 7 cases of parotid abscess were identified. 4 cases were diagnosed clinically and in 3 cases ultrasound was done showing heterogenous, hyperechoic, solid and cystic areas. In 2 patients, abscess was extending to the submandibular space. Incision and drainage was done in all patients. The most common bacteria was Methicillin Sensitive Staphylococcus aureus. Escherichia coli was reported in one patient, and was rare in parotid region. 2 patients had House Brackmann grade 2 marginal mandibular nerve palsy, and they recovered within 4½ months. Conclusion Parotid abscess is an uncommon but life-threatening condition in paediatric age group. Poor orodental hygiene was most important predisposing factor. Abscess can be diagnosed clinically and ultrasound scan is also an important diagnostic tool. It is commonly caused by Gram positive cocci and responds well to incision and drainage followed by appropriate antibiotics. No fistula may result if treated early.

Depression of facial contour after parotidectomy is still challenging to many of surgeons. A 68-year-old man presented with a 4-month history of a painless swelling in both parotid area. The mass was multiple and fixed at the parotid region. We conducted a parotid duct preserving bilateral superficial parotidectomy by one-stage operation to remove the multiple tumors. A lazy S incision was made in both preauricular area and the peripheral branches of the facial nerve were identified using surgical landmark. After dissecting the branches of the facial nerve and parotid duct, main parotid duct was preserved but only small fine ductules from the superficial lobe were ligated. Parotid gland was excised from its anterior aspect with about 1 cm of normal parotid tissue margin. The patient was followed up for 6 years to evaluate postoperative parotid gland function and the computed tomography (CT) was taken. Patient was satisfied with no significant complication such as sunken changes in facial contour, facial nerve function. As far as we know, it is the first study to compare long-term soft tissue contours of soft tissue of duct preserving superficial parotidectomy with duct sacrificing superficial parotidectomy by means of CT findings.