Migratory sialocele after fine needle aspiration of the parotid gland

Abstract

Sialocele is a subcutaneous collection which contains saliva. This collection is mainly developing at the area of parotid gland and it is evolving after trauma in this region or after a surgical procedure. During these procedures, a disruption of a duct or injury of the parenchyma promotes extravasation of the saliva and the formation of this collection in glandular or periglandular tissues [1]. This condition usually is a self-limited phenomenon and conservative measures are efficient in most of the times. Rarely, interventional measures like drainage of the collection and botulinum toxin injection or surgical management are needed [2, 3]. In this report, a case of a patient who developed a migrating sialocele after fine needle aspiration (FNA) for a Warthin tumor of the parotid gland is presented. This male patient 60-year old had a progressive bulge in his both parotid glands for approximately the last 10 years. The patient presented in our department with a painful swelling of his left gland after a diagnostic FNA 48 h before. This bulge was movable and the parotid duct in the affected side was normal and salivary flow had normal physical aspects without debris or purulent discharge. Imaging studies were performed. Ultrasound of the region revealed lesions in both of the glands. In the left gland, the lesion seems to be collection or abscess (Fig. 1). Moreover, a computed tomography (CT) of the cervix revealed a 3-cm tumor in the right parotid gland and two tumors in the left parotid gland approximately 1.0 and 1.3 cm in diameter (Fig. 2). CT and FNA results both confirmed that these tumors were Warthin tumors of the parotid gland type 2B. The patient was hospitalized and antibiotic therapy was administered. The fourth day after the FNA, this reddish bulge of the patient which located in the preauricular region in the left side of the patient moved distally to the cervix. The migration of this red bulge was continued and in approximately 6 h the bulge was located in the left sternocostal space. After this position, the bulge was progressively diminished. The presumptive diagnosis of this bulge in the left parotid gland site was initially the abscess from the previously performed FNA. But the rapid migration and disappearing of the bulge with complete loss of the symptoms and signs of inflammation just in few hours made the diagnosis of a sialocele as the most appropriate one. It seems that FNA generated an injury in Warthin tumor or the healthy part of the parotid gland and produced the collection of the saliva.