Parotid swellings in an adolescent

Abstract

We examined a 12-year-old boy, who had no relevant medical history, at the Salivary Gland Center in the College of Dental Medicine at Columbia University regarding a left facial swelling (Figure 1). His mother stated that the swelling had reached its peak 2 days previously and was now subsiding. She also stated that her son had had sporadic facial swelling at times the right side, at times the left, and occasionally bilaterally since the age of 4 years. The swellings had caused only moderate discomfort, were associated with low-grade fevers, occurred 4 to 6 times a year, and resolved with or without antibiotics within 2 through 5 days. Visual examination and palpation indicated that the swelling was associated with mild discomfort of the left parotid salivary gland (PG). The right PG was not swollen, and palpation revealed that it was painless and normal in tone. There was no cervical lymphadenopathy. Intraorally, the mucosa was normally moist, and no dental pathology was evident. Extraoral pressure on the left PG produced a slightly cloudy salivary return at its intraoral duct orifice. The saliva exiting from the right PG duct orifice was clear, but it contained some flocculations. A right-sided PG sialogram showed punctate sialectasis (Figure 2). An ultrasonic examination (Figure 3) revealed the presence of multiple focal hypoechoic areas in a heterogeneous background in both PGs. All serologic testing results were normal. Figure 2Right-sided parotid sialogram shows punctate sialectasis. View Large Image Figure Viewer Download Hi-res image Figure 3Sonogram of the left parotid salivary gland shows multiple hypoechoic areas. View Large Image Figure Viewer Download Hi-res image Dr. Yoon is a fellow, Oral Maxillofacial Surgery, Rutgers University, Newark, NJ. Dr. Peters is an assistant professor, Oral and Maxillofacial Pathology, Columbia University College of Dental Medicine, New York, NY. Dr. Vasilyeva is a research assistant, Salivary Gland Center; and resident, Oral and Maxillofacial Pathology, Columbia University College of Dental Medicine, New York, NY. Dr. Mandel is the director, Salivary Gland Center; and associate dean and clinical professor, Oral and Maxillofacial Surgery, Columbia University College of Dental Medicine, 630 West 168th St., New York, NY 10032.