Tender Preauricular Swelling with Feeding-Related Growth in an Older Man.

Abstract

To the Editor: An older man presented to the Oral and Maxillofacial Surgery Unit of Walter Cantídio Universitary Hospital (Ceará, Brazil) with a painless swelling on his face over the past 2 weeks (Figure 1). The mass had increased progressively in size (mainly during meals) but was not affecting his ability to swallow, speak, or chew, and he did not report any facial neurosensory changes. He denied any history of fever, ear pain or discharge, or any associated constitutional symptoms. A recent facial injury-related history of a fall from a height was reported. His hospital chart and initial imaging examinations revealed a right mandibular subcondylar fracture that had been surgically treated using a retromandibular approach for reduction and internal fixation. Physical examination (Figure 1A) showed a soft and slightly tender mass on his right preauricular region without significant change in skin color. The pinna was not displaced, examination of ears revealed no abnormalities, and right parotid duct gland massage produced normal drainage of saliva. The lesion was aspirated, and 5 mL of a clear fluid content similar to normal saliva was observed (Figure 1B), which led to a diagnosis of sialocele. Compressive dressings with adhesive tape combined with amoxicillin 500 mg were applied, and he was advised to compress the affected area during eating. He returned after 21 days with a recurrent lesion that was significantly larger, and 10 mL of saliva was aspirated. He subsequently underwent surgical treatment under general anesthesia to catheterize the parotid duct using a 16G by 2″ peripheral intravenous catheter, allowing saliva drainage after duct dilation (Figure 1C, D). The catheter was anchored and maintained in the surgical site using a nylon suture for 15 days (Figure 1E). Chlorhexidine mouthwashes and oral amoxicillin therapy were prescribed. After 3 months, complete remission of the lesion and preserved glandular function were observed (Figure 1F). The preauricular region of elderly adults may be prone to a wide number of soft tissue pathologies, varying from nonneoplastic conditions to benign or malignant diseases.1 This was an interesting case of sialocele in an older adult man that has educational importance because of the variety of possible differential diagnoses. Older adults with soft tissue preauricular lesions should be examined for salivary gland tumors,2 epidermal cysts,3 parotid infection,4 and parotid duct-related traumatic injury.5 In older age, parotid pleomorphic adenoma is the most common neoplasm of salivary gland origin, usually occurring in men as a firm, painless, slow-growing mass.2 A case of giant epidermal cyst was reported in an 83-year-old individual with a slow-growing asymptomatic preauricular mass extending over the temporal area, and a parotid infection in a 71-year-old man was diagnosed based one clinical symptomatology.4 Anamnesis and information on previous history of surgical intervention were essential to exclude the aforementioned lesions. Sialocele is a rare, benign salivary gland condition clinically represented by collection of salivary fluid in tissues surrounding the parotid gland duct or parenchyma without adequate drainage.5 Affected individuals present without pain, fever, chills, or skin erythema, as described in the current report.6 Sialoceles are frequently associated with a history of parotid gland parenchyma disruption, parotid duct-related traumatic injury, infection, ductal stenosis, or neoplasia.5 A PubMed literature search for parotid sialocele originating from surgical treatment of mandibular condylar fractures revealed only eight published cases. In addition, to the knowledge of the authors of the current letter, this is the first description of a sialocele in the geriatric literature. Clinical diagnosis is made according to a thorough history as performed in the present case, and fine needle aspiration with laboratory analysis of the fluid content may be useful for confirmation of the diagnosis.5, 6 Although a wide variety of surgical and nonsurgical treatment modalities has been documented,5, 6 minimally invasive surgical treatment through insertion of a catheter into the parotid gland duct is a functional treatment that may be suitable for older individuals. Recurrence of the lesion is uncommon.6 In brief, this case highlights the importance of information from a detailed anamnesis coupled with a meticulous physical examination in an older adult. Regardless of the rarity of sialocele, a differential diagnosis of preauricular lesions in these individuals may represent a potential educational exercise for some clinicians. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Carvalho, Soares, Costa: preparation of draft. Tavares, Silveira: data collection. Gois: completion of manuscript. Sponsor's Role: None.