Accessory Parotid Tissue Research Articles

Lymphoma presenting as preauricular tumor in unilateral parotid gland agenesis: a case report and review of literature

BackgroundParotid gland agenesis is a rare, congenital, usually asymptomatic disorder. Until now, only 24 cases with unilateral, incidentally found, parotid gland agenesis have been described. Here, we present the first reported case of an ipsilateral preauricular neoplasm in a patient with unilateral parotid gland agenesis. During surgery, the position of the greater auricular- and facial nerves was documented. Furthermore, we performed the first sialendoscopy for this rare disorder to assess the number of duct branches, which might be indicative of the abundance of parotid tissue. Moreover, we looked for sialendoscopic characteristic features that could aid in identifying these patients in the ambulatory setting.Case presentationA 50-year-old Greek man presented with a painless, slowly enlarging mass in the right parotid space. Magnetic resonance imaging revealed a complete absence of the right parotid gland without accessory parotid tissue. The right parotid gland was replaced by fatty tissue and the radiologist suggested a benign parotid tumor. Fine needle aspiration was indicative of a reactive lymph node. Sialendoscopy revealed only two branches within the right parotid duct. Surgical resection was performed through a conventional lateral parotidectomy. This revealed typical anatomic position of the greater auricular- and facial nerves despite the parotid tissue agenesis. Histopathology revealed a small lymphocytic lymphoma.ConclusionsSurgeons should feel confident to resect tumors of the parotid space in patients with parotid gland agenesis. Reduced branching observed during sialendoscopy might indicate parotid gland agenesis. Physicians should be even more cautious than usual with the watch and wait strategy in patients with tumors of parotid gland agenesis, since the probability of a tumor being a benign salivary gland tumor might be lower than usual.

Management of Basal Cell Adenoma of Accessory Parotid Gland Through Transoral Approach: Report of a Rare Case With Review

Diagnosis of mid-cheek mass has always been a diagnostic dilemma for clinicians. The incidence of the accessory parotid gland (APG) has been well documented in the literature. However, a diverse spectrum of pathologies can arise from this accessory parotid tissue. Basal cell adenoma is a rare benign tumor that predominantly affects the parotid gland. Its occurrence in the accessory parotid gland has been documented in 9 cases till date. Surgical approaches for the management of such APG lesions have been in debate. This report documents a case of Basal Cell Adenoma arising in accessory parotid tissue in a 55-year-old woman who was treated by transoral excision. This paper also reviews previously documented cases of all APG lesions and attempts to elucidate the rationale for selecting an appropriate surgical approach.

MORPHOLOGICAL AND STRUCTURAL VARIATIONS IN PAROTID GLAND: A CADAVERIC STUDY AND ITS CLINICAL IMPLICATIONS

Introduction: An accessory parotid gland is defined as “the salivary tissue present in close association to the Stenson’s duct lying on the masseter but away from the parotid gland”. Very often the accessory salivary gland tissue is located in front of the parotid gland. The accessory parotid tissue is found in more than 21% of adults. Any disease process which affects salivary glands may affect accessory parotid gland. Objectives: present study was conducted to study the morphology of parotid gland, structural variation including accessory parotid glands in Indian population. Materials and Method: study was conducted by studying 50 dissections of parotid glands. The Weight of the gland was measured in gms, cranio-caudal and ventro-dorsal dimension was measured in cms. Mean and standard deviation was calculated. Accessory parotid gland was explored and examined. Results: overall incidence of accessory parotid gland was noted in 5 (10%) of cases. Bilateral accessory gland was noted in 2 (4%) of cases. Unilateral accessory parotid gland was noted in 3 (6%) of cases. Conclusion: Accessory parotid gland is a prominent morphological variation in Indian population. Keywords: Morphological variations, Structural variation, Parotid gland, Ectopic salivary tissue

Unilateral Parotid Agenesis Associated with Pleomorphic Adenoma of Ipsilateral Accessory Parotid Gland

Congenital agenesis of the parotid gland is rare, and its association with accessory parotid tissue is even rarer. We report an unusual case of unilateral agenesis of the left parotid gland associated with pleomorphic adenoma of the left accessory parotid gland. To best of our knowledge, this is only the second such published case in the literature.

A Rare Case of Chronic Sialadenitis of Accessory Parotid Gland

The accessory parotid gland is salivary tissue adjacent to stenson's duct that is separated from the main parotid gland and lying on masseter muscle. It has secondary duct empting into the stenson's duct. The differential diagnosis of mid-cheek masses include pathology arising from normal anatomic structures or from variations of normal accessory parotid gland tissue. Surgical resection is the treatment of choice for the accessory parotid gland tumor. We report a case of accessory parotid gland with chronic sialadenitis in a 26years old male with the diagnosis and treatment. Accessory parotid gland pathologies should be included in the differential diagnosis of a patient presently with a mid-cheek mass.

Recurrent inflammation of accessory parotid tissue associated with unilateral parotid gland aplasia: diagnostic and therapeutic implications

Aplasia of the major salivary glands is a rare condition due to an alteration in the development of the ectodermal tissue of the oral cavity often related to other craniofacial abnormalities or alteration of structures deriving from the first or second archial branch, in particular the lacrimal glands; it can be total or partial and determine clinical states ranging from an asymptomatic condition to a severe xerostomia. The accessory parotid tissue is similar to normal parotid tissue, completely independent from the main gland and susceptible to the same pathological disorders. We describe a very unusual case of an inflammatory disorder of accessory parotid tissue in a 44-year-old male patient with concomitant, and previously unknown, aplasia of the main ipsilateral parotid gland. We also discuss the role of imaging and conservative therapeutic modalities such as botulinum toxin therapy and, in the future, minimally invasive endoscopic-assisted resection in the management of such salivary disorder.

Wide Excision of Accessory Parotid Gland With Anterior Approach

Accessory parotid gland tissue has been described as salivary tissue adjacent to the Stensen duct that is distinctly separate from the main body of the parotid gland. Of all parotid gland tumors, 1% to 8% arise from the accessory parotid gland. Little is known about the accessory parotid gland, and it is seldom mentioned in the literature. Between 1999 and 2010, we have treated and followed 8 patients with tumors of the accessory parotid gland. There were 5 males and 3 females with a mean age of 35 years. They all presented with an asymptomatic cheek mass, and 4 of them underwent fine-needle aspiration. Ultrasound or computed tomographic scan was used in all patients. All the patients underwent surgical intervention with standard parotidectomy incision and anterior extension. The mean follow-up time was 44 months (range, 6-120 months). Seven patients had benign disease. Four cases were pleomorphic adenoma, and the remaining 3 benign cases were parotid cyst, basal cell adenoma, and hemangioma. Only 1 patient had a malignant tumor that was a lymphoepithelioma-like carcinoma. In 7 cases, wide excision (excision of mass and accessory lobe of the parotid gland) was done because of the intra-accessory parotid gland lesion. One patient had concomitant superficial parotidectomy because the tumor was located very close to and has involved the parotid gland proper. There was no serious postoperative complication and recurrence. Prudent preoperative diagnostic evaluation and meticulous surgical approach are the keys to successful management of midcheek lesions. A wide excision of the accessory lobe of the parotid gland can be a definitive surgery in case of solitary tumor with an intact parotid fascia, and wide excision with anterior approach through a standard parotidectomy incision is preferred to a direct incision over the mass.

Aplasia of the parotid glands with accessory parotid tissue

Congenital absence of the parotid gland is a rare entity. Absence is most commonly unilateral, and is not associated with accessory glandular tissue. In the majority of reported cases, parotid gland aplasia is seen with craniofacial abnormalities or hypoplasia of other ectodermal structures, particularly the lacrimal glands. We present a 14-year-old male with bilateral parotid gland aplasia detected incidentally on MRI of the brain and then confirmed on neck CT. The studies also revealed accessory parotid tissue superficial to the left masseter muscle. There were no associated craniofacial abnormalities. The lacrimal glands and submandibular glands were normal.

Reply regarding pediatric salivary gland imaging

Sir, We thank Gadodia et al. [1] for their interest in our pictorial essay [2] and for clarifying the definition of accessory parotid gland tissue. We agree with their comment and would also like to reiterate the take-home point regarding accessory parotid tissue, which, given its high predominance, should not be mistaken for a mass. Regarding the comment on our omission of chronic recurrent parotitis, we did so because it is not typically imaged and often managed on a clinical basis. However, the interesting points made by Gadodia et al. [1] regarding chronic recurrent parotitis are notable, and it is certainly a diagnosis with which one should be familiar.

Pediatric salivary gland imaging

Sir, We read with great interest the pictorial essay on pediatric salivary gland imaging by Boyd et al. [1]. They have shown excellent radiological images of the wide spectrum of pediatric salivary gland disorders. However, we would like to point out an error in one of the figures (Fig. 2 in [1]) presented as accessory parotid gland. The images show contiguous extension of the superficial lobe of parotid gland draping the masseter muscle. Accessory parotid gland tissue has been described as salivary tissue lying adjacent and above the Stenson’s duct that is distinctly separate from the main body of the parotid gland [2]. This fact is highlighted in Fig. 1. In a postmortem study by Frommer [3], the prevalence of accessory parotid glands was reported to be 21%. The accessory gland typically lies anterior to the parotid gland along the masseter muscle and the average distance between the main parotid gland and the accessory parotid gland is 6.0 mm [3, 4]. Thus, the axial MR image (T2-W) in the paper by Boyd et al. [1] shows an enlarged superficial lobe of bilateral parotid glands draping over the masseter muscle rather than an accessory parotid gland. We also think that an important entity called chronic recurrent parotitis (CRP) of childhood has been omitted. CRP is the most common inflammatory disease next to mumps affecting the salivary glands in the pediatric population. A radiologist is likely to see CRP far more commonly than some of the very rare entities illustrated. CRP, also known as juvenile recurrent parotitis, is characterized by recurrent episodes of unilateral or bilateral parotid swelling, usually accompanied by pain, fever and malaise. The onset of disease is in early

副耳下腺から発生した多形腺腫例

The accessory parotid gland is a solitary salivary gland separate from the main parotid gland. Although it is recognized in 21-56% of individuals, the incidence of accessory parotid tumor is relatively rare. We report a 57-year-old male with pleomorphic adenoma arising from an accessory parotid gland. The patient had suffered from a gradually growing mass with no pain in his right cheek for six years. CT scans showed a well-circumscribed, 24×19-mm solid tumor lying on the masseter muscle. Fine needle aspiration revealed a cytological finding of pleomorphic adenoma. Considering the clinical course, radiological and cytological findings, pleomorphic adenoma of the accessory parotid gland was highly suspected. At surgery, a standard incision for parotid tumor was made and extended superiorly. Buccal branches of the facial nerve were detected at the anterior edge of the parotid gland. Total removal of the tumor with excision of the accessory parotid gland was performed. The pathological diagnosis was pleomorphic adenoma. Slight paresis of buccal branches resolved two months after surgery. No recurrence has occurred during 20-month follow-up. We recommend a standard parotidectomy approach that is safe and has cosmetic benefits for the surgical management of neoplasms arising from accessory parotid gland tissue.

O.542 Management of malignant parotid gland tumors

We report a case of pleomorphic adenoma which was assessed pre-operatively as arising from the accessory parotid gland. Computed tomography (CT)-sialography provided information about the relationship between the tumor and the remaining normal accessory parotid tissue, and fine-needle aspiration of the tumor provided additional information as to the histologic features of the tumor, i.e. it was identified as of salivary origin. Zygomatic and buccal branches of the facial nerve extended over the accessory parotid gland tumor and the parotid duct was located just beneath the tumor. Therefore, pre-operative assessment of the tumor's nature was important for prevention of facial nerve damage and salivary fistula. The normal accessory parotid gland tissue associated with the accessory parotid tumor was histologically different from that of normal parotid gland tissue dissected in other patients with pleomorphic adenoma of the parotid gland. It is suggested that the difference in cell composition between these glands affects the development of the associated tumors.

Bilateral aplasia of parotid glands correlated with accessory parotid tissue

Congenital absence of major salivary glands, especially the parotid gland, is a rare entity. It is usually monolateral and is not correlated with accessory salivary gland tissue. Aplasia of parotid gland may occur alone or in association with abnormalities of other salivary glands, first branchial arch developmental disturbances or other congenital anomalies.We report an interesting case of bilateral aplasia of the parotid glands together with bilateral accessory parotid tissue, without other congenital or developmental anomalies, and we describe the clinical and radiological findings.

Tumors of the accessory lobe of the parotid gland: a 10-year experience.

The differential diagnosis of midcheek masses include pathology arising from normal anatomic structures or from variations of normal accessory parotid gland tissue. Accessory parotid gland tissue has been described as salivary tissue adjacent to Stenson's duct that is separate from the main body of the parotid gland. We report our 10-year experience with the diagnosis and treatment of eight accessory parotid gland neoplasms that have been followed by the senior authors. This is a retrospective review of our experience with eight accessory parotid gland neoplasms. A literature review and retrospective chart review of our experience with accessory parotid gland tumors over the past 10 years. The presentation, evaluation, management, treatment, and outcome were recorded. Eight cases of accessory lobe parotid tumors were identified, which have been followed since the date of initial treatment. All of the patients presented with a slowly growing cheek mass. There was one case of carcinoma expleomorphic adenoma, one case of undifferentiated carcinoma (small cell carcinoma), one case of basal cell adenocarcinoma, one case of benign salivary cyst, two cases of pleomorphic adenoma, and two cases of monomorphic adenoma. A standard facelift approach or modified Blair incision was used to excise these tumors. Neoplasms of the accessory parotid gland are rare. Management of these tumors include a high index of suspicion, good understanding of the anatomy, and meticulous surgical approach.

Mucoepidermoid carcinoma of the parotid gland: A rare presentation in a young child

Although mucoepidermoid carcinoma (MEC) is the most common malignant salivary gland neoplasm in childhood and adolescence, it is rarely found in children under the age of 10. A 6-year-old girl had an asymptomatic neck mass for 5 months. Clinical examination findings showed a 1.5-cm smooth and firm but mobile nontender mass located in the upper left anterior cervical triangle, clinically separate from the parotid gland. Ultrasound examination findings showed a vascular mass, with a cystic component, possibly within the tail of the parotid gland. An excisional biopsy was performed and frozen section showed a low-grade MEC. A left superficial parotidectomy was then performed. Final histopathologic examination showed one positive resection margin. Subsequently, reexcision of the surgical site and an upper modified neck dissection was undertaken. This unusual presentation of MEC as a neck mass in one of the youngest reported patients illustrates that the anatomic region for parotid tumors is large. Possibly some of these tumors may arise from heterotopic or accessory parotid tissue.

Accessory parotid gland tumor: a case report

We report a case of pleomorphic adenoma which was assessed pre-operatively as arising from the accessory parotid gland. Computed tomography (CT)-sialography provided information about the relationship between the tumor and the remaining normal accessory parotid tissue, and fine-needle aspiration of the tumor provided additional information as to the histologic features of the tumor, i.e. it was identified as of salivary origin. Zygomatic and buccal branches of the facial nerve extended over the accessory parotid gland tumor and the parotid duct was located just beneath the tumor. Therefore, pre-operative assessment of the tumor's nature was important for prevention of facial nerve damage and salivary fistula. The normal accessory parotid gland tissue associated with the accessory parotid tumor was histologically different from that of normal parotid gland tissue dissected in other patients with pleomorphic adenoma of the parotid gland. It is suggested that the difference in cell composition between these glands affects the development of the associated tumors.

CT and MR imaging of the buccal space and buccal space masses.

The authors describe the normal variations in the buccal space and present the range of buccal space pathologic conditions seen on computed tomographic (CT) and magnetic resonance (MR) images. In a series of 50 patients studied with CT and 30 with MR imaging, the visualization and measurement of the normal facial expression and buccinator muscles, parotidomasseteric fascia, parotid duct, accessory parotid tissue, and facial neurovascular bundle were statistically equivalent. The size of the buccal fat pad was statistically the same from side to side within a given patient. Normal lymph nodes were rarely discernible from the facial neurovascular bundles. In a series of 26 patients with unsuspected buccal space masses, salivary gland tumors were the most common masses. Less frequently, benign lesions (eg, hemangioma and dilated parotid ducts) and soft-tissue malignancies (eg, sarcoma) manifested as buccal space masses. Occasionally, a cheek mass of uncertain cause proved to be lymphadenopathy; however, adenopathy is more commonly associated with clinically evident, deeply infiltrating facial neoplasms. Knowledge of the anatomic variations and expected abnormalities of the buccal space is useful for the radiologist interpreting facial CT or MR images.

副耳下腺に発生した多形性腺腫の１例

An accessory parotid gland is located anterior to the main parotid gland and occurs in about 30 per cent of human cadavers. Tumors arising in accessory parotid tissue are rare. This case report describes a pleomorhic adenoma arising in the accessory parotid gland.A 21-year-old male was seen in 1984 with a soft tissue mass in the left cheek. A sialogram revealed a duct system of accessory parotid tissue and unusual stenosis of Stensen's duct. At operation, the mass was freed from the main parotid tissue and enucleated easily. Histologically, the mass was pleomorphic adenoma.

Tumors arising in accessory parotid tissue

A summary is presented of our experience with 23 patients who had accessory parotid tumors, comprising 1 per cent of all primary parotid neoplasms seen during a 40 year period. Although more than half of the tumors proved malignant, adequate excision was usually curative. We prefer to approach these tumors through an extended cheek-flap incision. Once the lesion is exposed, either local excision or resection in conjunction with subtotal parotidectomy can be performed, depending on the clinical findings.