Parotid masses

Notes

## Basic introduction

  • Parotid glands lie behind the cheek in front of the ear

## Causes of parotid masses may include the following:

  • There are two types parotid swelling:

_Pseudoparotomegaly due to the swelling of adjacent structure

_True parotid swellings

  • Pseudoparotomegaly may include the following:

_Hypertrophy of the masseter

_Jaw swellings

_Parapharyngeal masses

_Lymphadenopathy

_Facial nerve tumor

  • True parotid swellings (masses) may include the following:

||| Sialolithiasis (Salivary Stones)

||| Sialadenitis

||| Infections:

||| Mumps

||| Bacterial infections

||| Epstein-Barr virus (EBV)

||| Flu

||| HIV/AIDS

||| Diabetes mellitus

||| Malnutrition

  • Cysts that may be caused by:

_Congenital as a result of development disorder

_Sialolithiasis

_Sialadenitis

_Infections

_Tumor mass

_Injury

  • Tumors that may include:

_Benign tumors such as:

||| Pleomorphic adenomas

||| Warthin's tumor

_Malignant tumors such as:

||| Mucoepidermoid carcinoma

||| Adenocystic carcinoma

||| Adenocarcinoma.

  • Sjogren's Syndrome

_This is a chronic autoimmune disease

Symptoms
  • A painful and tender lump under the chin or in the cheek
  • A painful lump on the floor of the mouth
  • Chills
  • Dry eyes, and a dry mouth (mainly in Sjogren's Syndrome)
  • General weakness
  • Headache
  • High fevers (if due to infections)
  • Facial nerve palsy (that is suggestive of malignancy)
  • Joint pain
  • Muscle aches
  • Poor appetite
  • Sometimes the mass may interfere with eating and speaking
  • Drooling with excessive salivation
Diagnosis
  • Clinical review
  • Hematological tests

_WBC

_ESR

_Serum protein

_HIV

  • Imaging

_X-rays (to detect Sialolithiasis)

_MRI

_CT scans

  • Blood culture and sensitivity
  • Salivary gland biopsy

_Fine needle aspirate (FNA) cytology

_Avoid open biopsy to reduce seeding of tumor and damage to the facial nerve and its branches

  • Eye tests (in case of suspected Sjogren's syndrome)
Differential
  • Not applicable
Prevention
  • It depends on the underlying causes
Reference

1. Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.http://apps.who.int/medicinedocs/documents/s21000en/s21000en.pdf

2. Tan, V. E. S., & Goh, B. S. (2007). Parotid abscess: a five-year review–clinical presentation, diagnosis and management. The Journal of Laryngology & Otology, 121(09), 872-879.

Management
  • Management of underlying causes
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