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| IMAGES |
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| Year : 2016 | Volume
: 3
| Issue : 2 | Page : 149-150 |
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Vegetable twig causing obstructive parotid sialadenitis
Jonathan Theodore Gondi1, Suhasini Gazula2
1 Department of Oral and Maxillofacial Surgeon, Tooth N' Gums Dental Centre, Secunderabad, Telangana, India
2 Chief Pediatric Surgeon and Head, ESI Corporation Superspeciality Hospital, Hyderabad, Telangana, India
| Date of Web Publication | 29-Feb-2016 |
Correspondence Address:
Suhasini Gazula
Chief Pediatric Surgeon and Head, ESI Corporation Superspeciality Hospital, Hyderabad, Andhra Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2348-3334.177641
We report the case of a 4-year-old boy with obstructive parotid sialadenitis in whom the classic clinical presentation clinched the diagnosis which highlights the importance of applied anatomy and clinical examination even in the present age of novel imaging techniques. Keywords: Obstruction, parotid, sialadenitis
How to cite this article:
Gondi JT, Gazula S. Vegetable twig causing obstructive parotid sialadenitis. CHRISMED J Health Res 2016;3:149-50 |
A 4-year-old boy came with painful swelling of the left cheek since 1 week. Examination revealed a tender swollen left parotid gland with a white granuloma seen classically at the opening of the left parotid duct (opposite the left upper second molar) [Figure 1]. Ultrasound-cheek suggested inflammatory parotid sialadenitis with no pus or foreign body. Characteristic location of the granuloma at the opening of Stensen's duct [Figure 2] prompted us for an intraoral exploration of granuloma which revealed a 3 mm long sharp twig-like vegetable matter [Figure 3] obstructing the opening of the parotid duct which was removed and the duct opening marsupialized. Swelling resolved completely in 4 days. | Figure 1: White granuloma seen classically at the opening of the left parotid duct (opposite the left upper second molar)
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 | Figure 3: 3 mm long sharp twig-like vegetable matter impinged in the parotid duct opening
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Patients with pain and swelling over the parotid usually have infective or obstructive sialadenitis. Sialolithiasis is the most common cause of obstructive sialadenitis followed by duct strictures. Parotid foreign bodies are infrequent, mostly by penetration from the skin and were reported to be pieces of glass, wood, metal and hair.[1] Ultrasonography requires a high index of suspicion and considerable experience to detect foreign bodies. Newer modalities include magnetic resonance sialography and sialoendoscopy. Foreign body removal presents a challenge with sialoendoscopy, gland exploration using concurrent imaging and facial nerve neuromonitoring described.[2]
Classic location of the granuloma in our patient opposite the upper second molar directed us to the diagnosis despite no evidence on imaging which emphasizes the value of applied anatomy and clinical examination even in the present era of emerging innovative imaging techniques.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Sreetharan SS, Philip R. Unusual foreign body of parotid gland presenting as sialolithiasis: Case report and literature review. Case Rep Otolaryngol 2012;2012:367349.  |
| 2. | Marchal F. A combined endoscopic and external approach for extraction of large stones with preservation of parotid and submandibular glands. Laryngoscope 2007;117:373-7. |
[Figure 1], [Figure 2], [Figure 3]
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