Imaging Evaluation of Pediatric Parotid Gland Abnormalities.

Parotid gland lesions in children can be divided into benign or malignant. The age of the patient helps narrow the differential diagnosis, with vascular and congenital lesions being more frequent in the 1st year of life, while solid tumors are more frequent in older children. Inflammatory disease usually has rapid onset in comparison with that of neoplastic or congenital processes, which have more gradual clinical evolution. Currently, multiple imaging techniques are available to study the parotid region, such as US, CT, and MRI. However, it is still a challenge to distinguish nonmalignant lesions from malignant ones. US is the first-line diagnostic approach in children to characterize the morphology and vascularity of these lesions. CT in children may be indicated for evaluation of abscesses or sialolithiasis. MRI is the imaging modality of choice for investigating the nature of the lesion and its extent. In addition to complete and detailed clinical information, knowledge of parotid gland anatomy and characteristic radiologic features of parotid disorders is essential for optimal radiologic evaluation and avoiding unnecessary interventional diagnostic procedures or treatment. This article illustrates a variety of entities (congenital, inflammatory, vascular, neoplastic) that can occur in the parotid gland, highlighting the most frequent radiologic patterns of manifestation and correlating them with clinical, surgical, and pathologic findings. ©RSNA, 2018.

Congenital parotid fistula.

Parotid fistula is a cause of great distress and embarrassment to the patient. Parotid fistula is most commonly a post-traumatic situation. Congenital parotid salivary fistulas are unusual entities that can arise from accessory parotid glands or even more infrequently, from normal parotid glands through an aberrant Stensen's duct. The treatment of fistulous tract is usually surgical and can be successfully excised after making a skin incision along the skin tension line around the fistula opening. This report describes a case of right accessory parotid gland fistula of a 4-year-old boy with discharge of pus from right cheek. Computed tomography (CT) fistulography and CT sialography demonstrated fistulous tract arising from accessory parotid gland. Both CT fistulography and CT sialography are very helpful in the diagnosis and surgical planning. In this case, superficial parotidectomy is the treatment of choice. A detailed history, clinical and functional examination, proper salivary gland investigations facilitates in correct diagnosis followed by immediate surgical intervention helps us to restore physical, psychological health of the child patient.

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.

Congenital infiltrating lipomatosis of the face with associated involvement of the TMJ structures. Case report and review of the literature.

We report a case of congenital infiltrating lipomatosis of the face (CILF) with right TMJ ankylosis causing asymmetry and reduced mouth opening. The management involved soft tissue debulking combined with a right TMJ arthroplasty and is explained in detail. A review of the relevant literature revealed the rarity of this condition. The diagnosis of CILF remains challenging. The currently accepted treatment strategy is less aggressive as facial asymmetry tends to recur. Infiltration of the facial structures from adipose tissue requires several surgical procedures in most cases. Bony hypertrophy on the affected side has been a common finding in reported cases. There have been no previous reports of TMJ ankylosis associated with this condition. CILF is a benign condition with a good long term prognosis. After 2 years of follow up our patient, has maintained full function despite facial asymmetry.

Congenital salivary fistula of an accessory parotid gland in Goldenhar syndrome.

OBJECTIVES: We report two cases of congenital salivary fistula of an accessory parotid gland, and we discuss its occurrence in Goldenhar syndrome. METHODS: Two teenagers complained of a congenital cheek fistula with constant salivary discharge. Computed tomography fistulography and sialography were performed. The diagnosis of Goldenhar syndrome was established based on clinical and imaging findings. Previously reported cases are reviewed and the clinical and radiological features summarised. RESULTS: In these two patients, a salivary fistula of an accessory parotid gland was demonstrated on computed tomography fistulography, and did not communicate with Stensen's duct. Deformity of Stensen's duct and hypoplasia of the ipsilateral mandibular ramus were present. Tragal appendices have frequently been reported in such cases. CONCLUSION: A congenital cheek salivary fistula of an accessory parotid gland should be considered indicative of Goldenhar syndrome.

Congenital agenesis of right parotid gland confounds MIBG scan interpretation in craniocervical neuroblastoma.

A 10-month-old boy with left infraorbital temporal neuroblastoma presented for I-123 metaiodobenzylguanidine scan with SPECT/CT for staging. Symmetrical metaiodobenzylguanidine uptake in salivary glands is usually considered normal. In this case of right parotid agenesis, symmetrical uptake was misleading. Tumor in the right mandibular ramus masqueraded as normal parotid gland. Repeat imaging 3 months after chemotherapy revealed absence of physiologic right parotid gland activity. Correlation with CT from SPECT/CT demonstrated right parotid agenesis, confirmed on MRI. Few cases of unilateral parotid agenesis are reported in published literature. We also discuss the potential added value of higher-quality CT images in SPECT/CT tumor imaging.

[Congenital parotid fistula]. / Vrozhdennyi okoloushnyi svishch.

21 cases of congenital parotid fistula are reported. The patients' age ranged from 7 to 50 years. Dissection of the fistula under local anesthesia was made in 9 patients. A 7-year-old patient was operated under intravenous calipsol anesthesia. Four kinds of the fistula depending on its shape and size are described. Two of them cause no trouble, the other two manifest from early childhood with inflammation, recurrences with abscesses. In such cases the fistula should be radically removed.

[A rare case of a preauricular fistula]. / Redkoe nabliudenie predushnogo svishcha.

A female patient with a preotic fistula caused by a defect in the development of the first branchial arch is described. Repeated surgeries for lateral fistula of the neck brought no success. The pathogenesis of the defect and difficulties in its diagnosis are discussed; the authors claim that fistulography with contrast agents may be effective. Histologic verification is needed in all the cases.

Congenital extraoral fistula from an auxiliary parotid gland.

A rare case of an auxiliary major salivary gland in the parotid region with an external fistula is reported. Clinical findings and management are described, and relevant embryology and etiology are discussed.

[A case of a child with congenital anomaly of the first branchial cleft]. / Przypadek dziecka z wrodzona wada pierwszej kieszonki skrzelowej.

The authors of the article describe the case of a child surgically treated for inborn anomaly of the first branchial cleft. Basing upon this example, they discuss the difficulties that the surgeon may encounter during the operative treatment. Concluding, they present the characteristic features of this type of developmental anomaly.

Parotid duct communicating with a labial pit and ectopic salivary cyst.

Labial pits are usually described as blind epidermal invaginations of lip mucosa with occasional drainage of minor salivary gland secretions. A case of an aberrant parotid duct in communication with both a unilateral, commissural labial pit and an interposed salivary cyst is presented. A 7-year-old boy who had experienced lifelong clear drainage from a congenital pit at his right oral commissure developed fever, pain, and a submucosal mass of the right cheek over a 6-week period. A preoperative sialogram through the pit demonstrated a communication between the oral commissure fistula, an intervening salivary cyst, and a proximal tract from the cyst to the parotid gland. An en bloc resection of the pit, fistula tract, and cyst was performed through a transoral approach. The dissection was medial to the buccinator muscle. There has been no recurrence of the cyst after 1 year follow-up. A description of labial pits and parotid duct anomalies is presented; however, to our knowledge, this combination of anomalies has not been previously described.

External fistula of the main parotid duct; the alternative procedure.

The authors present an alternative procedure for the treatment of an external fistula of the main parotid duct. Implantation of the orifice of the duct with a flocculus of the skin into the oral cavity was performed with a good result.

Congenital parotid gland fistula.

A rare case of congenital parotid gland fistula is reported. A 4-year-old boy presented with a fistula opening at the facial surface of the skin posterior to the left commissure of the lips. This fistula originated from an accessory parotid gland with a duct entirely distinct from the original Stensen's duct. Because of the salivary outflow from the fistula opening, the opening was translocated to the oral cavity using Delore's method.