Giant Stensen duct calculus.
A 37-year-old man presented with left-sided facial pain and swelling lasting for 7 days, a symptom that had occurred repeatedly for 3 years. On physical examination, a firm mass below the zygomatic arch on the left cheek was noted, with discharge of purulent saliva from the ostium of the left parotid duct upon parotid massage. No lumps were noted in any other part of the body, and the patient had no associated weight loss. Computed tomography (CT) showed a large, calcified nodule before the anterior border of the masseter muscle within the markedly dilated parotid duct (figure, A).
The patient underwent transoral sialolithotomy, and a hard stone measuring approximately 8x5 mm was removed (figure, B). Tire postoperative course was uneventful.
Sialolithiasis is the major cause of obstructive gland disease. Most calculi occur in the submandibular gland; they occur less frequently in the parotid gland. (1) Conditions that should be considered in the differential diagnosis of a superficial mass in the parotid gland include lymphadenitis, preauricular cyst, sebaceous cyst, benign lymphoid hyperplasia, or extraparotid tumor. (2)
The diagnosis of sialolithiasis is usually made clinically and sometimes with the help of imaging. A sialolith in the anterior third of a Stensen duct usually can be extracted in a minimally invasive manner via transoral sialolithotomy to avoid the morbidity associated with a sialadenectomy.
(1.) Kasaboglu O, Er N, Turner C, Akkocaoglu M. Micromorphology of sialoliths in submandibular salivary gland: A scanning electron microscope and X-ray diffraction analysis. J Oral Maxillofac Surg 2004;62(10):1253-8.
(2.) Torres-Lagares D, Barranco-Piedra S, Serrera-Figallo MA, et al. Parotid sialolithiasis in Stensens duct. Med Oral Patol Oral Cir Bucal 2006; 11 (1):E80-4.
From the Department of Otolaryngology-Flead and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (Dr. Lai, Dr. Lee, Dr. Chu, and Dr. Chang); and the Department of Otolaryngology-Head and Neck Surgery, Taichung Armed Forces General Hospital, Taichung, Taiwan (Dr. Lai).
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|Title Annotation:||HEAD AND NECK CLINIC|
|Author:||Lai, Wen-Sen; Lee, Jih-Chin; Chu, Yueng-Hsiang; Chang, Ying-Nan|
|Publication:||Ear, Nose and Throat Journal|
|Article Type:||Case study|
|Date:||Apr 1, 2015|
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