A case of severe dilatation of the parotid duct due to fibrinous sialodochitis.
A 50-year-old woman presented with a 10-year history of swelling of the left cheek during and after meals. She regularly pushed the cheek hard to decrease the swelling by excreting the saliva. She did not have pain or fever. She also complained of bronchial asthma and allergic rhinitis. Magnetic resonance imaging (MRI) revealed bead-like dilatation (3x4 cm) of the left parotid duct with hypointensity on T1-weighted MRI and hyperintensity on T2-weighted MRI. Technetium 99m-pertechnetate (Tc-99m) scintigraphy demonstrated hypofunction of the left parotid gland and retention of radioactive substrate in the left parotid duct even after acid loading. Since bougienage was impossible, we decided to perform a drainage operation. We exposed, fenestrated and sutured the duct wall to the buccal mucosa to make a large orifice. We inserted a Penrose drain for 1 month to avoid stenosis of the orifice. No complication was observed postoperatively, and drainage was still adequate at the most recent examination 3 years after the operation. Smears of saliva from the parotid duct with Hansel staining revealed numerous eosinophils, and fibrinous sialodochitis was diagnosed.
Shimada
Taketoshi
T
Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. tshimada@koto.kpu-m.ac.jp
Okano
Hiroyuki
H
Hisa
Yasuo
Y
D004108:Dilatation, Pathologic / Q000175:diagnosis / Q000601:surgery; D004322:Drainage; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010305:Parotid Diseases / Q000175:diagnosis* / Q000601:surgery*; D011877:Radionuclide Imaging; D018987:Salivary Ducts / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome