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Parotid cyst: A case report
Copyright©Munksgaard 1994
Int. J. Oral Maxillofac. Surg. 1994; 23:165-166 Printed in Denmark. All rights reserved
lnternationalJouraalof
Oral & MaxillofaciaISurgery ISSN 0901-5027
Par0tid cyst: a case report
K. Altman, B. M. W. Bailey Norman Rowe Maxillofacial Unit, Queen Mary's University Hospital, Roehampton, London SW15 5PN, UK
K. A l t m a n , B. M . W. Bailey." P a r o t i d cyst: a case report. Int. J. Oral M a x i l l o f a c . Surg. 1994; 23- 165-166. © Munksgaard, 1994 Abstract. A case of parotid cyst is reported, and the diagnosis, investigations,
and treatment are discussed.
Cystic lesions of the parotid gland are u n c o m m o n , comprising approximately 5% of all salivary gland tumours; m a n y of them represent cystic components of neoplasms 2. Histologically, the main types of cyst that may be found in the parotid gland are as follows: 1) simple cysts, comparable with both the extravasation and retention types of mucocele, but larger; 2) lymphoepithelial cysts, which are mainly congenital, but which are also reported in acquired immunodeficiency syndrome (AIDS) patientsS; 3) polycystic (dysgenetic) disease of the parotid
Fig. 1. Axial CT scan showing large cyst in
right parotid gland.
Key words: parotid gland; cysts. Accepted for publication 15 November 1993
gland, a developmental disorder which is limited to the parotid glands, often in females, and usually bilateral9; and 4) cystic tumours. This paper reports the case of a large intraparotid cyst and discusses the diagnosis, relevant investigations, and treatment of this lesion.
Case report A 10-year-old boy presented with a cystic swelling in front of the right ear. The lesion had been noticed a short time before; it was painless and thought to be enlarging. C!inical
examination revealed a 3-cm, soft, well-defined mass in the right preauricular region. A computerized tomography (CT) scan showed a 2.5 x 1.5 cm cyst extending from the anterior surface of the right parotid gland (Fig. 1). At operation, via an extended preauricular incision, the cyst was excised with a margin of superficial lobe of parotid gland, the upper divisions of the facial nerve being dissected free. Histological examination revealed a simple parotid cyst (Fig. 2). The lining consisted of a double layer of epithelium, stratified in some areas, and there was a fibrocollagenous wall. Myxoid change and foci of parotid gland acini were seen, and the cyst contents
Fig. 2. Photomicrograph showing collapsed, thin-walled cyst and adjacent parotid gland acini (HE x 25). Inset: high-power photomicrograph showing double layer of squamous epithelium and fibrocollagenous wall (HE × 400).
166
Altman and Bailey
were of gelatinous material. The patient made an uneventful recovery, and there has been no sign of recurrence. Discussion
Intraparotid cystic swellings are uncommon. RICHARDSONet al. 7 found 23 cystic lesions (3.2%) in a series of 708 parotidectomies; of these, 16 (2.3%) met their criteria for lymphoepithelial cysts, while five (0.7%) were simple cysts. PIETERSE SEYMOUR6 reported 16 intraparotid cysts (8.7%) in 183 cases. Nine (4.9%) had developed in parotid neoplasms, usually Warthin's tumours, while the remaining seven (3.8%) had no associated tumours. ADEKEYE ~ ORD 1, in a review of 100 cases, found parotid cyst to be the commonest nonneoplastic disease (10%). Histologically, seven of these were simple cysts and two were lymphoepithelial cysts. The clinical diagnosis of parotid cyst is often based on a slowly enlarging painless lump in the parotid region, and examination may not always confirm the cystic nature of the lesion. Investigations are important in diagnosis and treatment planning of these lesions. Fine-needle aspiration cytology ( F N A C ) is useful in certain cases 4. Sialography is not helpful in establishing the diagnosis, but does confirm the presence of a space-occupying lesion 3. Ultrasound is useful in showing the cystic nature of the lesion ~°, while C T scanning, with the possible use of contrast,
gives clear images o f the lesion and its anatomical relations, as in the patient reported here; moreover, it can detect bilateral disease and any associated cervical lymphadenopathy, as in patients at risk of developing A I D S 5,8. Magnetic resonance imaging (MRI) can reveal intraparotid cystic disease 8 and is generally more sensitive than C T scanning in detecting small intraparotid masses, although the latter provides a better means of distinguishing solid from cystic lesions. Treatment in the case reported was by surgical excision o f the cyst with a margin of superficial lobe of parotid gland, after dissecting the branches of the facial nerve. BRENNAN et al. 3 advocate this type of conservative surgery whenever possible. Survey of the literature reveals that most other authors favour superficial parotidectomy in these cases, especially if the diagnosis is in doubt or when a conservative approach cannot safely remove the lesion. References
1. ADEKEYEEO, ORD RA. Surgical parotid disease in Nigeria: a review of 100 cases. J Maxillofac Surg 1984: 12:118-22. 2. BATSAKISJG. Tumors of the head and neck. Baltimore, MD: Williams & Wilkins, 1974: 63. 3. BRENNAN MF, GWYNNE JF, MACBETH WAAG. Simple parotid cysts. Aust N Z J Surg 1970: 40: 15-19. 4. DROESEM. Cytological diagnosis of siala-
denosis, sialadenitis, and parotid cysts by fine-needle aspiration biopsy. Adv Otorhinolaryngol 1981: 26:49 96. 5. HOLLIDAYRA, COHEN WA, SCH1NELLA RA, et al. Benign lymphoepithelial parotid cysts and hyperplastic cervical adenopathy in AIDS-risk patients: a new CT appearance. Radiology 1988: 168: 439--41. 6. PIETERSEAS, SEYMOURAE. Parotid cysts. an analysis of 16 cases and suggested classification. Pathology 1981: 13: 22534. 7. RICHARDSON GS, CLAIRMONT AA, ERICKSON ER. Cystic lesions of the parotid gland. Plast Reconstr Surg 1978: 61: 364-70. 8. SHUGAR JM, SOM PM, JACOBSON AL, RYAN JR, BERNARD PJ, DICKMAN SH. Multicentric parotid cysts and cervical adenopathy in AIDS patients. A newly recognised entity: CT and MR manifestations. Laryngoscope 1988: 98: 77~5. 9. SMYTHAG, WARD-BooTh RP, HmH AS. Polycystic disease of the parotid glands: two familial cases. Br J Oral Maxillofac Surg 1993: 31: 38-40. 10. WARD-BOOTHRP, WILLIAMSED, FAULKNER TP, EARL PD. Ultrasound: a simple noninvasive examination of cervical swellings. Plast Reconstr Surg 1984: 73: 577-81.
Address: K. Altman, Registrar Norman Rowe Maxillofacial Unit Queen Mary's University Hospital Roehampton Lane London SWI5 5PN UK
Int. J. Oral Maxillofac. Surg. 1994; 23:165-166 Printed in Denmark. All rights reserved
lnternationalJouraalof
Oral & MaxillofaciaISurgery ISSN 0901-5027
Par0tid cyst: a case report
K. Altman, B. M. W. Bailey Norman Rowe Maxillofacial Unit, Queen Mary's University Hospital, Roehampton, London SW15 5PN, UK
K. A l t m a n , B. M . W. Bailey." P a r o t i d cyst: a case report. Int. J. Oral M a x i l l o f a c . Surg. 1994; 23- 165-166. © Munksgaard, 1994 Abstract. A case of parotid cyst is reported, and the diagnosis, investigations,
and treatment are discussed.
Cystic lesions of the parotid gland are u n c o m m o n , comprising approximately 5% of all salivary gland tumours; m a n y of them represent cystic components of neoplasms 2. Histologically, the main types of cyst that may be found in the parotid gland are as follows: 1) simple cysts, comparable with both the extravasation and retention types of mucocele, but larger; 2) lymphoepithelial cysts, which are mainly congenital, but which are also reported in acquired immunodeficiency syndrome (AIDS) patientsS; 3) polycystic (dysgenetic) disease of the parotid
Fig. 1. Axial CT scan showing large cyst in
right parotid gland.
Key words: parotid gland; cysts. Accepted for publication 15 November 1993
gland, a developmental disorder which is limited to the parotid glands, often in females, and usually bilateral9; and 4) cystic tumours. This paper reports the case of a large intraparotid cyst and discusses the diagnosis, relevant investigations, and treatment of this lesion.
Case report A 10-year-old boy presented with a cystic swelling in front of the right ear. The lesion had been noticed a short time before; it was painless and thought to be enlarging. C!inical
examination revealed a 3-cm, soft, well-defined mass in the right preauricular region. A computerized tomography (CT) scan showed a 2.5 x 1.5 cm cyst extending from the anterior surface of the right parotid gland (Fig. 1). At operation, via an extended preauricular incision, the cyst was excised with a margin of superficial lobe of parotid gland, the upper divisions of the facial nerve being dissected free. Histological examination revealed a simple parotid cyst (Fig. 2). The lining consisted of a double layer of epithelium, stratified in some areas, and there was a fibrocollagenous wall. Myxoid change and foci of parotid gland acini were seen, and the cyst contents
Fig. 2. Photomicrograph showing collapsed, thin-walled cyst and adjacent parotid gland acini (HE x 25). Inset: high-power photomicrograph showing double layer of squamous epithelium and fibrocollagenous wall (HE × 400).
166
Altman and Bailey
were of gelatinous material. The patient made an uneventful recovery, and there has been no sign of recurrence. Discussion
Intraparotid cystic swellings are uncommon. RICHARDSONet al. 7 found 23 cystic lesions (3.2%) in a series of 708 parotidectomies; of these, 16 (2.3%) met their criteria for lymphoepithelial cysts, while five (0.7%) were simple cysts. PIETERSE SEYMOUR6 reported 16 intraparotid cysts (8.7%) in 183 cases. Nine (4.9%) had developed in parotid neoplasms, usually Warthin's tumours, while the remaining seven (3.8%) had no associated tumours. ADEKEYE ~ ORD 1, in a review of 100 cases, found parotid cyst to be the commonest nonneoplastic disease (10%). Histologically, seven of these were simple cysts and two were lymphoepithelial cysts. The clinical diagnosis of parotid cyst is often based on a slowly enlarging painless lump in the parotid region, and examination may not always confirm the cystic nature of the lesion. Investigations are important in diagnosis and treatment planning of these lesions. Fine-needle aspiration cytology ( F N A C ) is useful in certain cases 4. Sialography is not helpful in establishing the diagnosis, but does confirm the presence of a space-occupying lesion 3. Ultrasound is useful in showing the cystic nature of the lesion ~°, while C T scanning, with the possible use of contrast,
gives clear images o f the lesion and its anatomical relations, as in the patient reported here; moreover, it can detect bilateral disease and any associated cervical lymphadenopathy, as in patients at risk of developing A I D S 5,8. Magnetic resonance imaging (MRI) can reveal intraparotid cystic disease 8 and is generally more sensitive than C T scanning in detecting small intraparotid masses, although the latter provides a better means of distinguishing solid from cystic lesions. Treatment in the case reported was by surgical excision o f the cyst with a margin of superficial lobe of parotid gland, after dissecting the branches of the facial nerve. BRENNAN et al. 3 advocate this type of conservative surgery whenever possible. Survey of the literature reveals that most other authors favour superficial parotidectomy in these cases, especially if the diagnosis is in doubt or when a conservative approach cannot safely remove the lesion. References
1. ADEKEYEEO, ORD RA. Surgical parotid disease in Nigeria: a review of 100 cases. J Maxillofac Surg 1984: 12:118-22. 2. BATSAKISJG. Tumors of the head and neck. Baltimore, MD: Williams & Wilkins, 1974: 63. 3. BRENNAN MF, GWYNNE JF, MACBETH WAAG. Simple parotid cysts. Aust N Z J Surg 1970: 40: 15-19. 4. DROESEM. Cytological diagnosis of siala-
denosis, sialadenitis, and parotid cysts by fine-needle aspiration biopsy. Adv Otorhinolaryngol 1981: 26:49 96. 5. HOLLIDAYRA, COHEN WA, SCH1NELLA RA, et al. Benign lymphoepithelial parotid cysts and hyperplastic cervical adenopathy in AIDS-risk patients: a new CT appearance. Radiology 1988: 168: 439--41. 6. PIETERSEAS, SEYMOURAE. Parotid cysts. an analysis of 16 cases and suggested classification. Pathology 1981: 13: 22534. 7. RICHARDSON GS, CLAIRMONT AA, ERICKSON ER. Cystic lesions of the parotid gland. Plast Reconstr Surg 1978: 61: 364-70. 8. SHUGAR JM, SOM PM, JACOBSON AL, RYAN JR, BERNARD PJ, DICKMAN SH. Multicentric parotid cysts and cervical adenopathy in AIDS patients. A newly recognised entity: CT and MR manifestations. Laryngoscope 1988: 98: 77~5. 9. SMYTHAG, WARD-BooTh RP, HmH AS. Polycystic disease of the parotid glands: two familial cases. Br J Oral Maxillofac Surg 1993: 31: 38-40. 10. WARD-BOOTHRP, WILLIAMSED, FAULKNER TP, EARL PD. Ultrasound: a simple noninvasive examination of cervical swellings. Plast Reconstr Surg 1984: 73: 577-81.
Address: K. Altman, Registrar Norman Rowe Maxillofacial Unit Queen Mary's University Hospital Roehampton Lane London SWI5 5PN UK