Abstract
Purpose
It has been long known that sialendoscopy has both diagnostic and therapeutic benefits in the identification and treatment of sialadenitis. Sialendoscopy can also be used to triage patients with traumatic injury or foreign bodies lodged in the parotid gland.
Procedures
We present a case of traumatic insertion a fishbone into the parotid gland parenchyma that was evaluated with sialendoscopy and successfully managed on the basis of stable endoscopy findings that correlated with improving symptomatology.
Main findings
We find that sialendoscopy presents a useful tool to help guide management.
Conclusions
We demonstrate that in an asymptomatic patient, foreign body impaction with absence of ductal obstruction on endoscopy can successfully be followed with simple observation.
1
Introduction
Foreign bodies, such as feathers, hair, pencil lead, plastic pen tops, and plant material, are rarely found to enter into the major salivary glands . The mechanism of entry is most commonly traumatic, with few foreign bodies finding their way intraorally through Wharton’s or Stensen’s duct . Salivary gland foreign objects present with inflammation and/or infection , and may be misdiagnosed as sialadenitis. Moreover, the sharp nature of many objects may lead to repetitive and ongoing glandular irritation and inflammation. Furthermore, any ductal obstruction could lead to stasis of salivary gland secretions and subsequent bacterial growth.
Sialendoscopy is a highly efficacious, minimally invasive diagnostic and therapeutic tool for the identification and treatment of sialoliths, mucus plugs, and foreign bodies that may be causing obstruction of salivary flow in the major salivary glands . However, to the best of our knowledge, no report in the literature has addressed the usefulness of sialendoscopy in dictating management strategy (i.e. observation vs. endoscopic/surgical removal) for patients with foreign body obstructive sialadenitis.
Here, we present a case of traumatic insertion a fishbone into the parotid gland parenchyma that was evaluated with sialendoscopy and successfully managed on the basis of stable endoscopy findings that correlated with improving symptomatology.
2
Case Report
A 43-year-old male presented to the otolaryngology clinic with a two-week history of intermittent left sided parotid swelling and fullness that began after eating fish for dinner. He recalled piercing of his cheek with a fishbone into his cheek during the meal, which he immediately removed. He experienced left cheek fullness over the next several days and was placed on a 10-day course of broad-spectrum antibiotics by his primary care physician.
CT was performed at that time and revealed a linear calcification involving the left parotid gland [ Fig. 1 ]. In-office ultrasound also demonstrated the presence of a linear calcification with posterior acoustic shadowing [ Fig. 2 , Video 1 ]. The patient was diagnosed with retained fishbone in the parotid gland. However, based on imaging, it was impossible to determine whether the retained foreign body was lodged in the parenchyma or involving the ductal system. In the office diagnostic sialendoscopy was then performed to further evaluate.
Parotid sialendoscopy of Stensen’s duct was unremarkable with no evidence of trauma, mucus plugging, calculus or other obstruction. It was determined that the fishbone was not involving the visualized main, secondary or tertiary ductal system, and likely lodged in the parotid gland parenchyma. The patient was counseled to return to clinic in 3 months for re-evaluation. He now has remained symptom free for 6 months since his initial injury.
2
Case Report
A 43-year-old male presented to the otolaryngology clinic with a two-week history of intermittent left sided parotid swelling and fullness that began after eating fish for dinner. He recalled piercing of his cheek with a fishbone into his cheek during the meal, which he immediately removed. He experienced left cheek fullness over the next several days and was placed on a 10-day course of broad-spectrum antibiotics by his primary care physician.
CT was performed at that time and revealed a linear calcification involving the left parotid gland [ Fig. 1 ]. In-office ultrasound also demonstrated the presence of a linear calcification with posterior acoustic shadowing [ Fig. 2 , Video 1 ]. The patient was diagnosed with retained fishbone in the parotid gland. However, based on imaging, it was impossible to determine whether the retained foreign body was lodged in the parenchyma or involving the ductal system. In the office diagnostic sialendoscopy was then performed to further evaluate.
