Maxillofacial Radiology 192

A 64-year-old male patient, who is human immunodeficiency virus (HIV) positive on treatment, presented with atwo-year history of a painful swelling involving the left parotid gland. Cone beam computerised tomographic (CBCT) imaging was performed (Figures A-D). What are the pertinent radiological findings and your diagnostic hypothesis?

“Chiclero’s Ulcer” Due to Leishmania mexicana in Travelers Returning from Central America: A Case Report and Review of the Literature

Cutaneous leishmaniasis (CL) due to a New World species of Leishmania is increasingly seen among returning international travelers, and most cases arise from travel to Mexico, Central and South America. We described a case of CL in a women presenting a nonhealing ulceration under her right ear with slight increase of size of the left parotid gland under the skin lesion, evolving for 4 months. In her history of travel, she reported a ten-day stay in Mexico during the Christmas vacation in the Yucatan region with only half a day walking in the tropical forest. Diagnosis of CL due to Leishmania mexicana was done via PCR detection and sequencing from swab sampling of the lesion. The patient recovered without antiparasitic treatment. Clinicians should consider diagnosing Chiclero’s ulcer in patients returning from endemic areas such as Central America and Texas who present with chronic ulceration. A noninvasive sampling is sufficient for the PCR-based diagnosis of this disease.

Giant pleomorphic adenoma of the parotid gland: a case report

Pleomorphic adenomas account for the majority of parotid masses, typically arising in the tail of the gland and enlarging slowly. Most are 2 to 6 cm in size when resected. We report the resection of a benign mixed tumour of the left parotid gland with a history of bleeding. The resected tumour measured 21 cm in diameter, weighed 1.81 kg, and on pathologic examination was a benign mixed tumour without malignant degeneration. The implications of this unusual case for the management of mixed tumours are discussed with a review of the literature.

Severe Ludwig’s angina caused by an unknown insect bite

Hereby, we report a case of a 75-year-old man who presented with a 3-day history of facial swelling and choking sensation. The only history of note was an insect bite on the left parotid gland area 3 days prior. The patient was later diagnosed with insect-bite-induced Ludwig’s angina. Enterococcus faecalis was detected on blood cultures and was presumed the source of infection. Intravenous antibiotics and corticosteroids were initiated. The patient was intubated and was subsequently made to undergo a tracheostomy insertion to establish a definitive airway. He was admitted to the intensive care unit and when his condition improved, he was transferred to the ward for full recovery. The patient spent a total of 66 days in hospital before being discharged. This case suggests that Ludwig’s angina can be caused by insect bites. However, further similar cases are needed to be documented to explore this theory.

Dentinogenic Ghost Cell Tumor in a Sumatran Rhinoceros

An adult female Sumatran rhinoceros was observed with a swelling in the left infraorbital region in March 2017. The swelling rapidly grew into a mass. A radiograph revealed a cystic radiolucent area in the left maxilla. In June 2017, the rhinoceros was euthanized. At necropsy, the infraorbital mass measured 21 cm × 30 cm. Samples of the infraorbital mass, left parotid gland, and left masseter muscle were collected for histopathology (Hematoxylin & Eosin, Von Kossa, Masson’s trichrome, cytokeratin AE1/AE3, EMA, p53, and S-100). Numerous neoplastic epithelial cells showing pleomorphism and infiltration were observed. Islands of dentinoid material containing ghost cells and keratin pearls were observed with the aid of the two special histochemistry stains. Mitotic figures were rarely observed. All the neoplastic odontogenic cells and keratin pearls showed an intense positive stain for cytokeratin AE1/AE3, while some keratin pearls showed mild positive stains for S-100. All samples were negative for p53 and S-100 immunodetection. The mass was diagnosed as a dentinogenic ghost cell tumor.

Cystic Teratoma of the Parotid Gland Involving Parapharyngeal Space: A Case Report and with Literature Review

Background: Teratomas are common neoplasms but are extremely rarely found in the parotid gland region, most benign teratomas are cystic, also known as mature cystic teratomas, and only 9 cases have been reported in the literature.Case presentation: Herein, we reported a single case of a patient with giant cystic teratoma in the left parotid gland deep lobe extended into the parapharyngeal space. The tumor was diagnosed based on complete preoperative imaging CT and MRI data and then postoperatively confirmed by pathology.Conclusion: Preoperative CT and MRI scanning are useful in determining the nature of teratomas and perform differential diagnosis of teratoma in the parotid gland by showing calcification, fatty elements, and a fat-liquid level in the parotid gland cyst. Yet, surgery and pathology can provide a final diagnosis.

A Rare Case of Parotid Gland Tuberculosis

Parotid gland tuberculosis is a very rare form of extrapulmonary tuberculosis, with less than 200 cases reported in literature. We describe a 10-year-old female who presented with a swelling in the left parotid region during the last month. CT scan neck revealed an abscess in the left parotid gland extending into the submandibular gland, muscles, and bone. Pus aspirated by FNAC showed acid fast bacilli in the ZN stain, and GeneXpert was positive for rifampicin-sensitive Mycobacterium tuberculosis. She was successfully treated with antituberculous therapy given for 6 months. Parotid gland tuberculosis, although rare, has a good prognosis with drug therapy. Surgery is rarely required.

Malignant Transformation of Chronic Nonspecific Sialadenitis: A Rare Clinical Presentation

ABSTRACT A 26-year-old man presented with a large, painless, mobile, pedunculated, fluctuant, and nontransilluminant swelling hanging in front of the left ear. He had undergone superficial parotidectomy 9 months ago elsewhere for chronic nonspecific sialadenitis of left parotid gland. The fine needle aspiration was nondiagnostic and revealed turbid dark yellow color fluid. A total parotidectomy was performed to remove the lesion completely as the tumor was involving the deep lobe. Histopathology was consistent with features of low-grade mucoepidermoid carcinoma. Immediate postoperatively the patient had a House and Brackman grade III left facial nerve paresis, which later improved to grade II. This unusual presentation of malignant transformation of chronic nonspecific sialadenitis is one of the rare unique reported cases to our knowledge. How to cite this article: Ashish G, Michael RC. Malignant Transformation of Chronic Nonspecific Sialadenitis: A Rare Clinical Presentation. Int J Head Neck Surg 2021;12(1):31–33.