gms | German Medical Science

Introduction: In cases of a persistent mass in the parotideal region surgical intervention is mandatory due to diagnostic and therapeutic reasons. A clinically minor finding might cause a compromise in the surgical approach thus meaning an unnecessary, potential risk for the integrity of the facial nerve.

Method: A 19-year-old female presented with a painful tumor of the left parotideal region, located subcutaneously, 0.5 cm in diameter on palpation. Ultrasound revealed a well-defined, markedly inhomogeneous mass. There was no clear distinction to the surrounding glandular tissue.

Result: Assuming a local lymphadenitis, an oral treatment with amoxicilline/clavulanic acic was administered for 10 days. As there has been no significant improvement, surgical removal of the mass was recommended. Preoperative consulting included the possibility of an intraparotideal knot, in which case a lateral parotidectomy would be indicated in order to guarantee the integrity of the facial nerve. Intraoperatively the importance of this possible management was confirmed: The mass was located within the glandular tissue, just on top of a mouth- and eyelid-serving branch of the facial nerve. Histology showed a sialolithiasis with sialadenitis of the parotideal gland.

Discussion: This case documents the ambivalence in the treatment of unclear masses of the parotideal region. Clinically minimal changes temptate local surgical excision, whereas the location nearby crucial anatomic structures tend to be neglected. Therefore, from a medical point of view one should never make compromises when it comes to risks the surgeon is aware of, and – last but not least – is responsible for.