Concluded Case

Sialolithiasis Parotid Gland

Sialolithiasis are calcified increments in the salivary gland 84% Sialoliths occur in the submandibular gland and only 13% occur in the parotid gland. Sialolithiasis of > 7mm are treated by open surgery Now a days most of the Sialolithiasis is treated by Sialoendoscopy combined with lithotripsy but this is available only at few centerse Chief Complaints A 45 year male patient presented with a swelling rt cheek associated with fever for 10 days History At the age of 18 yrs had undergone excision of soft tissue mass rt cheek which was reported as papillary cystadenoma lymphomatosum Later Underwent parotid duct dilatation 2 to 3 times .Was asymptomatic till the present complaints No history of diabetes, hypertension, hypothyroidism Vitals Conscious and alert Pulse 110/mg BP 120/80 Temp 101°F Physical Examination A soft tissue swelling approx 4 × 3 cm was palpable over the rt cheek anterior to the masseter muscle The swelling was cystic,tender and fluctuant with signs of inflammation Intraoral exam revealed thick foul smelling pus discharge from the orifice of Stensons duct Investigations All investigations attached in PDF format Diagnosis Provisional diagnosis Parotid abscess Final diagnosis Parotid duct large calculus Management Initially treated conservatively with antibiotics and other supportive treatment. Later presented with residual soft tissue swelling with no signs of inflammation CT scan was advised which revealed a large solitary Parotid duct calculus Operation Intraoral removal of Parotid duct calculus Few bits of tissue was taken for Histopathological examination considering the previous biopsy report Today it is 4th PO day Uneventful

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Post op uneventful. Biopsy report non specific inflammation, no evidence of granuloma / malignancy. Ideal treatment is Sialoendoscopy / Lithotripsy / removal of calculi.

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If the cyst is soft and moving then no problem... for inflammation... ginger is the best.lime juice pineapple with black pepper sprouts kalijeeri alkaline diet no sugar no nonveg diet no eggs no mushrooms no fried foods no processed or fermented foods and beverages... beetroot coriander juice... sweet potato...corn.. under strict supervision of Doctor

Thank you doctor
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Post op uneventful. Biopsy report non specific inflammation, no evidence of granuloma / malignancy. Ideal treatment is Sialoendoscopy / Lithotripsy / removal of calculi.

Informative and case presentation is too good

Informative, well presented and managed case .Thank you Doctor for sharing !

sir suturing is needed,if yes could you explain it in details

The edges of the opening were sutures circumferentialy for homeostasis and adequate drainage. It could have been left open also.
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Very good presentation of the case.Thank you Dr. Jangbahadurji.

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