8/3/2019 unilateral parotid swelling

1/3

286 Kurt H. Thoma, Henry D. Howe, and Martin Wenigbetalin, and 500 cc. amigen, 1 C.C. liver concentrate intramuscularly, and4 grains iron; this was repeated on September 14. On September 35 the pa-tients condition changed for the worse; he had Cheyne-Stokes respiration; thetemperature, pulse rate, and respirations were all elevated. The nonproteinnitrogen was 52 mg. per liter. He was given 2 cc. cedilanid intra.muscularly.In spite of all efforts, however? the patient died on September 16.

Pathologic report, gross : a hemispherical mass of friable, moderately soft,gray-brown meaty tissue, measuring 12 cm. in diameter and 7 cm. high, wascovered on the round surface with skin that was partially covered with hair,and in some areas was thin and irregular with many sess ile and pedunculatednodules measuring up to 2 cm. in diameter. The flat amputation surface wasred and covered with a thin layer of fascia. The tumor tissue extended every-where to the amputation surface. On section the mass had a 2 cm. broad capsuleof light gray meaty tissue within which was a yellow-pink mass of soft necrotictumor tissue. Diagnosis: Carcinoma, type undetermined (Fig. 427).

Case DfZUnilateral Parotid Swelling

DAVID WEISBERGER, D.M.D., M.D.H. S. (474528)) a 21-year-old woman, enfered the hospital on Jan. 9, 1945,

with a swelling on the left side of the face.About two and one-half months ago the patient was delivered of her second

child without complications. Five days later a swelling in the left preauriculararea was noticed; this gradually enlarged and became tender. The whole sideof the face was involved and the eye almost closed. The swollen area becamepainful, and the skin red and shiny. The face was numb and t,he patient couldnot move the left side; she had difficulty in opening the mouth to eat. Orig inallythe pain had been limited to mealtime, and was present under the left mandible.About one and one-half months ago the swelling reached its maximum. Duringt.his time the patient had a fever for about ten days. She had been in anotherhospital for two weeks where sulfonamides and penic illin were given, and in-cision and drainage were performed twice at about a weeks interval. Aboutone month after the swelling on the left appeared, the right side started to swell.There was a small mass in the preauricular area, but this never enlarged over afew centimeters and was not painful and not tender. It disappeared while thepatient was in the hospital. Shortly after the last incision and drainage, a small,red swelling appeared on the left side below the site of the drainage, and haspersisted to the present time, although it has gradually decreased in size.

The patients general health has been good, although she had headaches,dizzy spells, and tinnitus. Last summer she had a watery discharge from thenose when she bent over.

Examination showed a small, 2 by 3 cm., oval, fluctuant swelling in the leftpreauricular area. The edges overlying the skin were inflamed, and the centralarea was yellow in the most fluctuant part. There was only slight tenderness.The parotid tissue seemed to extend several centimeters beyond the edges ofthe raised mass, and felt indurated. There was a scar from the previous in-cisions. The ducts in the mouth were normal ; no pus could be expressed.

8/3/2019 unilateral parotid swelling

2/3

Clinic of Massachusetts General Hospital

Fig. 428.-Sialogram of parot id gland showing several di lated pockets f i l led wi th l ip iodol .I I , Parot id duct; P, pocket Al led wi th l ip iod ol .

Fig. 429.-Exaggerated Waters posi t ion. Sialogram showing di lated pockets f l l led wi thl ip iodol . D, Parot id duct; P, pocket f l l led wi th l ip iodol .

8/3/2019 unilateral parotid swelling

3/3

288 Kurt H. Thoma, Henq D. Howe, and Martin WenigImpression : Bilatera l parotid tumor. Sialograms were advised.

A sialogram taken on January 10 showed the left parotid gland and ductto be of normal size . The lateral and anterior portion of the gland showedseveral dilated pockets consistent with sialectasis (Figs. 428 and 429).

At this time the white cell count was 8,850 ; hemoglobin, 96 per cent ; pro-thrombin time, 17 seconds, normal 18 to 20 seconds; serum amylase, normal.On January 16, 4 cc. of grayish-ye llow pus was aspirated from the abscess

cavity through normal tissue. The culture showed Staphylococcus dbus. Onthe next day 4 CC. of grayish fluid was again aspirated, and the cavity collapsed.It was irrigated with 4 C.C. penic illin. The patient tasted a salty fluid in themouth, and the fluid was reaspirated and a pressure dressing applied. X-rayexamination showed that the lipiodol previously injected into the left parotidgland had ,ent irely disappeared.

On January 18 the patient was shown at grand rounds, and it was decidedthat a regime of multiple aspirations with pen icillin therapy should be followed.Two days later after dinner the patient complained of severe headache on theright side and vomited once or twice. She had blurring of vision. She statedshe had had simi lar attacks previously. Codeine brought relief. Impression :Migraine.

On January 25 the patient was seen in dental consultation. Examinationof the secretion of the left parotid gland revealed a scanty and viscid salivawhich could lx seen oil17 aft:r s+::nl -t o:l up31 chcwin:c a lemon. The ductwas probed with various-s ized lacrymal-duct probes, and it was found to be verynarrow and constricted. An attempt was made to dilate the duct. Followingthis, stimulation with lemon juice produced a moderate increase in thin saliva.It was believed that the gland would never function normally.

The patient was discharged on January 25 to be followed in the OutpatientDepartment for dilation of Stensens duct.

On February 1 the patient said the left side of the face was better. Theduct was probed, but very little saliva w as present.