CASE

PRESENTATION
Baguio General Hospital and Medical Center
DEPARTMENT OF GENERAL SURGERY

PRE-RESIDENT JORGE T. DE VERA JR

Sources:
Objectives 1 2 3
To present a To discuss the To discuss briefly the
history and embryology,
case of a parotid histology, anatomy,
mass physical
and physiology of
examination of
the parotid gland
the patient
 General data
History of present illness
Review of systems
Past medical history
Outline Family history
Social and environmental
Physical examination
Assessment
Differential diagnosis
Discussion
G. R.  30/F SINGLE FILIPINO

URDANETA
ROMAN PANGASIN
10/ /
CATHOLIC AN
INFRAAURICULAR MASS
• PEA-SIZED MASS, INFRA AURICULAR AREA, RIGHT
• NO CONSULT WAS DONE, NO MEDICATION TAKEN
2 YRS

• GRADUAL INCREASE IN THE SIZE OF THE MASS

• NO CONSULT, NO MEDICATIONS
INTERVAL

• PERSISTENE OF THE MASS

• CONSULT DONE AT A LOCAL HOSPITAL AND WAS GIVEN CLINDAMYCIN
2 MONTHS WHICH WAS TAKEN FOR 7 DAYS
INFRAAURICULAR MASS
• DUE TO PERSISTENCE OF MASS, THE PATIENT SOUGHT
CONSULT AT A PMD
 1 • THE PATIENT WAS OPTED FOR SURGICAL INTERVENTION
MONTH  BUT REFUSED

• THE PATIENT SOUGHT CONSULT TO A PMD AND WAS

ADVISED ALSO WITH SURGICAL INTERVENTION AND WAS
1 MONTH REFERRED HERE IN THIS INSTITUTION HENCE ADMITTED
 GENERAL: (-) FEBRILE EPISODE, (-) BODY MALAISE, (-)
HEADACHE, (-) WEIGHT LOSS

INTEGUMENTARY: (-) RASHES, (-) PRURITUS

Review of HEENT:

systems HEAD (-) HEADACHE

EYES (-) EYE PAIN, (-) DISCHARGES, (-) BLURRING OF

VISION

EARS (-) EAR PAIN, (-) EAR FULLNESS, (-) EAR

DISCHARGE

NOSE (-) PURULENT DISCHARGE, (-) EPISTAXIS

MOUTH & (-) DYSPHAGIA, (-) ODYNOPHAGIA, (-)

THROAT HALITOSIS
 RESPIRATORY: (-) COUGH, (-) DIFFICULTY OF
BREATHING

CARDIAC: (-) PALPITATIONS, (-) CHEST PAIN

(-) CHEST DISCOMFORT

Review of GIT: (-) VOMITING, (-) ABDOMINAL PAIN,

systems (-) DIARRHEA/CONSTIPATION

GUT: (-) DYSURIA, (-) FLANK PAIN, (-)

HEMATURIA, (-) URINARY
FREQUENCY

MUSCULOSKELETAL: (-) ARTHRALGIA/MYALGIA, (-)

DECREASED ROM

HEMATOLOGIC: (-) EASY BRUISING, (-) HEMATOMA,

(-) PETECHIAE

EXTREMITIES: (-) LIMITATION OF MOVEMENT, (-)

EDEMA
 •
PAST •
NO OTHER CO-MORBIDS
NO KNOWN ALLERGIES
MEDICAL •
•
NO ILLICIT DRUG USE

HISTORY
NO PREVIOUS SURGERIES
• NO PREVIOUS RADIATION THERAPY
• WITH 1 SEXUAL PARTNER (WIFE)

FAMILY HISTORY • NO HEREDOFAMILIAL DISEASES

• NO HX OF TB IN THE FAMILY
 • LIVES IN A 1-STOREY HOME WITH HIS
SOCIAL AND FAMILY, NON-CONGESTED, WELL-
VENTILATED, AWAY FROM THE ROAD
ENVIRONME • NON-SMOKER

NTAL • OCCASIONAL ALCOHOLIC BEVERAGE

DRINKER
HISTORY • NO RECENT TRAVEL
• NO PETS
Physical examination:

HEAD: No scars, no lesions, no

facial asymmetry, noted a 3x3
cms infraauricular mass, right,
firm, mobile, non-tender
EYES: no swelling, no redness, no tearing, anicteric sclear,
pinkish palpebral conjunctiva, intact EOMS

EARS: no pinna deformities, intact eac,

AU: Intact tympanic membrane, mobile on pneumatic
Otoscopy

NOSE: Nasal septum at the midline, no discharges, no sinus

tenderness
MOUTH AND THROAT
Moist, pink lips and oral mucosa
No dental carries
No noted bulge on the buccal mucosa
No atrophy of the tongue
No asymmetric palate elevation
No pharyngeal wall congestion

No noted masses on bimanual palpation

NECK
No gross deformities
no tracheal deviation
no masses, CLAD
 CHEST/LUNGS SYMMETRICAL CHEST WALL
EXPANSION, (-) RETRACTIONS, (-)
LAGGING, CLEAR BREATH SOUNDS

HEART PMI @ 5TH ICS LMCL, (-) HEAVES, (-)

THRILL, NORMAL RATE REGULAR
RHYTHM, (-) MURMURS
PHYSICAL
EXAMINATI ABDOMEN FLAT, NONDISTENDED, NORMOACTIVE
BOWEL SOUNDS, TYMPANITIC, SOFT,

ON NON-TENDER ON ALL QUADRANTS

EXTREMITIES NO GROSS DEFORMITIES, (-) BIPEDAL

EDEMA, FULL AND EQUAL PERIPHERAL
PULSES
NEURO NO NEURO DEFICITS
NO NEUROPATHIES
ASSESSMENT PAROTID MASS, RIGHT
: PROBABLY BENIGN
 DIFFERENTIALS

INFECTIOUS/INFLAMMATORY NEOPLASTIC
TB Disease of the Salivary Gland BENIGN
Pleomorphic adenoma
Warthin’s tumor
Lipoadenoma
MALIGNANT
Mucoepidermoid carcinoma
Adenoid cystic carcinoma
 • Begin their development during the sixth
week of gestation as solid, ridge-like
ingrowths of the oral epithelium
• Salivary secretion starts after birth.
• Intraparotid lymph nodes form within the
Embryology pseudocapsule of the parotid but lymph
nodes do not form within other salivary
glands.
• The parotid becomes encapsulated after
the development of the lymphatic system
and is therefore the only salivary gland
that contains lymph nodes
histology • Acinar cells are pyramidal shape
with a basal nucleus and
secretory granules at the apex.
• The serous cells of the parotid
are interposed by myoepithelial
cells that have a contractile
function.
• Acinar duct leads to the
intercalated duct, the
intralobular striated duct, and
the excretory duct.
• The intercalated and striated
ducts can modify the salivary
composition.
Histology - THEORIES OF
TUMORIGENESIS •MULTICELLULAR THEORY
•“Each type of neoplasm is
thought to originate from a
distinctive cell type within the
salivary gland unit”

•BICELLULAR RESERVE CELL

THEORY
•“The origin of the various types
of salivary neoplasms can be
traced to the basal cells of either
the excretory or the intercalated
duct.”
 ANATOMY
Largest major salivary gland and is the
first to develop in utero.
Borders of the Parotid Gland:
A. Superior border is the zygomatic
arch
B. Anterior border is the masseter
muscle.
C. Inferior border is inferior border of
the mandible
D. Posterior border is the tragal
cartilage and sternocleidomastoid
muscle.
 ANATOMY
• Divided into the superficial and
deep lobe by the facial nerve
• The facial nerve branches as it
enters the parotid forming the pes
anserinus.
• The upper divisions include the
temporal-facial branches.
• The lower divisions include the
cervico-facial divisions.
• The parotid acinar units and ductal
systems drain into a final secretory
duct known as the Stensen duct
 PHYSIOLOGY

• Saliva is 99.5% water and the

remainder proteins and
electrolytes
• Parotid gland secretion is
proteinaceous, watery, and
serous and is the predominant
saliva that is stimulated.
• Gustatory and olfactory
stimulation induce
predominantly parotid
secretion
 PHYSIOLOGY
• Saliva is 99.5% water and the
remainder proteins and
electrolytes
• Parotid gland secretion is
proteinaceous, watery, and
serous and is the predominant
saliva that is stimulated.
• Gustatory and olfactory
stimulation induce
predominantly parotid
secretion