The presence of two histologically distinct lesions within the same salivary gland is rare. The majority of lesions detected in salivary glands are benign and unifocal. Ultrasound scans and MRI imaging may not detect separate lesions that are in close proximity and this presents a challenge for radiologists and surgeons in the diagnosis of salivary gland lesions. We present a case when incidentally two distinct lesions were discovered during extracapsular dissection of a suspected pleomorphic salivary adenoma. We aim to highlight the difficulty in diagnosing these rare entities using existing investigative techniques.

Paediatric sialolithiasis is rare, with most sialoliths under 10 mm in their largest dimension and usually found in the submandibular gland. We present a case of a 25 mm parotid sialolith in a two-year-old boy. He presented to the emergency department with recurrent right-sided facial swelling and was admitted for management of suspected parotitis. An ultrasound completed the next day revealed massive dilatation of the right Stensen's duct throughout its length. After 24 h of intravenous coamoxiclav did not relieve symptoms, the patient was listed for examination under general anaesthesia. A 25 mm calculus was dissected from the right parotid duct alongside copious free-flowing pus, with follow-up showing normal healing. This case highlights the importance of not omitting this differential diagnosis in paediatric facial swelling, despite its rarity in children. InvestigationsThe ultrasound report showed a massive dilatation (approximately 7 mm) of the right Stensen's duct Oral Surgery 13 (2020) 135--138.

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