Painful buccal mass in a patient with bulimia nervosa

Abstract

Painless bilateral parotid swelling is a common occurrence in individuals with bulimia nervosa. The finding of a painful buccal mass in one such individual is thought to be attributable to her bulimic behavior and may represent an overlooked and, therefore, subsequently unreported complication of this condition. Theoretical mechanisms for buccal space involvement and parotid gland enlargement in bulimia are discussed.

Physiological Effects of Bulimia Nervosa on the Gastrointestinal Tract

“…Parotid gland: Binge-purge behaviour may cause bilateral or unilateral enlargement of the parotid gland and occasionally of the submandibular salivary glands. Some studies suggest that parotid enlargement is intermittent and painless (3,4,19,21); however, others have proposed that parotid swelling is irreversible (23) and painful (23)(24)(25)(26). Biopsies of the enlarged parotid gland have shown an increase in acinar size due to an increased number of secretory granules, fatty infiltration and fibrosis without inflammation (3,27).…”

“…Therefore, surgical excision was performed to exclude malignancy and improve drainage from the parotid gland. This is only one of the few cases of parotid swelling associated with pain (26). In another case of chronic bulimia, both parotid glands were surgically removed (23).…”

“…Parotid enlargement is a useful indicator in diagnosing and monitoring bulimia nervosa and it may eliminate unnecessary tests (14,21). Physicians should question patients about their eating behaviour if parotid swelling is unexplainable (21,26). Parotid hypertrophy may also occur in response to trophic stimuli released by the pancreas responding to stimuli or injury (33); therefore pancreatic pathology should be considered.…”