Solitary cysts of the parotid

Abstract

Gordon Museum, Guy's Hospital, London SEl 9RT, UK Correspondence tor Mr J. 0. Maynard Cystic changes in the parotid gland are found occasionally in long-standing parotid obstruction. The cysts are multiple and usually < 0.5 cm in diameter. Lymphangiomas occur occasionally in children and are obvious at operation. Solitary cysts in otherwise normal glands are rare but are more commonly seen in the parotid than the submandibular salivary gland. They account for 2-5percent of all parotid masses or spaceoccupying lesions'. Because cystic degeneration occasionally occurs in salivary neoplasms, all solitary cystic lesions in the parotid were widely excised after nerve dissection. The results of this policy are presented. Clinical descriptionSince 1967 a personal series of 324 parotidectomies was carried out for parotid masses. A parotid mass was defined as a probable cyst if it was obviously fluctuant on clinical examination and the diagnosis confirmed if it was clearly a cyst at operation. Twenty-four solitary cysts were widely excised during this period, an incidence of 7.4 per cent. In ten cases the histology showed the cyst to be a neoplasm-a surprisingly high incidence of nearly 42 per cent ( Table 1). Included among the non-neoplastic cysts were two large solitary cysts measuring 8 and 10 cm arising below the parotid and extending deep to the gland. They were thought on histological examination to be branchial cysts of second branchial cleft origin'. Three smaller cysts between 2 and 4 cm diameter lying in the central part of the parotid deep to the facial nerve and lined with squamous stratified epithelium were perhaps of first branchial cleft origin',3.The four cysts, classified as dermoid cysts, had arisen in the lower pole of the parotid and one on the anterior border and ranged between 1 and 2 cm in diameter.The neoplastic cysts were indistinguishable from the other cysts both clinically and at operation. Those that were pleomorphic adenomas had undergone central cystic degeneration. One measured 8 x 6 cm, was deep to the facial nerve and extended deeply behind the oropharynx. It had been explored abroad and left intact. It had the appearance of a thin-walled branchial cyst containing milky fluid. It was uncertain on histological examination whether it was a monomorphic or pleomorphic adenoma. One of the adenolymphomas was in the central part of the parotid; it had been repeatedly aspirated elsewhere and cytology had failed to demonstrate the presence of a neoplasm. The squamous cell carcinoma was a 1-cm plaque on the wall of a 4-cm thinwalled cyst. The four pleomorphic adenomas and the two carcinomas were followed up for a maximum of 15 years without recurrence.There were few complications of the operations. One patient with an infected probable first cleft branchial cyst has permanent weakness of the lower lip. A branch of the lower division of the facial nerve was closely adherent to the cyst wall and partly divided and then sutured. The remaining patients had no late detectable weakness of the facial ner...

Benign lymphoepithelial cyst of parotid gland: Review and case report

“…Also, the greatest problem related to the LEC in HIV-positive patients seems to be the progression to a lymphoma, which increases the responsibility for HIV infection investigation, as in the present case. [ 8 14 15 ]…”

Infected Parotid Cyst- A Case Report with Review of Literature

“…CT and MRI provides clear image of the lesion and reveal intraparotid cystic masses 9 . Management of such lesions should be superficial parotidectomy when a conservative approach cannot safely remove the lesion 10 .…”

A Rare Case of Parotid Cyst

“…The age and clinical symptoms of present case were found to be consistent with the literature. (5,14) Besides that, aspiration was particularly useful in identification of the nature of the cystic content. (6,4) The aspirate was usually clear watery or straw colour fluid.…”

“…However to this day the controversy still exists and at least four theories have been put forward to explain the origins of branchial cysts, which are 1) Branchial apparatus theory 2) Cervical sinus theory 3) Thymus-pharyngeal duct theory 4) Inclusion theory. (5,14,9,13) The first two theories are also known as classic theory holds that the cysts develop from the remnants of the branchial cleft because it occurs in the area of the embryonic gill apparatus. (4) However for this present case, the inclusion theory or so called recent theory would seem the most feasible explanation for the lymphoepitelial cyst which was found in the parotid gland.…”

“…(13) The pre-operative diagnosis of this case remains uncertain as the nature and clinical symptoms resemble the other cystic lesions of the parotid such as retention cysts, extravasation cysts or cystic degenerative salivary gland tumour. (5,14) In which the latter will affect the choice of the treatment. The investigations are important in diagnosis and treatment planning of these lesions as the clinical examination may not always confirm the cystic nature of the lesions.…”