False diagnosis caused by Warthin tumor of the parotid gland combined with actinomycosis

Rare Diseases of the Salivary Glands and of Facial Nerve

Salivary gland diseases are rare. In the European Union (EU) a disease is considered to be rare if not more than 5 of 10,000 people are affected by it. According to estimates in Germany are about 4 million people with a rare disease. In the EU are about 30 million people with rare diseases [1]. In the present work most of the described diseases of salivary glands and of the facial nerve fall in this category. They form a very heterogeneous group whose treatment takes place mainly in specialized centers. Still, it is essential for the otolaryngologist to identify and to diagnose these diseases in order to initiate the right therapeutic steps. The work is a compilation of innate andacquired rare salivary gland disorders and of rare facial nerve disorders. The etiologies of inflammatory diseases, autoimmune disorders and tumors are taken into account. For the individual topics, the current literature, if available, was evaluated and turned into summarized facts. In this context the development of new processes, diagnostics, imaging and therapy are considered. Genetic backgrounds of salivary gland tumors and the trends in the treatment of tumorous lesions of the facial nerve are picked up. Furthermore, also rare diseases of the salivary glands in childhood are described. Some of them can occur in adults as well, but differ in frequency and symptoms. Due to the rarity of these diseases, it is recommended to tread these in centers with special expertise for it. Finally, the difficulties of initiation of studies and the problems of establishing disease registries concerning salivary gland disorders are discussed. This is very relevant because these pathologies are comparatively seldom.

Benign parotid mass and facial palsy: systematic review

INTRODUCTION

Parotid masses causing facial palsy are highly indicative of malignancy. A significant number of cases describing benign parotid disease causing facial palsy have been reported.

MATERIALS AND METHODS

We performed a systematic review of the literature to establish the aetiology, clinical features, investigations and management undertaken during these presentations to assess how these factors differed from malignant presentations and to establish an evidence-based algorithm for their management.

RESULTS

A total of 85 cases were identified from 78 articles. Cystadenolymphomas were the most common histopathological type (p = 0.034). Mean facial palsy recovery duration in neoplastic aetiology was longer than for infective aetiology (p = 0.033). A significant association existed between uncommon infective organisms and development of facial palsy (p = <0.0001).

CONCLUSION

Uncommon benign aetiologies are associated with facial palsy. Investigations and management should be guided by patients' clinical presentations, avoiding excessive treatment. Complete facial palsy recovery rates are high, although not immediate.

Actinomycosis Presenting as Macroglossia: Case Report and Review of Literature

Cervicofacial actinomycosis is a common form of Actinomyces infection. However, the latter seldom occurs in the tongue. We present a case of a 66 year-old man with macroglossia caused by actinomycosis of the tongue. Radiographic features were compatible with a chronic inflammatory disease. Biopsies revealed granulomas containing giant cells and Gram positive bacterial clusters consistent with actinomycosis. The patient was treated with a 22 week course of antibiotics. Imaging showed a notable improvement in the extent of the lesions 1 year later. The patient was asymptomatic and in good condition during his second year follow-up. Diagnosis of actinomycosis of the tongue can prove to be challenging because of the non-specific nature of its symptoms, clinical signs, and radiographic features. Isolation of Actinomyces sp. is an added diagnostic hurdle, because of its fastidious nature.

Modified Procedure for Secondary Facial Rehabilitation Following Total Bilateral Irreversible Peripheral Facial Palsy

We present the case of a middle-aged gentleman who developed total bilateral irreversible peripheral facial palsy over a period of 10 years, starting with palsy of the marginal mandibular and buccal branches of the facial nerve and progressing to the zygomatic and temporal branches. The patient did not develop any other neurological symptoms, and all neurological and other tests have remained negative over the last 10 years. Dripping of saliva and inability to close the mouth necessitated reanimation of the perioral region with the help of a fascia lata graft fixed to the fascia of the masseter muscles. The increasing lagophthalmos and associated eye problems were alleviated with a temporal muscle transposition combined with a lengthening procedure using the temporal fascia, passed through the upper and lower eyelids and hooked around the medial canthal ligament. The fascia strips were sutured not to the canthal ligament itself, but to each other, thereby placing equal self-adjusted tension on the upper and lower eyelids. Both operations were successful and improved eating and eye closure functions, allowing resolution of the eye symptoms.

Extensive actinomycosis of the face requiring radical resection and facial nerve reconstruction

We present a case of extensive actinomycosis of the face, which appeared after dental surgery. Since antibiotic therapy was ineffective, the lesion was radically resected, and the skin, soft tissue and facial nerve were reconstructed using a free rectus abdominis musculocutaneous flap and simultaneously harvested intercostal nerves. Successful reanimation of the face was achieved 14 months postoperatively.