Parotid sialolithiasis in a two-year-old boy
A 2-year-old male patient was referred from a local clinic complaining of painful swelling in the right parotid area and low grade fever. He had no past medical history except for the treatment of his right parotitis at the local clinic 2 weeks before. At that time, he had suffered from painful swelling in the same right parotid area for 5 days, which was relieved the next day after the oral antibiotic was switched.\nOn admission, extraoral examination revealed a broad area of swelling in the right parotid area with indurated overlying skin that was warm and tender to the touch. Intraorally, a solid mobile formation was revealed near the right parotid duct opening on palpation, possibly the calculus, as well as pus discharge at the duct opening on pressing.\nA CT scan of the neck was performed, which showed an asymmetric enlargement and heterogenous enhancement in the right parotid gland () and two oval sialoliths located near the orifice of the right Stensen's duct (), suggesting acute suppurative parotitis with duct sialolithiasis.\nOn laboratory test, leukocytosis (white blood cells, 17,200/µL) and elevated C-reactive protein (1.54 mg/dL) were observed. The amylase (42 U/L) level was within the normal range and the IgG/IgM antibodies of mumps virus were negative. The total serum calcium (10.3 mg/dL) level was within the normal range and the Mantoux test was negative.\nAbdominal sonography showed no calculus in the regions of the gall bladder, kidneys, pancreas and other parts of the abdomen.\nMedical treatment was initiated immediately with analgesic-anti-inflammatory drugs and intravenous antibiotics. The pus was drained daily by means of dilating and milking the duct orifice with a lacrimal probe.\nOn the third day of hospitalization, the swelling and fever began to subside. As the calculi were located near the duct orifice, and the patient continued to complain of colicky pain, we planned their surgical removal by an intraoral approach. A simple sialolithotomy was performed with no invasive incision, because the calculi were just beneath the duct orifice that had become enlarged due to the drainage of pus. Appropriate pressure on the duct orifice was on its own satisfactory to retrieve the calculi and purulent discharge.\nThe calculi had irregular borders and a yellowish color. The fusiform-shaped one measured about 6 mm×2 mm in size and the rather ovoid-shaped one measured around 3 mm×3 mm (). Culture of the drained pus grew α-hemolytic streptococci, while the blood culture was sterile.\nThe patient was kept on parenteral antibiotics for 4 days and switched to an oral alternative when discharged from the hospital. On one week follow-up, the swelling was almost normalized without any further problems and the patient was prescribed 3 additional days of oral antibiotics.