Left Parotid Gland Sialolith Spontaneously Expelled Cutaneously through the Cheek

Abstract

Sialolithiasis frequently occur in major salivary glands, with parotid and sublingual stones being least common. Etiology of parotid sialoliths is not clearly understood and can occur in individuals with no predisposing factors. Diagnosis involves clinical history and imaging which includes: X-ray, sialography, ultrasound, computed tomography or magnetic resonance imaging. Depending on location and size, minimally-invasive technique for removal of sialolith can be undertaken by basket retrieval via sialography or sialoendoscopy. Invasive methods include removal of sialolith close to Stenson duct opening by incising into the duct behind parotid papilla to avoid stenosis, combined surgical removal with sialoendoscopy for larger and deep-seated stone, or the excision of the parotid gland. We present a 28-year-old female with no underlying medical history, who developed recurrent left facial swelling caused by parotid sialadenitis and she required several courses of antibiotics. After diagnosis with ultrasonography, and whilst waiting for sialography and basket retrieval of a 6 mm sialolith, she developed acute obstruction with facial swelling, pain and yellow discharge from parotid duct. After a course of antibiotic over a 6-day period, her acute swelling subsided with spontaneous expulsion of the sialolith through the cutaneous surface of her left cheek. There was no evidence of facial nerve weakness, recurrent sialadenitis or sialolithiasis, or unsightly cutaneous scar 3 months after the incident. Most parotid stones come out into patients' mouth on their own. It is unusual for the evacuation of parotid gland stone through the overlying cutaneous route of the cheek after the consequence of an acute parotid gland infection close to the cheek skin.