Saliva Firing from Parotid Ducts
A 52-year-old woman presented with an 8-year history of painless swelling in both cheeks. She had no fever, dry mouth, or other systemic symptoms; her only concern was cosmetic. She had no history of parotid sialadenitis, allergies, rheumatologic disease, or facial trauma or surgery, aside from dental work for multiple caries. The physical examination was notable for nontender facial swelling along the course of the parotid (also called Stensenβs) ducts (Panel A). Compression of these areas caused profuse salivary discharge from the duct orifices bilaterally (video). The opening of the parotid duct is located adjacent to the maxillary second molar in the buccal (cheek) mucosa. Computed tomography of the neck showed dilatation along the course of the parotid duct bilaterally without an identified cause of obstruction (Panel B). Initially, the patient was treated with hydration, a sialagogue agent (pilocarpine), and massage; however, there was no reduction in the facial swelling. Parotidectomy was recommended, but the patient declined to undergo the procedure. She has not had any additional complications on serial follow-up evaluations.