Unexpected pathologies in pediatric parotid lesions: Management paradigms revisited

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Conference Proceeding

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Educational Objective: At the conclusion of this presentation, the participants should be able to discuss the management of persistent pediatric parotid masses and explain the role of surgery as a diagnostic and therapeutic tool for these lesions. Objectives: To present case vignettes of unusual parotid pathologies and discuss management paradigms in the context of these lesions. Study Design: Retrospective case series. Methods: Five consecutive patients over the past 18 months undergoing parotidectomy for a parotid neoplasm, each with an unusual pathology, were reviewed. Results: Ages ranged from 17 months to 16 years. All presented with a remarkably similar clinical course, consisting of a mostly painless, persistent parotid mass for more than 3 months. Most (4/5 patients) had been treated with antibiotics prior to otolaryngology consultation. Fine needle aspiration (FNA) was performed on 3 patients and was diagnostic in one. Complete excision was performed in each child through a parotidectomy approach (3 total, 2 lateral lobe). The final pathology consisted of metastatic neuroblastoma (17 mos. old), undifferentiated primitive sarcoma (22 mos. old), mucoepidermoid carcinoma (11 years old), nodular fasciitis (12 years old), and hyperplastic lymph node (16 years old). The patient with neuroblastoma died. Conclusions: The differential diagnosis for a persistent pediatric parotid mass is expansive. In most cases it is impossible to discern the pathology, or rule out malignancy, based upon the clinical course, imaging, or FNA results. Excisional surgical management remains the gold standard diagnostic and therapeutic tool for most patients. Our anecdotal case series highlights the importance of having a low threshold for parotidectomy in these children. Copyright © 2010 The American Laryngological, Rhinological, and Otological Society, Inc.

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