Postoperative infection of the skull base surgical site due to suppurative parotitis:A case report

BACKGROUND Paraganglioma occurring at the lateral skull base is a rare tumor.Surgery is the primary treatment of benign paragangliomas.Postoperative infection of the surgical site at the lateral skull base is very dangerous and hard to manage.CASE SUMMARY A 30-year-old man with a 1-year history of left-side progressive hearing loss,tinnitus,facial palsy,and choking failed conventional treatment and is the focus of this case report.Imaging revealed a mass around the left jugular foramen that was approximately 47 mm×38 mm×34 mm in size and had eroded the bone of the vertebral and horizontal segments of the internal carotid artery.The tumor breached the meninges and occupied the cerebella pontine region.A two-stage surgery was designed for the resection of the mass.In the first-stage,the epidural portion of the mass was removed.The abdominal fat and the temporal muscle flap were transposed within the surgical site.The surgery was successful;however,25 d after surgery,he developed suppurative parotitis,and the infection spread to the surgical site at the skull base.Broad-spectrum antibiotics were used,and debridement was deployed.After that,the wound was cleaned daily.Five months after the first-stage surgery,the wound was still unclosed,and there was intermittent purulent exudation within the surgical site.vacuum sealing drainage(VSD)was used,and the wound healed in a month.One year after the first surgery,the second-stage of the operation was performed to remove the intracranial portion of the tumor.Recurrence of the tumor was not detected after a 6-month follow-up.CONCLUSION After a lateral skull base surgery,suppurative parotitis can spread into the operative cavity leading to infection of the surgical site.VSD can help to effectively heal the infected wound.A two-stage surgical approach offers a safer option for removing the lateral skull base paraganglioma that involves the meninges.

Recurrent Parotitis: Extrapulmonary Manifestation of Childhood Tuberculosis

Recurrent parotitis of childhood is a rare condition involving the largest salivary gland. The aetiology is multi-factorial and is usually non-obstructive or non-suppurative type of inflammation. It involves recurrent swelling of the parotid gland unilaterally or bilaterally over a period of months to years. Tuberculosis rarely involves the parotid gland, however in developing countries where tuberculosis prevalence is very high, any child with recurrent parotitis should be investigated for the same. We hereby, describe a 2 and half-year-old female child with recurrent parotid gland swelling below the right ear since 6 months. The swelling was acute in onset, gradually increasing in size with no discharge or pain. There was no history of fever, cough, cold, dryness of mouth or eyes, joint pain or rashes. There was history of koch’s contact in the maternal grandfather. A positive mantoux test and significant cervical lymphandenaopathy on Computed Tomography scan was noted. Common causes of recurrent parotitis, i.e. sjogrens syndrome, immunodeficiency and obstruction were ruled out. On the basis of the above history and investigations, the child was diagnosed as tuberculous parotitis.

A Rare Case of Suppurative Parotitis with Facial Nerve Palsy

Parotid mass causing facial nerve palsy is rare, and is associated with malignant tumours. Acute infection or abscess leading to facial nerve palsy is an extremely rare complication. A literature review revealed only 16 cases of facial nerve palsy associated with suppurative parotitis or parotid abscess. We present a case of deep parotid abscess which is complicated by facial nerve dysfunction.

Effects of Huangqi and bear bile on recurrent parotitis in children:a new clinical approach

Objective:To evaluate the pharmacological effects of traditional Chinese medicine,bear bile capsule and Huangqi granule,on recurrent parotitis in children.Methods:In this prospective,controlled,and randomized study,a total of 151 young children were divided into three groups:Group A included massaging the children's parotid region and melting vitamin C in their mouth daily;Group B included swallowing bear bile capsule and Huangqi granule daily;and Group C included massages and vitamin C as prescribed in Group A,and traditional Chinese medicine as prescribed in Group B.Children were treated individually for one month and then a follow-up study was conducted for 1 to 3.5 years.Analysis of variance(ANOVA) and Ridit analysis were employed for statistical analysis.Results:The recurrence rate decreased in every group,but was significantly more in Groups B and C when compared to Group A.The recurrences significantly decreased(P<0.01) in Group B and their recovery rate was as high as 63%,significantly better than those of the other groups(P<0.01).Conclusions:Huangqi and bear bile could be a novel clinical approach for treating recurrent parotitis in children.

Potassium Dehydroandrographolide Succinate Injection for the Treatment of Child Epidemic Parotitis:A Systematic Review and Meta-Analysis

Objective： To systematically evaluate the clinical efficacy and safety of Potassium Dehydroandrographolide Succinate Injection （PDSI） in the treatment of child epidemic parotitis （EP）. Methods： Randomized controlled trials （RCTs） regarding PDSI in the treatment of child EP were searched in China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database, PubMed, and Cochrane Library from inception to July 30, 2013. Two reviewers independently retrieved RCTs and extracted information. The Cochrane risk of bias method was used to assess the quality of included studies, and a meta- analysis was conducted with RevMan 5.2 software. Results： A total of 11 studies with 818 participants were included. The quality of the studies was generally low, among which only one study mentioned the random method. The meta-analysis indicated that PDSI was more effective than the conventional therapy with Western medicine for EP in the outcomes of the total effective rate [relative risk （RR）=1.23, 95% confidence interval （CI） [1.14, 1.33], P〈0.01], the time of temperature return to normal, the time of detumescence [mean difference （MD）=-2.10, 95% CI [-2.78, -1.41], P〈0.01], and the incidence of complications （RR=0.14, 95% CI [0.03, 0.72], P=0.02）. There were 6 adverse drug reactions （ADRs） in this systematic review, 2 of which were mainly represented rash and diarrhea in the experiment group, while another 4 ADRs occurred in the control group. Conclusions： Based on the systematic review, PDSI was effectiveness and relatively safety in the treatment of child EP. But further rigorously designed trials are warranted to determine its effectiveness.

Role of ranulas in early diagnosis of Sjögren’s syndrome: A case report

BACKGROUND Although the presentations of Sjögren’s syndrome(SS)are variable,ranging from mild dryness to wider systemic involvement,ranulas as early clinical signs were scarcely reported.Here,we present an adult patient with SS,who developed a unilateral simple ranula and was diagnosed primary SS 3 years later.We also provide a review of cases of SS and ranulas from 1980 to 2020.CASE SUMMARY A 22-year-old girl was found to have a left painless floor-of-mouth lesion 3 years ago,without obvious trauma or inducement.The diagnosis of a unilateral(left)simple ranula was made,and the ranula was surgically treated.Within 3 years after the ranula surgery,she developed acute lymphadenectasis in unilateral parotid twice without inducement,and ultrasonic examination revealed diffuse lesions in bilateral parotids and submandibular glands,which strongly suggested SS.Serologic tests and the unstimulated whole saliva flow rate confirmed the SS diagnosis.CONCLUSION Our study underlines that ranulas are early clinical signs of SS.As early diagnosis and early intervention of SS are important to obtain better outcomes,our findings underline the need for histopathological test after sublingual adenectomy and imaging detection of exocrine glands for the patients with ranulas.