Congenital salivary fistula of an accessory parotid gland in Goldenhar syndrome

Congenital Cheek Fistula: A Rare Case of Developmental Abnormality in the Buccal Area

A congenital cheek fistula is a rare malformation in the buccal area. Here, we report the case of a congenital cheek fistula in a 50-year-old woman who visited our clinic with complaints of swelling and pain in her left cheek. Physical examination revealed a small hole in the left corner of the mouth present since birth. She had no other congenital malformations in the maxillofacial region such as an accessory ear and cleft lip. Manual compression of the cheek mass induced serous discharge from the hole. Magnetic resonance imaging (MRI) showed a cystic lesion in the left cheek and a fistula within the orbicularis oris muscle that opened into the small hole. After immediate incision and drainage of the cyst, both the cyst and fistula were surgically resected. The cystic lesion was completely delineated from the boundary of the parotid gland. The orbicularis oris muscle was partially incised to remove the fistula and the surrounding scar tissue. Histopathological examination of the resected specimen revealed a cavity consisting of epithelium inside the fistula. The postoperative course was insignificant. No recurrence of the cyst was observed six months postoperatively. The operative and pathological findings demonstrated that the ectoderm-derived epithelial tissue was enclosed by the mesoderm-derived muscle tissue. The mixture of different germ layer-derived tissues suggested that the fistula was a type of congenital transverse facial cleft induced by malfusion of the mandibular and maxillary prominences during embryonic development. The differential diagnoses of the congenital cheek fistula included orocutaneous fistulas and salivary fistulas. MRI was useful in delineating the border between the lesion and the surrounding tissue.

Rare Diseases of the Salivary Glands and of Facial Nerve

Salivary gland diseases are rare. In the European Union (EU) a disease is considered to be rare if not more than 5 of 10,000 people are affected by it. According to estimates in Germany are about 4 million people with a rare disease. In the EU are about 30 million people with rare diseases [1]. In the present work most of the described diseases of salivary glands and of the facial nerve fall in this category. They form a very heterogeneous group whose treatment takes place mainly in specialized centers. Still, it is essential for the otolaryngologist to identify and to diagnose these diseases in order to initiate the right therapeutic steps. The work is a compilation of innate andacquired rare salivary gland disorders and of rare facial nerve disorders. The etiologies of inflammatory diseases, autoimmune disorders and tumors are taken into account. For the individual topics, the current literature, if available, was evaluated and turned into summarized facts. In this context the development of new processes, diagnostics, imaging and therapy are considered. Genetic backgrounds of salivary gland tumors and the trends in the treatment of tumorous lesions of the facial nerve are picked up. Furthermore, also rare diseases of the salivary glands in childhood are described. Some of them can occur in adults as well, but differ in frequency and symptoms. Due to the rarity of these diseases, it is recommended to tread these in centers with special expertise for it. Finally, the difficulties of initiation of studies and the problems of establishing disease registries concerning salivary gland disorders are discussed. This is very relevant because these pathologies are comparatively seldom.

Congenital Parotid Fistula: Surgical Management in Two Infants and Review of Literature

Congenital salivary gland fistulas are uncommon. They develop as a result of abnormalities of the first and second branchial arches. Operative and nonoperative methods of management have been described. We report two rare cases of congenital parotid fistula presenting to us in infancy that were managed surgically.

The ectopic accessory parotid system with congenital cheek fistula: An overview and current update

OBJECTIVE

This review attempts to provide a comprehensive, updated overview of the ectopic accessory parotid system (EAPS) from clinical and developmental perspectives and investigates its eligibility to be included in the oculo-auriculo-vertebral spectrum (OAVS).

REVIEW METHODS

Results of the keyword-based search in the PubMed/MEDLINE, Google Scholar, LILACS, and Cochrane Library were subjected to the given inclusion and exclusion criteria that corroborated with the definition of EAPS. Eleven records were shortlisted, their full texts studied and references cross-checked. Finally, 10 articles collectively describing 16 patients were considered for review.

RESULTS

The average age of presentation was 8.33 years, with 44% of the patients aged below 5 years. Boys were affected 1.67 times more. The cheek fistula was always unilateral, with marginal left predilection. About 94% of the patients were of East Asian descent, chiefly from China and India. Thirteen children had preauricular appendages, mostly ipsilateral, with occasional ipsilateral mandibular hypoplasia (25%). The ectopic parotid was anterolateral to the masseter, lateral to buccinator, and inferior to the Stensen duct. Complete surgical removal of the EAPS (intraoral approach) or transposing the fistula into the oral cavity formed the mainstay of treatment.

CONCLUSION

The EAPS is a rare craniofacial anomaly presenting with a saliva-draining cheek fistula, associated with ipsilateral preauricular appendages (microtia) and occasional mandibular hypoplasia. Speculative developmental theories suggest dysmorphogenesis of the first two pharyngeal arches, clinically and embryologically relating it with OAVS. This review summarizes the clinical aspects, and establishes isolated EAPS as a mild but discrete phenotype of OAVS irrespective of the presence of other congenital stigmata. Laryngoscope, 127:1351-1360, 2017.

Cheek fistula from the ectopic salivary gland: a variant of the oculo-auriculo-vertebral spectrum

OBJECTIVES/HYPOTHESIS

This study aimed to investigate the diagnosis and management of a distinct developmental deformity syndrome characterized by congenital cheek fistula, ectopic accessory parotid gland, and preauricular appendage.

STUDY DESIGN

Retrospective study.

METHODS

We analyzed the medical records, radiologic and histopathologic findings, and follow-up data for seven patients (four males) with a congenital cheek salivary fistula. Computed tomography, fistulography, and sialography had been performed for diagnosis. Surgical treatment effect was evaluated.

RESULTS

The mean age of the patients was 8.1 years (range, 2-16 years). The distinctive clinical feature was a congenital skin orifice lateral to the commissure with saliva discharge during eating. The cheek fistulae were accompanied by ipsilateral preauricular appendages in all seven patients. The skin orifice connected to an ectopic gland anterior to the masseter and inferior to Stensen's duct. Parotid sialography demonstrated an intact Stensen's duct in all cases. Hypoplasia of the ipsilateral mandible could be observed in five cases. Excision of the ectopic gland, skin orifice, and fistula was performed in five cases resulting in optimal treatment outcomes with no recurrent or adverse events.

CONCLUSIONS

A congenital saliva-discharging fistula with an ectopic accessory parotid gland, ipsilateral preauricular appendage, and mandibular hypoplasia constitutes a rare developmental syndrome. Surgical excision can effectively treat congenital cheek salivary fistula.

LEVEL OF EVIDENCE

4.