Pediatric salivary gland lesions

Pediatric primary salivary gland tumors

OBJECTIVES

To characterize the presentation and treatment of children presenting with primary salivary gland neoplasms.

METHODS

A retrospective review of primary salivary tumor patients presenting to Children's Hospital Colorado between January 2000 and August 2020.

RESULTS

Fifty children were identified with primary salivary gland tumors, comprising of 39 (78 %) benign and 11 (22 %) malignant lesions. Pleomorphic adenoma was the most common benign tumor (36/39, 92 %), while acinic cell carcinoma was the most common malignancy (7/11, 64 %). The parotid gland was the most common site, followed by the submandibular gland (66 % vs. 34 %). No tumors were found in the sublingual glands. Benign neoplasms accounted for 70 % of parotid lesions and 94 % of submandibular tumors. No significant differences in age (13.6 years, SD 4 vs. 13.0 years, SD 4.3) were noted between patients with benign and malignant disease, but tumors in females were more frequently malignant (M:F 1:1.3 vs. 1:2.7 for benign and malignant tumors, respectively). Neck dissection and/or facial nerve sacrifice were required in 27 % (3/11) and 9.1 % (1/11) of malignancies, respectively. Local recurrence was observed in 7.7 % (3/39) of benign cases and 9.1 % (1/11) of malignant cases. No salivary malignancies required chemotherapy, though one patient with neurofibromatosis received imatinib prior to resection. Two patients with locoregional malignancy received adjunctive radiation. The average duration of follow up for benign and malignant disease were 12.6 ± 25 and 45.1 ± 32 months, respectively.

CONCLUSIONS

This study presents one of the larger single institutional experiences of pediatric primary salivary neoplasms in the past 20 years, identifying pleomorphic adenoma and acinic cell carcinoma as the most common benign and malignant etiologies, respectively. While this review found most neoplasms presented as a localized mass effectively managed with conservative surgical resection, aggressive tumors required multidisciplinary care.

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.

Oral mucosal calcified nodule requiring palatoplasty

Calcinosis cutis describes a condition of pathologic calcium deposition in the dermis. Several subtypes exist, including the subepidermal calcified nodule. The oral mucosal calcified nodule (OMCN) was posited in 1992 as a specific term for a subepidermal calcified nodule occurring in the oral cavity, and since that time only six such lesions have been described in the literature. This report explores a case of OMCN on the palate of a 3-month-old infant with the goal of supplementing extant literature, providing a consideration of the differentials of palatal lesions in the pediatric population, and describing a unique instance in which OMCN resulted in a full-thickness defect requiring palatoplasty for repair.

Computed tomography and magnetic resonance imaging in pediatric salivary gland diseases: a guide to the differential diagnosis

Salivary gland pathologies in children are frequent, particularly viral infections, but rarely need cross-sectional imaging. However, when a mass involves the salivary spaces (primarily or as a secondary invasion from other neck spaces) it may pose problems in the differential diagnosis and in immediate management. Infrequently, systemic autoimmune diseases can also involve the salivary parenchyma in children and correctly interpreting the constellation of findings in the whole body is critical for the diagnosis. Distinguishing between cystic and solid masses is the first step for radiologists in order to narrow down the diagnosis. Location and spatial extension are the most important elements differentiating cystic masses, while signal characteristics, internal structure and local invasion help in the differential diagnosis of solid masses.

[Pediatric salivary gland tumors and tumor-like lesions]

Salivary gland tumors and tumor-like lesions in the pediatric population are uncommon. They comprise a heterogeneous group of infectious/inflammatory and neoplastic conditions. Pediatric salivary neoplasms include benign tumors of mesenchymal or epithelial origin as well as malignancies of epithelial (carcinomas), mesenchymal (sarcoma) or hematolymphoid (lymphoma) derivation. Infectious/inflammatory conditions and hematolymphoid malignancies may represent either genuine parenchymal pathology or conditions involving intraglandular lymph nodes of the parotid glands (intraglandular lymphadenopathy and intraglandular nodal lymphomas). Pediatric sialadenitis may be of diverse etiologies including viral (mumps, CMV, HIV, etc.), bacterial, autoimmune (juvenile Sjögren syndrome) or idiopathic (chronic recurrent juvenile sialectatic sialadenitis). Angiomatous lesions (juvenile capillary hemangioma, lymphangioma and vascular malformation) and pleomorphic adenomas represent the most common pediatric benign mesenchymal and benign epithelial tumors, respectively. The vast majority of salivary gland carcinomas in children and adolescents represent low-grade mucoepidermoid carcinomas followed by acinic cell and adenoid cystic carcinomas (together >80% of carcinomas). Other malignant neoplasms include (rhabdomyo-) sarcomas, malignant lymphomas and very rarely sialoblastomas. This long differential diagnosis list of etiologically and biologically highly heterogeneous entities, their shared clinical presentation as "salivary gland enlargement" and the significant differences in their therapeutic strategies and prognosis underline the need for careful assessment to identify the correct diagnosis. Diagnosis is mainly based on a set of typical clinical and imaging features, serological/microbiological findings and, in selected cases, histomorphological characteristics in biopsy specimens.

Paediatric Neck Lumps I – Inflammatory and Neoplastic Lesions Including Salivary Gland Abnormalities

This article will concentrate on solid neck masses in children, giving an overview of 3 main areas: cervical lymphadenopathy, neoplasms presenting as neck masses and salivary gland abnormalities in children. Most neck lumps in children are benign, even solid masses and the child's age is an important factor in narrowing the differential diagnosis. Inflammatory lesions are very common, especially in young children and usually involve lymph nodes, but infected congenital cystic lesions can mimic inflammatory processes. The most common inflammatory masses are reactive or suppurative lymphadenitis, which classically present following an upper respiratory tract or pharyngeal infection. Malignant lesions are seen occasionally and it is important to know when to be concerned about a child's neck mass. Malignant lesions tend to be painless, solid and associated with systemic manifestations. Ultrasound is the primary imaging modality of choice for children, but does have limitations. It is vital that all imaging is interpreted in conjunction with clinical information, especially as imaging findings can be non-specific. Any lesion that does not have typical benign appearances or behaviour requires biopsy. Salivary gland disorders are uncommon in children compared with adults; salivary calculi, autoimmune disorders and tumours are rare. The most frequent cause of parotid swelling in a child is infection, usually viral, although intra-parotid lymph nodes can suppurate resulting in abscess formation. As with neck masses in other locations, certain factors in the clinical history should raise the possibility of malignancy and prompt further investigation, including biopsy. These include rapid growth, facial nerve palsy and associated lymphadenopathy.

Pediatric salivary gland carcinomas: Diagnostic and therapeutic management

OBJECTIVES/HYPOTHESIS

To analyze clinical presentations, treatment modalities, and evolution of pediatric cases of salivary gland carcinomas to standardize care for these rare diseases.

STUDY DESIGN

Multicentric, retrospective study.

METHODS

We included in this retrospective study all children and adolescents (aged ≤18 years) treated from 1992 to 2012 in six pediatric centers in Paris, France. Pathological tumor specimens of these cases were reviewed.

RESULTS

Forty-three children were included (sex ratio male/female = 19/24, median age = 13 years). The parotid gland was the most common (37 cases) location for tumors. Histological subtypes were mucoepidermoid carcinomas (n = 20), acinic cell carcinomas (n = 14), and other (n = 9). Initial fine-needle aspiration was performed in 15 cases (33%), and was concordant to final diagnosis in three cases (20%). Primary surgery was performed in 42 patients, leading to a complete microscopic resection in 80%. Associated lymph node dissection was performed in 28 patients (homolateral: 27, bilateral: 1) and showed lymph node metastases in only two patients. One patient had distant metastases. Adjuvant irradiation was delivered to 11 patients (median: 60 Gy; range: 50-65) and chemotherapy in five cases. After a median follow-up of 5 years, six tumors relapsed, but no deaths occurred.

CONCLUSIONS

Childhood salivary gland carcinomas have a good prognosis despite possible recurrences. Treatment is mainly based on surgery, with simultaneous node dissection in cases of clinical or radiologic node enlargement. Radiation therapy seems to be restricted to inoperable high-grade tumors or after recurrence.

LEVEL OF EVIDENCE

4 Laryngoscope, 127:140-147, 2017.

Actinomycosis arising from the nasal cavity, with rare fatal progression

Actinomycosis is a common treatable disease caused by Actinomyces, and generally has a good prognosis. However, we report a fatal case of actinomycosis of the nasal cavity. A 54-year-old man, reporting of left nasal obstruction, swelling and sharp pain around the root of the nose, was referred to our hospital. Histopathological examinations led to a definitive diagnosis of actinomycosis, and oral antibiotics were administered in an outpatient setting. However, the patient discontinued follow-up at the outpatient clinic because of the adverse effects of intravenous delivery, and poor compliance with oral antibiotic therapy led to him receiving a less than adequate dose. Thus, in the absence of sufficient antibiotic treatment, necrosis gradually progressed in the lesion, and the patient died of multiple organ failure and disseminated intravascular coagulation caused by local infection.

Disorders and tumors of the salivary glands in children

Salivary gland neoplasms are rare in children. In infants most tumors are benign hemangiomas, with some notable exceptions, such as sialoblastomas. An asymptomatic swelling in the periauricular region is the most common presenting complaint in older children. Approximately 50% of these lesions are malignant, which dictates a thorough diagnostic evaluation by a head and neck surgeon. Surgical excision is the primary treatment modality. Prognosis is primarily determined by histopathologic findings. This review discusses neoplastic lesions of the salivary glands in children, and malignant epithelial tumors in particular.

Tumors in the parotid are not relatively more often malignant in children than in adults

INTRODUCTION

Tumors of the parotid gland in children are rare and very little data has been published regarding the incidence of these tumors. We present a nationwide survey on this topic.

METHODS

Data regarding benign and malignant tumors in the parotid gland in children from January 1st, 1990 to December 31st, 2005 in Denmark was collected retrospectively from nationwide registries. This generated 61 patients for inclusion in this study.

RESULTS

85% of the tumors were benign and the malignant tumors made up the last 15%. The most common of the malignant tumors was the acinic cell carcinoma (n=4) followed by the mucoepidermoid carcinoma (n=3) and adenoid cystic carcinoma (n=2). The overall female-to-male ratio was 1.18, with a ratio of 1.08 and 2.0 in the benign and malignant groups, respectively. At the end of follow-up (August 1st, 2014) two patients had died, one with adenoid cystic carcinoma and one with mucoepidermoid carcinoma. Both patients had perineural invasion and involved resection margins at presentation. The incidence was 0.12 and 0.53 per 100,000 children of the malignant and benign tumors, respectively.

CONCLUSION

Pleomorphic adenomas were the predominant neoplasm in the parotid gland in children. The most frequent of the malignant tumors was the acinic cell carcinoma, which is in contrast to previous studies. The proportion of malignant-to-benign parotid gland tumors is in contrast to earlier study reports not higher in children than in adults.

Salivary gland diseases in children

Salivary gland diseases in children are rare, apart from viral-induced diseases. Nevertheless, it is essential for the otolaryngologist to recognize these uncommon findings in children and adolescents and to diagnose and initiate the proper treatment.

The present work provides an overview of the entire spectrum of congenital and acquired diseases of the salivary glands in childhood and adolescence. The current literature was reviewed and the results discussed and summarized.

Besides congenital diseases of the salivary glands in children, the main etiologies of viral and bacterial infections, autoimmune diseases and tumors of the salivary glands were considered. In addition to the known facts, new developments in diagnostics, imaging and therapy, including sialendoscopy in obstructive diseases and chronic recurrent juvenile sialadenitis were taken into account. In addition, systemic causes of salivary gland swelling and the treatment of sialorrhoea were discussed. Although salivary gland diseases in children are usually included in the pathology of the adult, they differ in their incidence and some­times in their symptoms. Clinical diagnostics and especially the surgical treatment are influenced by a stringent indications and a less invasive strategy. Due to the rarity of tumors of the salivary glands in children, it is recommended to treat them in a specialized center with greater surgical experience.

Altogether the knowledge of the differential diagnoses in salivary gland diseases in children is important for otolaryngologists, to indicate the proper therapeutic approach.

Mucoepidermoid carcinoma of the palate in a 5-year-old girl: case report and literature review

BACKGROUND

Minor salivary gland tumors in children are uncommon. However, despite the low overall incidence, there is a high incidence of malignancy in these young patients which is reported to be above 50 %, with mucoepidermoid carcinoma (MEC) predominating. We hope that this case report will contribute to the enlightenment of the behavior and prognosis of pediatric MEC of palatal minor salivary gland tumors.

CASE REPORT

A 5-year-old girl was admitted to our center with a histologically confirmed MEC of the left hard palate. Primary incision for drainage of a supposed abscess and secondary biopsy had been performed elsewhere 14 days before. After further workup, we excised the tumor and the adjacent bone; clear margins of 10 mm were revealed. Adjuvant therapy was not necessary. The defect was allowed to undergo secondary wound healing. As of the 1-year follow-up, there had been no recurrences.

CONCLUSION

For differential diagnosis, MEC should be considered in cases of soft, slow-growing, painless, pale bluish-purple lumps of the palate even in young patients. Especially for nonresponders to initial treatment, early biopsy is recommended for histological confirmation or exclusion of a minor salivary gland tumor.

Salivary gland neoplasms in children

PURPOSE

Salivary gland neoplasms in pediatric population are extremely rare. The aim of the present study was to determine the clinicopathologic characteristics of salivary gland neoplasms in patients younger than 19 years at our institution.

METHODS

During a 38-year period, a total of 119 pediatric patients met the diagnosis of epithelial salivary gland neoplasms. Clinicopathologic parameters were reviewed.

RESULTS

There were 87 (73.1%) benign and 32 (26.9%) malignant neoplasms. The mean age of pediatric patients was 15.1 years. The male-to-female ratio was 1:1.25. One hundred thirteen cases occurred among patients not younger than 10 years. The highest frequency of epithelial salivary gland neoplasms was pleomorphic adenoma (70.6%). Mucoepidermoid carcinoma (16 cases) was the most common malignant tumor in the salivary gland, occupying 50.0% of the malignancies and 13.4% of all salivary gland neoplasms.

CONCLUSIONS

Salivary gland neoplasms in Chinese pediatric patients are rare. There is a female predominance. Most of the tumors occur among patients not younger than 10 years. The most common benign tumor is pleomorphic adenomas, and the most common malignant tumor is mucoepidermoid carcinomas.

A Rare Cause of Submandibular Swelling in a 12-year-old child: Pleomorphic Adenoma

Pleomorphic adenoma is rare in pediatric populations, where viral and congenital problems are the usual culprits responsible for submandibular masses. We report the case of a 12-year-old child who presented with a painless right submandibular mass that had developed over the course of 4 months. The patient denied fever, erythema, and edema. The mass was diagnosed as a branchial cleft cyst before complete excision was performed. The pattern and etiology of a pleomorphic adenoma in children differs from those in adults. In children, it requires prompt and correct diagnosis to keep morbidity and mortality at a minimum.

Epithelial salivary gland tumors in children: a twenty-five-year experience of 122 patients

OBJECTIVE

The purpose of this study was to evaluate our 25-year experience of pediatric salivary tumors.

METHODS

Patients less than 19 years old with a diagnosis of salivary tumor were identified at Oral-maxillofacial Head and Neck Tumor Center, China Medical University from 1987 to 2011.

RESULTS

122 patients were included in our study, 105 tumors were benign and 17 were malignant. The most common involved site was parotid gland, pleomorphic adenoma represented 91.4% in benign group, and mucoepidermoid carcinoma represented 47.1% in malignant group. All tumors in submandibular gland were benign. Warthin's tumor was diagnosed in one patient. In our follow-up, no regional recurrences occurred in patients without neck dissection. The 5- and 10-year overall survival rates of patients with malignant salivary tumors were 81.8% and 66.7% respectively.

CONCLUSIONS

Epithelial salivary tumor was rare, parotid gland was most common involved site, pleomorphic adenoma and mucoepidermoid carcinoma were the most common benign and malignant tumor respectively. The prognosis of patients with malignant salivary tumors was not very favorable.

A clinical analysis of nine new pediatric and adolescent cases of benign minor salivary gland neoplasms and a review of the literature

INTRODUCTION

Minor salivary gland neoplasms of epithelial origin are rare in children and adolescents and most are not well documented, except for a few small series and case reports. This study represents a retrospective clinical analysis of nine cases of benign epithelial salivary gland neoplasms accessioned over a 35-year period at the Louisiana State University School of Dentistry and combines the data with well-documented cases from the English-language literature.

METHODS

A retrospective clinical analysis of nine cases of benign epithelial salivary gland neoplasms was performed over a 35-year period at the Louisiana State University School of Dentistry and combined with data of well-documented cases from the English-language literature.

RESULTS

The nine benign salivary gland neoplasms in patients aged 19 months to 18 years accounted for 2.3% of the Louisiana State University School of Dentistry accessioned salivary gland tumors. These nine cases comprised eight pleomorphic adenomas and one cystadenoma. There were 40 cases in the literature, of which 34 were pleomorphic adenomas. Combining the data for the 42 pleomorphic adenomas resulted in a mean age of 12 years with a 2.8:1 female predilection. The hard palate and/or soft palate were the most common site (69.1%). The average duration and size was 2.1 years and 2.4cm, respectively. Bone involvement occurred in seven cases. Wide local excision was the treatment most often employed. Cases followed for two years or more had a recurrence rate of 13.0%. The remaining seven neoplasms in the combined data comprised myoepithelioma, cystadenoma and sialadenoma papilliferum.

CONCLUSIONS

A relatively long duration (2 years) of a submucosal mass in a minor salivary gland-bearing area with or without bone involvement occurring in a child or adolescent should raise the question of a possible salivary gland neoplasm. A pleomorphic adenoma is the most common benign salivary gland neoplasm in the first and second decade of life. Complete surgical excision affords the best chance of preventing recurrence for pleomorphic adenomas. The recurrence rate of pleomorphic adenomas with two or more years follow-up is 13.0%. Other types of minor salivary gland neoplasms are exceedingly rare and therefore data is sparse, precluding any valid conclusions.

Paediatric salivary gland cancer in Finland

OBJECTIVES

Worldwide, only 5% of all salivary gland tumours are reported in children and 35-50% of these are malignant. According to the Finnish Cancer Registry, 15 children were diagnosed with salivary gland cancer (SGC) during 1990-2009 in Finland. There are no previous studies available on the histopathology, treatment, and survival of patients with these rare malignancies in Finland.

METHODS

Retrospective patient and tumour data covering the past 20 years were retrieved from the five University Hospitals in Finland. Ten paediatric SGC patients with a median age of 14 years (range, 9-19 years) and with available adequate patient data were included. The series comprised four boys and six girls. Follow-up time varied from five months to 14 years.

RESULTS

Two patients had a history of a previous malignancy. The majority of cases had a parotid gland cancer (7/10), and mucoepidermoid carcinoma was the most common histological subtype (5/10). All patients presented with Stage I-II disease and were treated surgically with curative intent. One patient with a Stage I mucoepidermoid carcinoma of the parotid gland received postoperative radiotherapy. No recurrences were encountered and all patients were free of disease at the last follow up.

CONCLUSIONS

The individual treatment design for paediatric SGC should follow consistent treatment strategies. All patients in the present study had low-grade tumours with a favourable prognosis. Since paediatric SGC is infrequent worldwide, the diagnostics, treatment, and follow up should be centralized in multidisciplinary Head and Neck Centres.

Minor salivary gland mucoepidermoid carcinoma in children and adolescents: a case series and review of the literature

Introduction

Because well-documented cases of mucoepidermoid carcinomas that are of minor salivary gland origin and occur in children and adolescents have rarely been reported, little information regarding their clinical features and biologic behavior is available. This case report represents a retrospective clinical analysis of five minor salivary gland mucoepidermoid carcinomas accessioned from a 35-year period at the Louisiana State University School of Dentistry and combines the data with 15 well-documented cases from the English language literature.

Case presentation

The five mucoepidermoid carcinomas in patients from birth to 19 years of age accounted for 1.3% of the accessioned minor salivary gland neoplasms. There were an additional 15 well-documented cases in the literature. Combining the data for the 20 mucoepidermoid carcinomas resulted in a mean age of 13.5 years and a 2.3:1 female-to-male ratio. Collectively, the hard palate, soft palate, and hard palate/soft palate junction accounted for 85% of the cases. Thirty-five percent of the cases presented as a fluctuant submucosal swelling with surface color alterations. The average duration was five months, and bone involvement occurred in seven cases. A histologic grade of low to intermediate predominated (95%). Surgical removal was the treatment in all cases. Thirteen cases had adequate follow-up of three years or more, and recurrence was documented in only one case. There were no cases of death or metastasis in this series.

Conclusions

In children and adolescents, mucoepidermoid carcinomas have a female predilection and occur most commonly on the hard or soft palate or both. A fluctuant submucosal lump with a bluish color is a helpful diagnostic clue. The histologic grades of most mucoepidermoid carcinomas in the first and second decades of life are low and, to a lesser degree, intermediate. Complete surgical excision is the treatment of choice and results in a recurrence rate of less than 10%.

Pediatric parotid tumors: clinical review of 24 cases in a Chinese population

OBJECTIVE

To evaluate the incidence, types, and treatment outcomes of pediatric parotid tumors in Chinese population.

METHODS

Pediatric salivary gland tumors treated at Stomatolgy Hospital, of Wuhan University, from 1990 to 2010, were analyzed retrospectively.

RESULTS

One hundred and two patients 18 years old or younger were diagnosed as parotid mass, of which 24 (23.5%) were parotid tumors. Of these patients, 11 (45.8%) were benign and 13 (54.2%) malignant. Hemangioma was the most frequent no-epithelial tumor. The most common benign epithelial tumor was pleomorphic adenoma (63.6%), and the most common malignant epithelial tumor was mucoepidermoid carcinoma (38.5%), with both of them showing a female to male predominance. The most common treatment was parotidectomy (83.3%).

CONCLUSIONS

Although pediatric parotid masses are unusual, they can represent a variety of pathological diagnoses, including malignancy. The intralesional injection can treat parotid hemangiomas in pediatric population effectively. Parotidectomy remains the mainstay treatment for both pediatric parotid gland benign and malignancies of epithelial cell origin. Adjuvant radiotherapy should be used judiciously in pediatric patients due to the higher risk of post-irradiation complications.

[Major salivary gland disorders in children and adolescents]

The aim of this study was a review of 67 children treated for salivary gland tumors in the ENT Department Medical University of Gdańsk since 1974 to 2008. In that group we observed 52 children with tumor of the parotid gland, 13 with tumor of submandibular gland and 2 with subligual gland tumors. Tumor-like lesions were stated the largest group of tumors and were observed in 33 (49%) of children, mainly of chronic sialadenitis (17 cases). Predominant number of tumors was observed in scholarship children. The most common symptoms were slow enlargement of tumor and swelling of the salivary gland. In the group of benign tumors most common was pleomorphic adenoma (19 cases) and in the group of malignant tumors most common was clear cell carcinoma (2 cases) and rhabdomyosarcoma (2 cases). In this report the authors describe basic epidemiological and clinical data (age, sex, duration of symptoms, histological structure of tumor, diagnostic methods, methods and results of treatment) and observations connected with differences of salivary gland tumors in that group of patients.

Congenital ectopic fistula of a minor salivary gland

A rare case of congenital salivary gland fistula is reported. A 3-year-old girl presented with clear discharge from a dimple on the left cheek. An ectopic salivary gland fistula was unexpectedly diagnosed during operation. This is the first case of congenital salivary fistula draining from a minor salivary gland to a cutaneous pit. We completely excised the lesion, and the patient remains complication free.