Chronic Recurrent Parotitis after a Fish Meal

Background Sialolithiasis is the main cause of unilateral diffuse parotid or submandibular gland swelling. Organic substances that enter the salivary duct system can give rise to salivary calculi by acting as a nidus for the layered deposition of inorganic and organic substances.

Case Presentation A 48-year-old male patient presented with chronic intermittent painful unilateral swelling of his parotid gland. He recalled an incident five years previously when a fishbone had lodged in his left cheek. It had been removed from his parotid duct papilla using forceps and a salivary gland probe. Before presenting to our clinic, he had been admitted to the hospital several times for intravenous antibiotic treatment of acute purulent parotitis.

Investigations Clinical examination showed purulent drainage from the opening of the left Stenson’s duct. Ultrasound of the left parotid gland showed a linear echogenic structure (8x2mm) in the distal segment of Stenson’s duct and minor proximal distention of the duct system.

Treatment Sialendoscopy revealed a sialolith with a central fish-bone in the distal segment of Stenson’s duct. We extracted the calculus using a nitinol stone retrieval basket after performing an extended papillotomy. A sialostent was inserted into Stenson’s duct to prevent papillary stenosis.

Outcome and follow-up The sialostent was removed three months postoperatively and the patient remained symptom free.

Discussion We report the rare case of a fishbone-induced sialolith in Stenson’s duct. Although rare, several reports describe salivary calculi formed around aliments or other foreign bodies in Wharton’s duct. Our report underlines the value of sialendoscopy and that foreign bodies should be removed promptly from the salivary duct system to prevent sialolith formation.

Poster-PDF A-1995.pdf

Publication History

Article published online:
07 August 2020