Unclear calcified lesion in the parotid region 16 years after total parotidectomy and fat obliteration because of an unclear inflammation

Introduction There are multiple differential diagnoses for tumors of the parotid gland. Radiological (MRI or CT) and ultrasound diagnostics can provide further information regarding the entity of the tumor. However, in most cases histopathological confirmation of the diagnosis is required. We report an interesting case of a 68-year-old male patient with an unusual differential diagnosis of a tumor in the parotid gland.

Method A male patient presented with increasing pain around the right upper jaw and cheek for several weeks. He additionally palpated a tumor in the right parotid region. In 2003, a total parotidectomy on the same side was performed due to an unclear epithelial cell granulomatous inflammation.

Results In ultrasound a large sialolith was suspected. CT-scan showed a calcified structure in the area of the former parotid area. On MRI, non-specific calcified lesion showed no conspicuous contrast enhancement. Because of the uncertain diagnosis, the revision-explorative parotidectomy was performed. Intraoperatively, there was a bone-like lesion within the free fat transplant that had been implanted to cover the defect at the last parotidectomy. Histology confirmed an organized liponecrosis with scarring fibrosis and regressive calcifications without any signs of malignancy.

Conclusion Free fat transfer is one of the possible techniques for defect coverage after parotidectomy. Wound infection with fat necrosis is a well-known early complication. This case report presents liponecrosis with calcification as a possible long-term complication.

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Publication History

Article published online:
13 May 2021