Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Surgery Final Year Case Presentation Parotid_Split Clinical Examination Discussion and Treatment
Virugambakkam , shopkeeper by occupation ,
belonging to lower middle class
presented with chief complaints of
SWELLING BELOW AND BEHIND THE RIGHT
EAR FOR PAST 3 WEEKS
HISTORY OF PRESENTING ILLNESS
Patient was apparently normal 3 weeks back
after which he developed a swelling behind
the right ear
-duration 3 weeks
-insidious in onset
-initially small in size & gradually
increased in size to attain the current
size.
-Not associated with pain
-No h/o sudden increase in size of the
swelling
-No h/o difficulty in opening the mouth
- No h/o difficulty in swallowing
- No h/o increase in size or pain during
chewing
-No h/o trauma
-No h/o fever
-No h/o ear discharge , ear pain
- No h/o of drooling of saliva , difficulty in closing
eyelid
-No h/o swelling elsewhere in the body
-No h/o loss of weight and appetite
No h/o dry mouth, dry eye
No h/o cough with hemoptysis
No h/o bone pain
PAST HISTORY :
-No H/o similar complaints in the past
-No H/o TB , asthma , DM , hypertension ,
epilepsy , jaundice
-No H/o chronic drug intake
-No H/o previous surgeries/ hospitalisation
-No H/o radiation exposure
PERSONAL HISTORY:
-normal bowel & bladder habits
-consumes mixed diet
-non smoker & non alcoholic
FAMILY HISTORY : no relevant family history
GENERAL EXAMINATION
- conscious, oriented ,moderately built &
nourished
-No pallor ,
icterus ,
cyanosis ,
clubbing,
pedal edema ,
generalised lymphadenopathy
Pulse rate : 82 /min , regular in rhythm ,normal
in volume and character , no vessel wall
thickening , no radioradial/radiofemoral delay
Felt in all peripheral vessels
Respiratory rate : 16/min , abdominothoracic
Blood pressure : 110 /70 mm Hg measured in
left upper arm in sitting posture
Patient is afebrile
LOCAL EXAMINATION
After explaining the procedure and getting consent ,
examination was done under bright light
INSPECTION
-A single hemispherical swelling of size 3*3 cm below
and behind the right ear is seen
-borders well defined
- extent upper border 3 cm above angle of mandible
lower border just above angle of mandible
anteriorly 1 cm in front of angle of mandible
posteriorly upto mastoid
- Skin over the swelling ? normal
- no scars , sinuses , dilated veins , visible
pulsation
- lifting of ear lobule is present
-Retromandibular groove obliterated
-On opening of mouth swelling becomes less
prominent
-On clenching of teeth swelling becomes more
prominent
PALPATION
Not warmth & not tender
Inspectory findings of site, size , shape and extent
are confirmed
Surface ? smooth Skin- pinchable
? Consistency ? firm
Swelling is mobile in both horizontal and vertical
direction but not above the zygoma (curtain sign)
No induration in surrounding area
On clenching the teeth mobility not restricted
No preauricular or postauricular lymphadenopathy
? Bidigital Palpation of stenson duct- saliva
oozes out no discharge
? Bimanual palpation of parotid gland ? no
deep lobe enlargement
Examination of left parotid region ?normal
Examination of submandibular gland- normal
Examination of oral cavity-
-lips
-ant and posterior commisure
-gums/alveolus/floor of mouth
-buccal mucosa normal
-anterior 2/3 of tongue
-hard palate
-uvula in midline
-tonsil normal not pushed medially
-Dental formula 2 1 2 3 2 1 2 3
2 1 2 3 2 1 2 3
EXAMINATION OF OF FACIAL NERVE
-wrinkling of forehead present
-able to close eyelids against resistance
-nasolabial folds normal
-no deviation of angle of mouth
- able to blow cheek
- anterior 2/3 of tongue taste normal
-corneal reflex -normal
conjunctival reflex- normal
EXAMINATION OF HEAD AND NECK NODES ?
normal on inspection and palpation
-Respiratory system :
Normal vesicular breath sounds heard . No added
sounds
-Cardiovascular system :
S1 S2 heard . No murmurs
-Central nervous system :
No focal neurological deficit
-Abdomen :
Soft , non tender , no organomegaly , no free fluid ,
hernial orifices free , external genitalia normal
-Spine and cranium : normal
DIAGNOSIS
swelling in the right parotid region
most probably pleomorphic adenoma without
deep lobe or facial nerve involvement
? DIFFERENTIAL DIAGNOSIS:
? warthin tumour
beningn oncocytoma
parotid lymph node enlargement
Management :
Baseline Investigation:
- Blood ? CBC, TC , DC, ESR , hb % , blood
grouping and typing
- serum ?sugar , urea , creatinine
- urine ? sugar , albumin, deposits
- ECG & CHEST X-ray
- Serology : HIV , VDRL , HBsAg
SPECIFIC INVESTIGATIONS
USG neck
FNAC
CECT neck MRI NECK
? TREATMENT
SUPERFICIAL PAROTIDECTOMY WITH
FACIAL NERVE CONSERVATION ON RIGHT SIDE
This post was last modified on 08 August 2021