From the Guidelines
Multiple benign appearing cysts in the left parotid gland should be managed with observation and regular follow-up for asymptomatic small cysts, while symptomatic cysts may require fine needle aspiration or surgical options like partial superficial parotidectomy. The cause of these cysts can be attributed to conditions such as benign lymphoepithelial lesions, Warthin's tumors, or salivary duct obstructions 1. Treatment depends on the size, symptoms, and specific diagnosis. For symptomatic cysts, fine needle aspiration to drain fluid and reduce discomfort may be necessary. For recurrent or larger cysts, surgical options include partial superficial parotidectomy or complete parotid gland removal, performed by an otolaryngologist or head and neck surgeon, as suggested by the management of salivary gland malignancy guideline 1. Antibiotics such as amoxicillin-clavulanate (875/125 mg twice daily for 7-10 days) may be prescribed if infection is present. Patients should maintain good oral hygiene, stay hydrated, and avoid smoking to prevent complications. Warm compresses can help with discomfort, and over-the-counter pain relievers like ibuprofen (400-600 mg every 6 hours) may provide relief. Definitive diagnosis requires imaging (ultrasound or MRI) and possibly fine needle aspiration cytology to rule out malignancy, as approximately 20% of parotid masses can be malignant despite benign appearance 1. Key considerations in management include:
- Regular follow-up for asymptomatic small cysts
- Fine needle aspiration for symptomatic cysts
- Surgical options for recurrent or larger cysts
- Maintenance of good oral hygiene and avoidance of smoking to prevent complications
- Use of warm compresses and over-the-counter pain relievers for discomfort management.
From the Research
Cause of Multiple Benign Appearing Cysts in the Parotid Gland
- The cause of multiple benign appearing cysts in the parotid gland can be congenital, acquired, or occasionally may arise from surrounding structures 2.
- Polycystic disease of the parotid glands is a rare disorder that presents as a painless enlargement of one or both parotid glands, with no association with other disease processes within the head and neck 3.
- Benign lymphoepithelial cysts are a widely recognized cause of parotid gland swelling in patients infected with the human immunodeficiency virus (HIV) 4.
Treatment Options for Multiple Benign Appearing Cysts in the Parotid Gland
- The treatment of choice for benign cysts of the parotid gland consists of superficial parotidectomy 2.
- For benign lymphoepithelial cysts, treatment options include repeated fine-needle aspiration and drainage, surgery, radiotherapy, sclerotherapy, and conservative therapy, with institution of highly active antiretroviral therapy medication 4.
- Intralesional bleomycin injections have been reported as a successful treatment for benign lymphoepithelial cysts of the parotid gland in HIV-positive patients 5.
- Surgical intervention offers the best cosmetic result for patients with benign lymphoepithelial cysts 4.