Benign lymphoepithelial cysts of the parotid: long-term surgical results

Abstract

Benign lymphoepithelial cysts are a widely recognized cause of parotid gland swelling in patients infected with the human immunodeficiency virus (HIV). These cysts are pathognomonic for HIV. The cysts frequently grow to be exceptionally large, causing physical deformity and gross asymmetry of facial contour. This clinical commentary analyzes this cosmetically deforming disease entity and the many treatments that accompany it. The patient presented in this paper is a surgical case-control. The case is a microcosm for our findings upon review of the literature. Treatment options for benign lymphoepithelial cysts include repeated fine-needle aspiration and drainage, surgery, radiotherapy, sclerotherapy, and conservative therapy, with institution of highly active antiretroviral therapy medication. Based on this surgical case-control and our review of the literature, it is concluded that surgical intervention offers the best cosmetic result for these patients.

Nonsurgical management of human immunodeficiency virus‐associated parotid cysts: A systematic review and meta‐analysis

“…Syebele and Bütow reported the highest rates of complete response at 90% with combination HAART (stavudine, lamivudine, and efavirenz). The considerable discrepancy in the range of rates of complete response and partial response may be attributed to variable access to affordable medications, variable compliance with daily regimens, or the lack of combination drug therapy . Due to the continued enhancements of ART and the subsequent improvement in patient compliance, HIV is more commonly a chronic illness rather than a terminal diagnosis.…”

“…Among HIV‐infected individuals, the incidence has been reported to range from 3%‐6% in adults and 10%‐30% in children . If left untreated, these lesions can cause drastic deformity, leading to social stigmatization, depression, and even rare complications, such as facial nerve weakness …”

“…An array of management options exist, including observation, surgery, highly active antiretroviral therapy (HAART), aspiration, sclerotherapy, and radiation . Surgery, although often resulting in a definitive response, introduces significant risks, including postoperative infection in an immunocompromised host, HIV exposure to the treatment team, and facial nerve injury . Although nonsurgical options avoid these risks, they may not be as effective.…”

“…Although nonsurgical options avoid these risks, they may not be as effective. Additionally, they carry risks of their own, including recurrence, xerostomia, necrosis, mucositis, and pulmonary fibrosis …”

“…Therefore, there is ongoing debate with regard to the most effective and safe nonsurgical treatment option. Because these lesions are neither invasive nor associated with malignant transformation, a conservative approach seems appealing; however, the information on nonoperative management is sparse and heterogeneous. Previous cohort studies and literature reviews have primarily recommended the use of radiotherapy but the individual studies have limited sample size.…”