Unusual parotid gland foreign body

An unusual intraparotid foreign body simulating a tumour: shrapnel from the Spanish Civil War

“…Foreign bodies lodged in the salivary glands are uncommon 2,3,5,8,9 . Cases have been reported of wooden toothpicks, blades of grass, toothbrush bristle, fish bone, hair, nidus of lepthotrix, a piece of straw or grass, brome grass, stem or seed, portion of fingernail, spike or wheat, splinter of wood, thorn and chicken pinfeather and a piece of a ballpoint pen 2,3,5,8,9 .…”

“…Cases have been reported of wooden toothpicks, blades of grass, toothbrush bristle, fish bone, hair, nidus of lepthotrix, a piece of straw or grass, brome grass, stem or seed, portion of fingernail, spike or wheat, splinter of wood, thorn and chicken pinfeather and a piece of a ballpoint pen 2,3,5,8,9 . Most of the reported foreign bodies lodged in the salivary glands reached the gland through Stenson's duct or Wharton's duct 2-6 .…”

“…Most of the reported foreign bodies lodged in the salivary glands reached the gland through Stenson's duct or Wharton's duct 2-6 . Usually these foreign bodies are localized in glandular ducts and induce salivary calculus, recurrent sialadenitis or glandular sinus and cutaneous fistula 2,3,5,9 Recurrent trismus and salivary calculus were also reported 2, 3,5,8,9 . The diagnosis of a foreign body in the parotid gland may be suspected when the injury is recent and symptoms such as infection, fistula or trismus are present 3 .…”

“…MEKTUBJIAN 7 noted that the bullet was probably sterile, and the infection associated with gunshot wounds is usually due to clothing, wadding or other organic debris contaminating the wound 8,10 . Metals (like shrapnel) may give rise to chemical and secondary bacterial inflammation of the surrounding tissue resulting in abscess or salivary fistula, and the salivary gland is the most responsible lesion due to autolysis by amylase 8 . Clinical or histological signs of infection were found after removing the intraparotid mass.…”

“…Sometimes neither fine needle aspiration nor radiology is capable of providing an accurate diagnosis before surgery. Foreign bodies in the salivary glands are rare 2,3,5,8,9 . The possible routes for a penetrating foreign body in the salivary glands are through their duct from the oral cavity or through the skin 3,5,9 . Damage to the parotid is often overlooked or underestimated in patients with facial injuries.…”