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Parotid abscesses are a very uncommon pathology, which may occur in immuno-incompetent patients or might sometimes be related to foreign body injuries.
At the Department of Maxillofacial Surgery of the School of Medicine and Surgery of ‘Federico II’, University of Naples, we recently observed an interesting case of parotid abscess caused by Bacillus Licheniformis, previously unreported as a pathologic agent of parotid infections.
The patient, a 48-year-old Caucasian male, presented with a swelling in the left parotid region. The lesion grew in about 2 months, until it reached the dimension of 2.5×2 cm2.
The patient was in good general health and there were no signs of injuries in the parotid region.
The lesion was covered by normal skin, smooth in appearance, painful, tender and well circumscribed; no sign or symptom of facial nerve involvement was present.
The patient had already undergone a CT scan, with intravenous iodine medium infusion, which revealed an enlargement of the left parotid gland due to the presence of a 2.5 cm roundish mass of the inferior parotid portion, with peripheral contrast enhancement; a bilateral swelling of the lymph nodes of the neck was also present (Fig. 1) .
Fig. 1CT scan showing enlargement of the left parotid gland due to the presence of a 2.5 cm roundish mass of the inferior parotid portion, with peripheral contrast enhancement.
Ultrasound examination of the left parotid gland revealed a 2.3×1.7 cm2 nonhomogeneous hypoechoic ovoid mass. Fine Needle Aspiration Cytology (FNAC) was inconclusive.
Under general anaesthesia, the parotid mass was enucleated, under control of a nerve stimulator (Fig. 2) . The specimen measured 2.3×1.5 cm and was brownish, tender, covered by a thin capsule. On cutting the specimen, a white-yellowish caseous-like material was released and a microbiologic assay and antibiogram showed positivity for B. Licheniformis.
The patient was treated with an amoxicillin-clavulanic acid association, 1 g twice a day for 5 days. The postoperative course was normal with prompt improvement. The function of the facial nerve was totally preserved. Two months after intervention the abscess had completely resolved with a very good functional and cosmetic result.
B. Licheniformis is a Gram positive micro-organism of the I B group, like the Bacillus coagulans, Bacillus firmus, Bacillus subtilis, etc. Microbiological assay consists in a growing plate (nutrient agar with beef extract 3.0 g, peptone 5.0 g, agar 15 g and distilled water 1.0 l) or in anaerobiosis growth technique, to evaluate and classify the bacteria.
B. Licheniformis is frequently found in ocular infection, but it is possible to recognise it in the gastrointestinal tract, since it is often present on fresh food incorrectly washed.
B. Licheniformis is very responsive to treatment with most antibiotics such as amoxicillin-clavulanic acid, gentamycin, amycacin, kanamycin, and to all tetracyclines.
Parotid abscesses are very rare but in case of sialadenitis associated with a parotid mass, this occurrence should be suspected to avoid unnecessary surgery.
References
Salkinoja-Salonen M.S
Vuorio R
Andersson M.A
et al.
Toxigenic strains of Bacillus licheniformis related to food poisoning.
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