Niamat Ullah, Naveed Yousaf.
Hydatid Disease of the Submandibular Gland.
J Coll Physicians Surg Pak Jan ;11(10):661-2.

Echinococcosis is a tissue infection of the human caused by the larval stage of Echinococcus granulosus or E. multilocularis. Hydatid cyst of the head and neck region is uncommon and the involvement of salivary glands, especially the submandibular gland, is very rare. A case of submandibular gland hydatid cyst is reported in this article, in a patient who was presented with swelling of this area of three months` duration. Examination revealed a soft, non-tender, mobile mass measuring 6x4 cm. Chest X-ray and abdominal ultrasonography were normal. Excision of the whole mass was performed and pathological examination confirmed the fine needle aspiration cytology report.

A 7 years old female child was admitted in ENT unit, Lady Reading Hospital, Peshawar, with a swelling on the right side of her neck in the submandibular region of a duration of three months, prior to which the patient had no complaints. The swelling had increased in size, but had remained painless and without any other significant problem. She had a course of conservative management, but there was no response. No history of cough, hemoptysis or jaundice was reported, and examination revealed her to be afebrile. The skin overlying the mass was soft, non-tender, mobile and showed no redness or warmth. The size of the mass was 6x4 cm and intraoral examination revealed no stones in the right submandibular gland duct.

Milking of the submandibular glands showed decreased saliva production on the involved side, which was clear and examinations of her chest and abdomen proved normal. X-ray of the submandibular region, however, showed a soft mass with no radiopaque shadow or erosion of the mandible. Ultrasonography of the submandibular area revealed a large non-vascular predominantly cystic mass having some internal solid components with a few enlarged lymph nodes. Fine needle aspiration cytology (FNAC) of the mass showed many scolyces and hooklets along with some inflammatory cells. Complete blood count and sedimentation rate were normal except mild eosinophilia. The tuberculin test (PPD) was also normal. With the impression of hydatid cyst of right submandibular gland, surgery was performed via a horizontal incision about 4 cm below the lower edge of the mandible. After dissection of the surrounding tissue, the submandibular gland was exposed and completely removed without rupturing the cyst. The submandibular gland was incised and a 4x4 cm sized cyst containing a whitish-yellow fluid was seen. The patient was discharged from the hospital with no complications.5 The pathologic report showed a hydatid cyst.

Periodic check-ups, including abdominal ultrasonography and x-ray examination, were performed during the first six months postoperatively which revealed no pathological findings.

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