A presentation that discusses a medical condition that may be a of concern to cosmetic appearance of a human being as they go about performing their daily tasks. The presentation focusses on the pathophysiology, root causes and management.

1. ZAGS CLINICAL
PRESENTATION
LIVINGSTONE - UTH
12/08/2022
Presenter: Dr. Madiondo Katende Paul
Supervisor: DR Mutuna Chiwele

2. Demographics
• BM
• Male/44years
• seen in the surgical clinic on 22 march 2022

3. Presenting complaint
Lump anterior to the tragus of his left ear causing concern for cosmesis

4. History of presenting complaints
• painless lump slow growing over the past 5 years
• No pain when eating
• No lump in another body location

5. History(contd.)
• ROS: nil
• PmHx: HIV-,DM-,HTN-,Asthma-,covid neg
• DHx: nil
• FmHx: nil
• Social/economic: farmer ,married with 6 children,alcohol-,smoking-,

6. Physical examination
• GC: stable
• P-,j-,c-
• Vitals:Bp:111/68mmHg
P:70Bpm ,regular volume
RR:20bpm
T:36.3*C
SATS: 98% on room air
• Oral- cavity: no abnormality
• facial animation was symmetric and normal
• No trismus ,no sensory loss

7. Physical examination(contd)
• RS: clear
• CVS: S1S2 normal
• P/a: unremarkable
• L/e: left-sided smooth preauricular
mass, nontender ,not warm,
mobile,non pulsatile,non compressible,
unreducible ,no regional enlarged LNs,
normal overlying skin
• Normal testes.

8. Laboratory test results-FBC

9. Cytology report
• Groups of oncocytic cells with lymphocytes
• mucoid turbid fluid with an amorphous cellular debris and a mixture
of lymphocytes ,epithelial cells, and oncocytic cells in sheet
Conclusion: warthin’s tumour with minor focal inflammation

10. Diagnostic impression
• Warthin’s tumour of the left parotid gland

11. Surgical interventions
• Surgical approach
-Pt under GA ,intubated ,eyes well protected;
the neck slightly extended and the head turned to the left side
-Modified Blair incision done
• Intraop findings: a single 4.1x3.0cm sized brown,
,rubbery,encapsulated mass in superficial lobe of the parotid gland
• done:resection of the mass.
• wound closed with vicryl 3/0
• and penrose drain left in situ

12. Post-Op Plan
• NPO
• Iv cephalosporin
• IM diclofenac
• sample sent for histology

13. Post-operative course
• Uneventful
• drain removed day 2 postop(10cc in the last
24hours)
• Discharged the same day on :
-oral cephalosporin x 4/7 and bruffen
• Reviewed 252 and one month later:
slight pain on the SS,wound healed

15. Discussion point
1. Parotid mass:when to consider operative management ?
2. Parotidectomy :surgical technique

19. References
1. https:www.ncbi.nlm.nih.gov/books/NBK557651/
2. https://www..ncbi.nlm.nih.gov/pmc/articles/PMC4050083/
3. https://parotidpatientproject.org/parotid-education/types-of-
parotid-surgery.html
4. https://medicine.uiowa.edu/iowaprotocols/parotidectomy-facial-
nerve-dissection