A 58-year-old male presented with a painless, gradually progressive swelling below his right ear for one year. On examination, he was found to have a solitary, firm-to-hard, bilobed swelling measuring 8x3cm in the right parotid region. All other physical findings were normal. The probable diagnosis is a swelling of the right parotid gland.

1. CASE PRESENTATION
Presenter DR CHAITRA N

2.  NAME : Marudevayya
 AGE : 58 years
 SEX : male
 RELIGION : Hindu
 OCCUPATION : labour
 ADDRESS : BANGALORE
 DOA : 27/06/2023

3. CHIEF COMPLAINTS
 c/o swelling below the right ear since 1 year

4. HISTORY OF PRESENTING ILLNESS
 Patient was apparently normal 1 year back after which he
developed swelling on right side of face below the ear which was
insidious in onset, gradually progressive in size, initially was size of
peanut which progressed to present size
 Patient also noticed the sudden increase in size in last 2 months
 The swelling was not associated with pain or discharge

5.  No h/o difficulty or pain during swallowing
 No h/o restricted mouth opening, facial weakness
 No h/o trauma to face
 No h/o any other swelling on face
 No h/o ear pain
 No h/o fever, weight loss

6. PAST HISTORY
 No significant history in the past
 Not a known case of hypertension, type 2 DM, TB
FAMILY HISTORY
• No significant history in the family

7. PERSONAL HISTORY
 Diet : mixed
 Sleep : adequate
 Appetite : normal
 Bowel and bladder : normal and regular

8.  h/o smoking cigarettes : 2 to 3/day for 15 years
stopped smoking in last 2 years
 h/o consumption of alcohol : 90m;/day for 10years
stopped consumption of alcohol; in last 2 years

9. Treatment history
 Not taken any treatment for present condition
 No h/o any surgeries in the past

10. Summary
 A 58 year old male presented with a painless gradually progressive
swelling in front and below the right ear lobule since 1 year with no
comorbidities

11. GENERAL PHYSICAL EXAMINATION
 Patient , moderately built and nourished
 Conscious , co operative
 Patient is afebrile
 Pulse : 80bpm
 BP : 110/70mmhg
 Spo2 : 98% in room air

12.  Pallor
 Icterus
 Clubbing
 Cyanosis absent
 Lymphadenopathy
 Edema

13. Head and neck examination
Inspection
 Solitary swelling, ovoid in shape
 Situated in the right parotid region
 Extent : superiorly just above the level of intertragal notch extending 3 cm below the
angle of mandible
posteriorly till anterior border of sternocleidomastoid
 Surface : appears smooth
 Borders : well defined
 No visible pulsations over the swelling

14.  Skin over the swelling is normal
 Left parotid region appears to be normal
 No other swellings noted in the face and neck

15. Palpation
 No local rise in temperature
 On palpation there is a single swelling in the front, below and behind the right ear lobule
with a size of 8cm (vertically) x 3cm (horizontally)
 Skin over the swelling is pinchable
 Shape : bilobed shape
 Consistency : firm to hard in consistency
 Margins : well defined

16. Auscultation
 No bruit heard
Lymph node examination
 No palpable cervical lymph nodes
Facial nerve examination : normal

17.  NOSE EXAMINATION :
 External frame work of nose :
root : normal
nasal bridge : normal
Tip: normal
 Skin over the nose : normal
 Elevation of tip: nasal vestibule normal

18. Anterior rhinoscopy
Right Left
Septum Deviated to left
Mucosa Normal Normal
Inferior turbinate Normal Normal
Inferior meatus Normal Normal
Middle turbinate Normal Normal
Middle meatus Normal Normal
Floor Normal Normal

19. Right Left
Smell sensation Normal Normal
Cold spatula test Decreased fogging
Cottle’s test negative negative
Functional tests

20. Paranasal sinus tenderness
Para nasal sinus Right Left
Frontal Absent Absent
Ethmoidal Absent Absent
Maxillary Absent Absent

21. ORAL CAVITY EXAMINATION
Lips
Buccal mucosa
Hard palate normal
Floor of mouth
Anterior 2/3rd of Tongue
Retromolar trigone
Teeth: nicotine stains present

22. OROPHARYNX EXAMINATION
Uvula : normal
Anterior pillar : normal
Tonsillar area : normal
posterior pillar : not visible
posterior pharyngeal wall : normal

23. LOCAL EXAMINATION
Ear Right Left
Pinna Normal Normal
Pre auricular area Normal Normal
Post auricular area Normal Normal
Tragal tenderness Absent Absent
Mastoid tenderness Absent Absent
EAC Normal Normal
Tympanic membrane Intact Intact
EAR EXAMINATION

24. NECK EXAMINATION
 External laryngeal contour: normal
 Trachea: midline
 Laryngeal crepitus: present
 No palpable lymph nodes

25. Probable diagnosis
 Right parotid swelling