A 32-year-old woman presented with a 2-year history of a swelling below her right ear. On examination, there was a 4.5x1.5cm swelling in the right parotid region with well-defined margins. The swelling was non-tender, firm, and mobile with normal overlying skin. No lymphadenopathy or other abnormalities were noted. Based on the examination, the doctor's diagnosis was a likely benign parotid tumor given the painless swelling without signs of facial nerve palsy or metastasis.

1. Parotid swelling
NAVEEN PRAJAPATI
MBBS (2015)
Vardhman Mahavir Medical College & Safdarjung Hospital
New Delhi

2. Mrs. X ,a 32 years old lady ,BANKER by occupation,HINDU
by religion,Resident of NEW DELHI
Presented in SJH OPD
With chief complaint of:
SWELLING In front & below right EAR
since 2 years

3. History Of Presenting Illness:
Pt. was apparently well 2 yrs back , when she noticed a swelling in
right parotid region
SWELLING is:
Insidious in onset
Non progressive in size
Not associated with pain, no any secondary changes over the swelling.
No any other change in character of swelling noticed

4. Not associated history of fever with or without chills and rigor or evening rise
of temperature.
No history of trauma
No history of any other swelling in the body
No history of upper respiratory tract infection.
No associated history of dryness of mouth, pain during mastication or any
change in size during mastication
No history of difficulty in swallowing , drooling of saliva from angle of mouth
No difficulty in closing the eye.
No history of weight loss or loss of appetite
No history suggestive of any other metastatic symptoms
Pt. is not a known case of diabetes & hypertension

5. PAST HISTORY:
No past history suggestive of swelling previously appeared in the same region
No past history suggestive of jaundice , epilepsy, or any chronic ailment.
FAMILY HISTORY:
There is no history of head and neck cancer in family

6. Pt has undergone FNAC from same swelling
PERSONAL HISTORY:
Pt. has mixed Indian diet, with normal appetite ,sound sleep ,regular bowel and
bladder movements
She is not addicted to alcohol, smoking and chewing tobacco
There is no history of allergy to any drug
OBSTETRICS HISTORY :
She is P1L1 menstruating lady married since 4 yrs ,
She had menarche at age of 12 yrs ,
Her LMP was on 8th of January & she is having a regular menstrual cycle of 28 days
with normal flow lasting for 4 days

7. EXAMINATION
Pt. was examined in a well lit room I sitting position , with proper informed
consent , in presence of her husband bed side
Pt. was conscious, cooperative, alert and well oriented to time, place &
person.

8. General Physical Examination
Pt. was afebrile
She had pulse of 80/min, with regular rhythm , good in volume, vessel wall not
palpable, without any R/R or R/F delay
Her Sitting Blood Pressure was 122/ 74 mm of Hg.
Her respiratory rate was 18/min. ,which was regular, thoraco-abdominal, not in
distress
Pt. had adequate hydration with adequate nutrition with weight of 61 kg and
height of 156 cm , having BMI of 24.6 kg/(m)2
with no signs of micro and macro-nutrient deficiency
There was no pallor , icterus, cyanosis, clubbing, edema and generalized
lymphadenopathy.
Her Kernofsky performance score was 90

9. HEAD AND NECK EXAMINATION
EXAMINATION OF SWELLING
 On INSPECTION:
There was a small single ovoid swelling over right parotid region
measuring about 4.5*1.5cm in size
situated below in front and below right ear ; extending vertically upto
zygomatic arch and inferiorly touching the imaginary horizontal
plane passing through the angle of mandible
With well defined margins
Skin over the swelling appeared normal with no scar, sinus, fistula ,
no visible pulsations seen
No any inflammatory changes over the swelling
The Ear lobule was raised
Opening of the parotid duct was visible with no purulent / bloody
discharge

10.  On PALPATION :
The findings of inspection were confirmed on palpation
The local temperature was not raised
The swelling was non tender, firm in consistency, mobile, with smooth
surface and
well defined margins
Skin over the swelling was no fixed & the swelling was not fixed to
underlying masticator muscle
Duct orifice was not compressed
Deep lobe was not palpable on bidigital palpation
REGIONAL LYMPH NODE EXAMINATION:
THE REGIONAL LYMPH NODES WERE NOT ENLARGED

11. ORAL CAVITY EXAMINATION:
Pt. had good orodental hygiene
There was no erythroplakia , leukoplakia, melanoplakia,
Teeth were not stained
Mouth opening was adequate
Tongue mobility was normal , taste sensations were present
There were no ulcers in the oral cavity
Ant. , post. Pillars and tonsillar fossa appeared normal
Uvula was hanging in the central position
Gag reflex was present
Other salivary glands appeared normal

12. Cranial Nerve Examination
1) FACIAL NERVE EXAMINATION:
Bilateral symmetrical forehead wrinkling were present
Pt was able to close her eyelids properly
Nasolabial folds appeared normal
There was no drooling of saliva from angle of the mouth
Overall facial symmetry was mantained
2) REST OTHER RELEVANT CRANIAL NERVES WERE NORMAL

13. Diagnosis
32 y/o lady with painless swelling in right parotid region
without any signs and symptoms suggestive of facial nerve
palsy & distant metastasis ; most probably a case of
benign parotid tumor.