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Masseteric Myositis: A Unique Cause of Obstructive Sialadenitis of Parotid Gland.

To the Editor: Disorders of the salivary glands are uncommon. When they do occur, experience in managing the process is diluted over a range of disciplines. The result is that traditional views go unchallenged and are recast, unchanged, from one text book to another. Obstructive sialadenitis (OS) of the parotid gland is an insidious inflammatory disorder that tends to progress secondary to a compression, reduced flow or physical obstruction and may lead to the formation of a fibrous mass if left untreated. The definitive etiology and pathogenesis of the disease remains obscure but reduced salivary flow is considered the most important factor in its multifactorial etiology. The parotid gland projects forward onto the surface of masseter. The stensons duct passes horizontally across masseter, approximately midway between the angle of the mouth and the zygomatic arch and then turns medially at its anterior border at almost a right angle, and traverses the buccal fat pad and buccinators muscle. Any obstruction or compression of the duct will definitely lead to backflow of saliva and dilatation of the proximal duct. When a muscle becomes inflamed, such as the masseter muscle, the condition is described as a myositis. A 19-year-old male was referred to our center as a clinically diagnosed patient of OS of right parotid gland. However, on clinical examination the positive findings other than the tense parotid region were tender masseter muscle and trismus. The association between OS and myositis has never been reported in the literature. Obstructive sialadenitis is never associated with trismus. The ultrasonography revealed increased bulky right masseter with heterogenous echotexture (Fig. 1A), increased vascularity (Fig. 1B), and enlarged parotid gland with dilated stensons duct (Fig. 1C). Keeping in view the quantum of inflammation, surgical anatomy of the duct, and its relation to the masseter muscle conservative management in the form of oral antibiotics, anti-inflammatory drugs adequate hydration was prescribed to cure the acute symptoms of myositis. Within 2 weeks of time the patient was asymptomatic. Ultrasonography revealed reappearance of normal echogenicity of right masseter muscle (Fig. 1D) and normal size of the parotid gland and its duct’s caliber (Fig. 1E). In masseteric myosistis the inflammation can lead to compression of the vertical part of the parotid duct causing OS. This anatomical relation should be kept in mind while treating OS. It is important to treat the cause of OS rather than carrying out surgical exercise on the gland. To the best of the knowledge of the authors, this is the first patient reported in the existing literature where masseteric myosistis has caused OS of parotid gland.