A healthy 11-year-old girl was referred with a gradually enlarging, asymptomatic facial mass. She had no history of infection, feline scratches, tuberculosis exposure, or prior lesions. A solitary, nontender, nonfluctuant mass was evident between the sternocleidomastoid muscle and the angle of the mandible. The overlying skin was normal. The findings of a complete head and neck examination, including cranial nerves, were otherwise normal.
Computed tomography revealed a 4-cm, hypodense, heterogeneous mass involving the left parotid gland, displacing the retromandibular vein laterally, and extending toward the parapharyngeal and prestyloid spaces, without significant enhancement (Figure 1). The results of fine-needle aspiration were nondiagnostic. A Gram stain and cultures were negative for organisms. The patient underwent a total parotidectomy with facial nerve preservation. A cystic mass in the deep lobe of the parotid gland was excised contiguously, with a solid component extending into the parapharyngeal space.