Superficial Parotidectomy in Chronic Sialoadenitis Post Covid Case Report

SARS-CoV-2 exhibits a high tropism for salivary glands, which can lead to chronic sialadenitis. This inflammatory entity can clinically and ultrasonographically mimic benign neoplasms, complicating the preoperative diagnostic approach. This case report is about a 38-year-old female, non-smoker, presented with a progressively enlarging left parotid mass that developed 8 weeks after a COVID-19 infection. Ultrasound revealed a vascularized hypoechoic nodule, and fine-needle aspiration cytology (FNAC) diagnosed a Warthin tumor. She underwent a superficial parotidectomy with facial nerve preservation. Postoperatively, she developed transient paresis of the marginal mandibular branch and a surgical site seroma, both of which resolved favorably with conservative management. The definitive histopathological report confirmed chronic sialadenitis, ruling out any neoplastic process. Oncocytic metaplasia and lymphoid hyperplasia, typical of chronic post-viral inflammation, closely mimic the cellular architecture of a Warthin tumor, leading to false-positive cytological diagnoses. It is imperative to maintain a high index of suspicion for parotid masses in patients lacking the classic epidemiological profile but with a recent history of COVID-19. Furthermore, surgeons must anticipate significant intraoperative technical difficulties due to inflammatory fibrosis, which increases the risk of postoperative morbidity.