Revisiting a controversial surgical technique in the treatment of bulimic parotid hypertrophy.

Bulimia nervosa is a recognized cause of bilateral parotid gland enlargement that may not be appreciated by most otolaryngologists. Classically the parotid enlargement is transient but may be permanent and spectacular. Our review of the published literature revealed only 2 previous cases that have been considered for superficial parotidectomy, along with much debate as to the efficacy of such treatments. Neither case reported any postoperative complications. We present a bulimic patient who developed bilateral postoperative fistulae after surgery for marked, permanent enlargement of her parotids. Both fistulas closed spontaneously. However, a year later she has relapsed into bulimic behavior and developed further parotid gland hypertrophy. Because of this complication, we believe surgery has no role to play in the overall treatment of these severe cases unless the patients show a prolonged cessation of their bulimic behavior.