Parotidectomy for bulimia: a dissenting view.

Bulimia nervosa is an eating disorder syndrome characterized by frequent binge-eating episodes followed by self-induced vomiting, fasting, excessive exercise, or the use of laxatives or diuretics. In addition to the psychological manifestations of this disorder, the patient may exhibit an array of physical symptoms. The major otolaryngologic finding is the presence of benign, persistent enlargement of the parotid and/or submandibular salivary glands in some patients with more severe bingeing and purging behavior. Recent reports in the otolaryngology literature have advocated superficial parotidectomy for correction of the cosmetic deformity of this sialadenomegaly. A detailed description of the psychological and behavioral manifestations and natural history of this illness is presented. The authors believe that surgical management of parotid enlargement in patients with bulimia nervosa is contraindicated by the surgical risks, the natural history of the disorder, and the patient's psychological state.