"Bird fancier's mouth", an unusual case of obstructive sialadenitis.

We report an unusual case of a patient who developed obstruction of the duct of her left submandibular salivary gland, with subsequent sialadenitis, from impaction of a bird feather. This was most likely the result of her habit of nuzzling her cockatoo and sucking its feathers. Following removal of the feather and antibiotic therapy, she made an uneventful recovery. CASEREPORT A 49 year old female presented at the Accident and Emergency Department, having been referred by her General Practitioner. She complained of pain on the lower left side of her face and mandibular region, radiating into her ear. Examination revealed a low grade pyrexia of 37.5°C, with tender swelling of her left submandibular salivary gland. Inspection of the floor of the mouth revealed a black linear object protruding approximately 3cm from the orifice of the left submandibular duct. It appeared to have a flexible tip and initial concerns were of some type of worm. The black structure was grasped with a pair of forceps and dislodged easily from the duct, releasing a discharge of blood and pus from the orifice. Inspection of the foreign body revealed it to be an inert structure. Initial thoughts that it may have been a mass of matted animal hair or a worm were unfounded when it was teased out and found to represent a feather. On specific questioning, she gave no history of recent travel abroad, but owned a small puppy and a cockatoo. She admitted being very affectionate with her animals, kissing and nuzzling them frequently, including sucking at her cockatoo's feathers. The patient was treated with Co-amoxiclav and Metronidazole and made an uneventful recovery. DISCUSSION Obstruction of the ducts of the salivary glands, leading to sialadenitis, is a far from rare occurrence. Such obstruction is most commonly due to calculus formation in the duct, with stasis leading to infection ' although neoplasms of the gland 2 or an epidermoid cyst 3 may result in salivary stasis and infection. Obstruction of the punctum by dentures,4'5 a fingernail 6 and a fishbone I have also been documented as causes of obstructive sialadenitis. Rarely, isolated submandibular suppurative sialadenitis can present in the premature neonate.8 This case is very unusual because of the bizarre nature of the foreign body. Close contact with animals including birds may cause a variety of specific zoonoses, but this case demonstrates an illness caused by a mechanical complication of close contact …