Case Report: Swelling without a bruise: delayed-onset traumatic parotitis in a child following minor blunt facial trauma

Facial swelling in pediatric patients presents a diagnostic challenge due to multiple possible etiologies. Parotid swelling is usually infectious and presents with pain, glandular enlargement, xerostomia, and occasionally, fever. Trauma-induced parotitis is rare, particularly in the absence of external indicators such as bruising, hematoma, or skin laceration. This report describes a 9-year-old boy with autism spectrum disorder (ASD) who was presented at the emergency department with a delayed unilateral facial enlargement, following a minor fall. Clinical assessment revealed localized parotid tenderness without fever or systemic illness. Ultrasound showed heterogenous parotid parenchyma with small anechoic areas and preserved vascularity. Computed tomography (CT) confirmed right glandular edema with mild surrounding inflammation but no stones, abscesses, fractures, or injuries to adjacent structures, indicating a diagnosis of right-sided traumatic parotitis. A conservative approach was adopted, with analgesics, hydration, a soft diet, and warm compresses leading to full recovery within 2 weeks. This case emphasizes the importance of considering occult trauma in the differential diagnosis of facial swelling, particularly in non-verbal pediatric patients or those with communication impairments.