Severe cervical swellung under parotitis epidemica tracheostomy from ages 1 m to 2 y, and 5 y to 10 y, 10 m sirolimus discontinued after tracheostomy reversal, restarted due to increase of LM PIK3CA mutation, switch to alpelisib at age 17 y, 6 m ongoing monthly avastin since age 4 y. The gene discussed is PIK3CA; the disease is parotitis.