Parotid Duct Injury in Temporalis Tendon Transfer

Abstract

Objectives: 1) Know the course of the parotid duct relative to the path of dissection for temporalis tendon transfer. 2) Apply anatomic concepts and technique modifications to protect the parotid duct during temporalis tendon transfer. Methods: A retrospective chart review of 40 consecutive adult patients undergoing temporalis tendon transfer for unilateral facial reanimation was performed. Cases represent operations done with the technique described in the literature as well as those performed with the additional step of parotid duct cannulation. In the latter, the path of dissection and course of the parotid duct were documented with introperative X-ray. Instances of parotid duct injury using both techniques were recorded. Treatment course for patients with parotid duct injury was also reviewed. Results: Two instances of parotid duct injury were identified (incidence = 5%). Both were in cases without parotid duct cannulation. However, only 3 cases have been performed since the addition of parotid duct cannulation to our surgical technique. Intraoperative plain films showed that the path of dissection and the course of the parotid duct run obliquely and passed within 5 mm of each other. Both patients with parotid duct injury had resolution of symptoms with medical management, including botulinum toxin injection into the affected parotid gland and placement of pressure dressings. Conclusions: Parotid duct injury is an uncommon complication of temporalis tendon transfer that can be adequately managed with medical treatment. Cannulation of the parotid duct allows for intraoperative localization and possibly prevention of injury to this important structure.