Parotid Fistula: Case History

Abstract

Several years ago Dr. Orndoff and Dr. Ivy did some experimentation upon dogs in an effort to determine what effect roentgenization had upon the salivary glands. They proved that the effect was always depressing upon the secretory function, and so reported their findings. I was privileged to be present when some of this experimental work was being done and was impressed with the painstaking care exercised in the details of the work, little thinking that it would ever have any application to therapy in my hands. Parotid fistulæ are notoriously difficult to heal, and when they occur in operation scars such as those following a mastoid operation, where the area is near a bony wall and nerves, operative measures to cure them are not lightly undertaken. This is evidenced from the following case, which was referred to me by an ear surgeon. Patient, girl, 8 years of age, small, dark skinned, of southern European parentage. Four years before she had had a radical mastoid operation on the left side and within the next four months had had two other mastoid operations on the same side. She was in the hospital from October 18, 1922, to May 30, 1923. On January 13, 1926, examination revealed a small opening behind the left ear, just posterior to the tragus, which for the past two and one-half years had been discharging a clear, transparent fluid. Analysis of the discharge proved it to be saliva, and the diagnosis of parotid fistula was confirmed. Various methods undertaken to induce healing and closure of fistula had failed. In June, 1925, radium had been applied, without benefit. On January 13, 1926, at 2:30 p. m., I administered 60 milliampere-minutes (6 ma. for 10 min.), at 70 K.V.P., 12 inches anode skin distance, filtered through 5 mm. sole leather and 3 mm. aluminum. At 11 a. m. the next day the area was dry, and the mother of the patient said that it had been dry since 7 a. m. that morning, for the first time in two and one-half years. The area was again slightly moist on the tenth day following the treatment (January 23), and on February 8 the same dosage was applied, with the result that the discharge dried up and the sinus healed. The gland resumed its function (as nearly as could be determined) after another ten days, but in the meantime the sinus had had time to contract its lumen and fill with granulations. No further evidence of the discharge is recorded.