Traumatic injuries to the parotid gland and duct

Abstract

Although parotid gland and duct injuries represent a small percentage of the overall soft tissue trauma, the oral and maxillofacial surgeon must be aware of such an injury because failure to recognize it will permit the onset of a number of different complications, some of which are difficult to resolve. Trauma to the parotid region may involve not only the parotid gland and duct system (PGDS) but also adjacent structures such as the facial nerve, the external auditory canal, and the temporomandibular joint. In contrast to trauma to the PGDS region, the other injuries are easily diagnosed because of more evident signs like facial nerve deficits, otorraghy, or abnormal mandibular movements. Parotid gland injuries are usually not so obvious, and they may go unseen in a multiply traumatized patient, requiring a more intensive work-up from the attending surgeon. Normally, when these injuries are not recognized, salivary drainage from the facial wound is seen in the early days after injury (Fig 1). Both surgical and nonsurgical approaches are accepted as modalities of treatment for PGDS injuries. The type of treatment will be dictated by the extent of injury to the area. Nonsurgical approaches are usually used when only parotid gland parenchyma is contused. Nonsurgical treatments include the use of antisialogogues, elastic bandages, and refraint from oral intake until the injury is healed.1,2 Surgical techniques are used to repair extensive injuries to the parenchyma of the parotid’s or to Stenson’s duct and to treat some of the complications of PGDS injuries such as sialocele and fistulas.3-7 Postoperative sialogram are used as follow-up study for injuries of the PGDS, yet the introduction of the sialoendoscopy8 allowed a better and more accurate examination of the intraductal anatomy after harm to the gland. The purpose of this article was to review the currently accepted protocol sequence of treatment for parotid gland and duct injuries (Fig 2).