Management Of Parotid Duct Injuries Research Articles

DS28 In search of salivation? Management of parotid duct injury following Mohs micrographic surgery

Abstract Parotid duct injury is a rare complication of cutaneous surgery usually occurring after excision of deep infiltrating tumours on the cheek. The existing literature is limited to case reports. We present our experience of two cases encountered in our unit over the last 15 years. Our first patient was an 87-year-old man referred for Mohs excision of a biopsy-confirmed morphoeic basal cell carcinoma (BCC) on his right cheek. During tumour extirpation, it was necessary to sacrifice a short section of the parotid duct. This was confirmed by direct visualization of the duct and a visible salivary leak. Immediate referral was made to the plastic surgery department, who also noted ipsilateral weakness in the distribution of the buccal branch of the facial nerve. The parotid duct was repaired over a lacrimal stent secured to his buccal mucosa. The wound was reconstructed with a large rhombic transposition flap and the parotid gland infiltrated with botulinum toxin. Four weeks later, the salivary stent had spontaneously fallen out and fresh-looking saliva was noted emerging from the parotid ampulla. Our second patient was a 65-year-old man referred for Mohs excision of a 3-cm nodular BCC on the left cheek. During tumour extirpation, a short section of the parotid duct was resected, which was clearly visible in the Mohs layer. On this occasion, the patient was referred to colleagues in the maxillofacial surgery department who attended the dermatology surgical unit. Under local anaesthesia, the parotid duct was cannulated using an epidural catheter secured both intraorally and to the residual duct using an absorbable monofilament suture (intraoperative pictures will demonstrate the technique). The Mohs defect was reconstructed with a bilobed transposition flap. Hyoscine patches were supplied to help reduce salivary flow. Marked swelling of the parotid gland developed postoperatively, which settled without further intervention. After 4 weeks, the epidural catheter was removed, and saliva was noted to be flowing from the parotid ampulla. Weakness of the lip elevators was noted in keeping with facial nerve injury. Despite the infrequency of parotid duct injury, it is important that cutaneous surgeons/Mohs surgeons are aware of how to proceed in these cases. In cases where assistance is not available from other specialties, the technique could be undertaken by an appropriately trained dermatological surgeon/Mohs surgeon using local anaesthesia.

Surgical Management of Parotid Duct Injury Using a Feeding Tube.

The parotid duct (Stenson's duct) can be damaged during traumatic injuries and surgical interventions. Early diagnosis and treatment of a duct injury is of great importance because complications such as sialocele and salivary gland fistula may develop if the duct is not surgically repaired. We think that the feeding tube is an ideal material in the parotid duct repair because of its technical characteristics, availability, and low cost. In this article, we described the use of a feeding tube for the treatment of a parotid duct rupture in a facial stab wound laceration, as it is a low-cost and easy-to-access material readily available in every operating room.

A novel technique in the treatment of post traumatic parotid duct sialocele

<p>Stenson's duct of parotid gland is a major duct which drains saliva into the oral cavity. Deep penetrating wound in the form of cut or crush injury to the buccal area carries the risk of parotid duct injury. It is in the form of ductal exposure, laceration, total severing, or crushing of the duct. These conditions are difficult to diagnose because of complex anatomy and variable nature of injury. Successful management of parotid duct injury depends on early diagnosis and appropriate intervention, failing of which may lead to complications like sialocele or salivary fistula. Many techniques have been proposed for diagnosis and management of parotid duct injuries. This article presents an easy and an innovative technique to diagnose and manage the parotid duct injuries using an "epidural catheter" which is often used for inducing spinal anesthesia. The technique of epidural catheter usage, its advantages, and limitation over other techniques proposed for the management of parotid duct injury are discussed. </p>

Surgical management of Stenson′s duct injury using epidural catheter: A novel technique

Stenson's duct of parotid gland is a major duct which drains saliva into the oral cavity. Deep penetrating wound in the form of cut or crush injury to the buccal area carries the risk of parotid duct injury. It is in the form of ductal exposure, laceration, total severing, or crushing of the duct. These conditions are difficult to diagnose because of complex anatomy and variable nature of injury. Successful management of parotid duct injury depends on early diagnosis and appropriate intervention, failing of which may lead to complications like sialocele or salivary fistula. Many techniques have been proposed for diagnosis and management of parotid duct injuries. This article presents an easy and novel technique to diagnose and manage the parotid duct injuries using an "epidural catheter" which is often used for inducing spinal anesthesia. The technique of epidural catheter usage, its advantages, and limitation over other techniques proposed for the management of parotid duct injury are discussed.

Parotid duct repair using an epidural catheter

The anatomy of the buccal region of the face is complex and injuries in this region can lead to significant complications. Trauma in this region can easily injure the parotid duct and facial nerve. The management of parotid duct injuries is usually by microsurgical anastomosis, diversion of salivary flow by creating an oral fistula, or suppression of salivary gland function. The authors present a case of parotid duct injury treated by using an epidural catheter.

Management of Parotid Duct Injuries

Management of Parotid Duct Injuries

Management of parotid duct injuries

Injuries to the buccal region of the face can carry multiple complications due to the complex anatomy that lies within. The facial nerve and the parotid duct can be easily injured by sharp or penetrating trauma to the cheek. The purpose of this paper is to present the full spectrum of current treatment modalities available to manage these injuries. The anatomy of the parotid gland and duct are described, and surgical techniques and therapeutic alternatives for the immediate and delayed treatment of the parotid duct injuries are reviewed. Clinical cases are presented to illustrate the treatment options outlined.

Parotid duct injury: is immediate surgical repair necessary?

This prospective study investigated the outcome for non-operative management of parotid duct injuries in 19 patients with injury confirmed by the methylene blue method. Nine (47 per cent) healed without complications. Short-term salivary fistulas complicated seven (36.8 per cent) wounds and a sialocele occurred in four (21.1 per cent). All complications resolved without the need for operative intervention. Acute surgical repair of damaged ducts can no longer be recommended, since conservative management of parotid duct trauma is both safe and effective; simple surgical procedures exist for the management of the rare long-term disorders.