Parotid Duct Injuries Research Articles

Management of parotid sialocele after facial trauma creating a transoral salivary fistula: two case reports

Sharp penetrating trauma of the face, besides causing a cosmetic defect, may also injure deeper anatomic structures. Lacerations in the cheek region may involve branches of the facial nerve, parotid gland or its duct, and vascular structures such as the transverse facial artery. Failure to recognize a parotid duct injury may result in the formation of a sialocele or cutaneous fistula. We describe a simple technique using intravenous tubing for the management of a persistent parotid sialocele.

Parotid Duct Injury in Temporalis Tendon Transfer

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.

Stensen's duct injuries: the role of sialendoscopy and adjuvant botulinum toxin injection.

IntroductionStensen's duct injuries are uncommon but troublesome sequelae of facial surgery or other external traumas.AimTo investigate the feasibility of sialendoscopic control of Stensen's duct in iatrogenic injuries and the efficiency of botulinum toxin adjuvant therapy.Material and methodsIn 2008 and 2010, 5 patients with parotid sialoceles or fistulas, infrequent complications after plastic surgery or trauma, were treated in a single institution, Poznan University of Medical Sciences ENT Department. The group consisted of 5 patients with diagnosed Stensen's duct injuries, which were post-surgery and post-traumatic sequelae. All were treated by means of open surgery. Botulinum toxin injection was administered during the procedure to decrease the saliva secretion and to improve the healing process. A sialendoscopy was performed to control the lumen of the junction after the duct injury was repaired.ResultsComplete healing of the fistulas and sialoceles after the reparative surgery followed by a single botulinum toxin application was observed in all patients within 10-14 days. No side effects were noticed.ConclusionsOur findings suggest that sialendoscopy is a valuable tool and an important step of control in the surgery of parotid duct injuries and the injection of botulinum toxin is an effective and safe second-line treatment.

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.

Salivary Gland Trauma: A Review of Diagnosis and Treatment

Salivary gland trauma is uncommon. Parotid gland and duct injuries are far more common than injuries to submandibular and sublingual glands due to anatomic position. Several methods of treating salivary duct injuries and their complications have been advocated. Optimal treatment outcomes can be achieved with early diagnosis, adequate evaluation, and proper management. This article presents current diagnostic and treatment protocols of salivary gland trauma. The anatomy of the salivary glands is briefly described and clinical cases are also presented to illustrate the treatment options described.

Redefining the Surface Anatomy of the Parotid Duct

The surface anatomy of the parotid duct is important when assessing facial lacerations and in facial rejuvenation surgery but is inconsistently described in reference texts. The aim of this study was to map the surface anatomy of the adult parotid duct using ultrasound. Fifty healthy adults (31 women; mean age, 33 years) were scanned by an experienced sonographer using a 13-5 MHz linear probe and a Siemens Sonoline Antares ultrasound machine. The caliber, length, and course of the parotid duct were recorded bilaterally. The parotid duct was identified bilaterally in all participants. One subject had a double duct bilaterally. In the remaining 49 individuals (98 ducts), the duct had a mean maximum internal caliber of 0.6 ± 0.2 mm and length 42 ± 7.5 mm. Ninety-two (94 percent) ducts were below the most popular surface marking, which is reported as a line between the lower border of the tragus and mid philtrum. In 93 percent of individuals, the duct was within 1.5 cm of the middle half of a line between the lower border of the tragus and cheilion. A more accurate description of the surface anatomy of the parotid duct should assist with early diagnosis of parotid duct injuries and avoidance of iatrogenic injury. Diagnostic, IV.

Case series of parotid duct injuries, treatment and sequelae

Introduction: The aetiology of parotid duct injuries is thought to be frequently caused by penetrating injuries in the parotid region, blunt trauma, complication of parotid duct cannulation for sialography and intra-operative iatrogenic injuries (tumour resection.) Approximately 0.2% of patients presenting with a penetrating injury to the parotid region experience injury to the parotid duct.

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.

Three Cases of Surgical Repair of Traumatic Parotid Duct Injury

It is important to both recognize parotid duct injuries and immediately repair them to prevent complications that accompany these injuries. Although there have been some reports of successful conservative treatments of the parotid duct injury, many authors recommend early surgical repair of the parotid duct and, when possible, primary anastomosis as the best treatment. Sialography is very useful for the diagnosis of parotid duct injury and can also support the information of parotid duct system. We present three cases of successful treatment of parotid duct injury with surgical repair. Also, we discuss about the effectiveness of surgical repair of parotid duct injury and how to assess it preoperatively. � Korean J Otorhinolaryngol-Head Neck Surg 2011;54:77-80

The diagnosis and treatment of trauma to parotid duct

Objective To study the diagnosis and treatment of trauma to parotid duct. Methods The clinical data of 17 patients were retrospectively reviewed. The patients' records were reviewed for gender, ages,mechanism of injury, location, clinical symptoms, assistant examination, therapy and prognosis. Results Aage prediction for 20-29 (represented 58.82% of the total cases); the most location of the trauma were in duct over masseter muscle; the injuries were usually caused by knives. Sialography can be used to diagnosed parotid duct injuries. Anastomosis of parotid duct can achieve good prognosis. Conclusion It may be possible to restore the function of parotid gland by timely diagnosis and proper treatment of trauma to parotid duct. Key words: Parotid gland; Parotid duct; Trauma; Sialography

Traumatic Sialocele of Parotid Duct: Report of a Case with Review of Literature

Parotid gland or duct injury can be caused by assault with a knife, bottle, or more rarely, gunshot. Post-traumatic parotid gland and duct injuries are not common.The low rate of occurence of parotid injury may account for the missed diagnosis of parotid and duct injury on admission and, after a varying period, sialoceles or fistulas. This report describes a case of a post-traumatic sialocele of parotid gland. A review of the literature and description of the medical and surgical management options for these injuries are also provided.

Trauma Evaluation of the Parotid Duct in an Austere Military Environment

Evaluation of the parotid duct from trauma in an austere military environment can be challenging. Appropriate radiologic evaluation of a potential isolated parotid duct injury in this environment has not been reported. The use of a plain X-ray sialogram at the forward surgical team is demonstrated and may be beneficial in this setting.

Peroral drainage of post-traumatic sialocoeles: report of three cases

To discuss the technique and outcome of this simple procedure and the management of post-traumatic parotid sialocoeles, and to review the literature regarding this condition. We report the successful surgical treatment, by peroral drainage, of three patients with post-traumatic parotid sialocoele resistant to conservative management. We discuss the method and outcome of the surgical procedure performed, along with the causes, presentation and management of parotid sialocoele. Correct initial management of a parotid duct injury may prevent the formation of a sialocoele. When conservative treatment of post-traumatic parotid sialocoele fails, we advocate the surgical technique described in this report as it is effective, simple and carries minimal risk to the patient.

The Use of Botulinum Toxin in the Treatment of a Parotid Duct Injury During Mohs Surgery and Review of Management Options

Aggressive skin cancers on the cheeks may involve the parotid duct. For such tumors to be successfully removed, at least part of the parotid duct must be excised as well. Failure to properly address parotid duct injuries that result from Mohs micrographic surgery exposes the patient to a variety of adverse sequelae. To discuss the various diagnostic and treatment options that should be considered when managing parotid duct injuries that result from skin cancer extirpation. We describe a patient who sustained a parotid duct injury after Mohs micrographic surgery for treatment of squamous cell carcinoma. The patient was treated with intraparotid injections of botulinum toxin. Two weeks after treatment of the injury with botulinum toxin, the patient reported complete resolution of his symptoms. If a parotid duct injury is diagnosed at the time of tumor extirpation, then surgical repair of the duct should be attempted, but if surgical repair is not possible or if an injury remains unrecognized until well after tumor extirpation, then surgery is not necessary. In such cases, conservative, nonsurgical measures, such as treatment with botulinum toxin, will provide excellent results.

Prise en charge non chirurgicale des plaies de la glande parotide et du canal de Stenon : intérêt de la toxine botulinique

Salivary fistulas and sialoceles are rare complications of post-traumatic or postoperative parotid gland and duct injuries. Local injections of type A botulinum toxin represent a new and effective treatment for complications of these injuries, which is less invasive, stressful and lengthy than conventional methods. The authors report five cases in which three salivary fistulas and two sialoceles were successfully treated by botulinum toxin injections. The therapeutic protocol is described; it allows simple management of these complications and use of smaller doses than those described in the literature for treatment of sialoceles. The authors recommend use of botulinum toxin injections in first intention for management of salivary fistulas and sialoceles.

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.

Traumatic injuries to the parotid gland and duct

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).

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.

Parotid Gland and Facial Nerve Trauma

Included in this study are all patients with trauma to the parotid region seen at our center from 1979 to 1989. There was a total of five patients with injury to the parotid area: two patients with isolated facial nerve injury; one with isolated parotid duct injury; two with combined duct and nerve injury. There were four males and one female, with a mean age of 34 years (range, 16 to 62 years). The three patients with parotid duct injury required other procedures for associated trauma. A total of eight nerve branches were severed in four patients. Seven of the eight nerve branches (82.5%) were primarily repaired, with excellent functional results. Two of the three ductal injuries were repaired primarily over a stent, and one was ligated. No complications resulted from either treatment. Based on our clinical experience and review of the literature, we suggest that the treatment of parotid region injuries should include: 1) a complete initial assessment; 2) primary repair of parotid duct transection within 24 hours when possible; 3) primary repair of all facial nerve injuries, although delayed nerve repair remains a viable alternative; and 4) nonsurgical treatment of sialoceles and fistulae.