Parotid Duct Research Articles

Obstructive Parotitis From Extraorally Introduced Foreign Body in the Stensen Duct

A rare phenomenon, the extraoral traumatic penetration of a foreign body into the lumen of the parotid duct, is described. The ensuing obstructive symptomatology and its diagnostic approach and therapy are reviewed.

Combined percutaneous ultrasound and fluoroscopic‐guided recanalization of stensen's duct

Laryngoscope, 124:659–661, 2014

Parotid Duct Foreign Body in a Dog Diagnosed with CT

A 12 mo old castrated male German shorthaired pointer was referred with a 3 mo history of a recurrent left-sided facial swelling. Contrast-enhanced computed tomography (CT) combined with a positive contrast sialogram revealed the presence of a thick-walled dilated region of the left parotid duct and a normal appearance of the parotid gland. The affected parotid duct, complete with grass seed foreign body, was surgically removed under general anesthesia, and the parotid duct was ligated leaving the parotid gland in situ. Twelve mo later, the dog was doing well with no reported complications.

Surgical Anatomy of the Middle Premasseter Space and Its Application in Sub–SMAS Face Lift Surgery

The premasseter space is a recognized, sub-superficial musculoaponeurotic system (SMAS) soft-tissue space overlying the lower masseter immediately anterior to the parotid. The performance, safety, and effectiveness of composite face lifts are enhanced when the space is used. This has drawn attention to the need for better understanding of the premasseter anatomy above the space. The anatomy of the upper premasseter region was investigated in 20 fresh cadaver dissections as well as intraoperatively in hundreds of composite face lifts. A small, transverse, rectangular soft-tissue space overlies the upper masseter and was named the middle premasseter space. The space (transverse width, 25 to 28 mm; vertical width, 10 mm) is separated from the originally described (lower) premasseter space by a double membrane. It is a safe space between the upper and lower buccal trunks of the facial nerve, which are immediately outside the space and separated from it by the respective upper and lower boundary membranes. The parotid duct immediately beneath the floor of the space usually underlies the upper boundary membrane. The middle premasseter space is significant, as it is the center of the key anatomy immediately cephalad to the lower premasseter space. When used in composite face lifts, the space provides predictable sub-SMAS dissection between the buccal trunks of the facial nerve to the mobile area beyond the anterior border of the masseter where the SMAS overlies the buccal fat pad.

Rhabdomyosarcoma of Stensen's Duct in Children

Stensen's duct is a very uncommon location for rhabdomyosarcoma. The purpose of this article was to review the clinical history of 2 patients who had rhabdomyosarcoma of Stensen's duct. We reviewed the clinical history, imaging studies, histologic analysis, and treatment of 2 patients with rhabdomyosarcoma of Stensen's duct. An 8-year-old boy (case 1) and a 17-year-old boy (case 2) presented with nonspecific facial swelling. In both patients, imaging studies showed a tumor at Stensen's duct, and biopsy showed embryonal rhabdomyosarcoma. Both patients were treated with preoperative chemotherapy, parotidectomy, and resection of Stensen's duct and postoperative chemotherapy and radiation therapy. Follow-up at 9 years (case 1) and 2 years (case 2) after surgery showed that the patients were free of disease. Stensen's duct rhabdomyosarcoma is rare and may have a better prognosis than rhabdomyosarcoma in other locations in the head and neck.

Keratocyst of the buccal mucosa: case report and immunohistochemical comparative study with sporadic intraosseous keratocystic odontogenic tumor

Describe a new case of keratocyst of the buccal mucosa and compare its immunohistochemical features with 13 sporadic intraosseous keratocystic odontogenic tumors (KOT). A male complaining about an enlargement on the left buccal mucosa was referred to the Stomatology Clinic. Clinical examination revealed a solitary nodule posterior to the parotid papilla. An excisional biopsy was performed following clinical diagnosis of epidermoid cyst. Microscopically, the lesion was characterized by a lining of five cell layers, with columnar basal cells and a corrugated parakeratinized surface. Immunohistochemical reactions for PTCH-1, Smo, Shh, mTOR, bcl-2, Ck17, and Ck19 were performed. PTCH-1 was not expressed in the keratocyst of the buccal mucosa, but was observed in suprabasal layers of eight (61.5%) cases of sporadic intraosseous KOT. Shh, mTOR, bcl-2, Ck17, and Ck19 expression was observed in all the cases investigated. The morphology and immunoprofile of this lesion are similar to sporadic intraosseous KOT.

A case of myoepithelioma emerging in the buccal region: verification of the primary site based on magnetic resonance imaging, computed tomography, histopathological, and anatomical findings

A case of myoepithelioma presumed to have arisen from an accessory parotid gland is reported. Preoperative fine-needle aspiration cytological findings suggested a malignant tumor, possibly an adenoid cystic carcinoma, while histopathological findings acquired during surgical resection revealed a myoepithelioma. The tumor was located adjacent to the Stensen duct, suggesting an accessory parotid gland origin. The diagnostic potential of magnetic resonance imaging and contrast-enhanced computed tomography in diagnosing this disease is discussed.

Effects of pre-incubation in sheep and goat saliva on in vitro rumen digestion of tanniferous browse foliage

SUMMARYA two-stage in vitro procedure was used for assessing the activity of parotid saliva to enhance rumen digestion of tanniniferous browse foliage. The procedure consisted of pre-incubation in saliva for 4 h at 39 °C followed by incubation in diluted buffered rumen fluid. Using this procedure, a study was conducted to examine the effects of pre-incubation in sheep (SS), quebracho-supplemented sheep (qSS) and goat (GS) parotid saliva or in McDougall's artificial saliva (AS, used as control) on in vitro rumen fermentation kinetics (estimated using the gas production technique) of browse foliage from six shrub species (Cytisus scoparius, Genista florida, Rosa canina, Quercus pyrenaica, Cistus laurifolius and Erica australis) collected over two seasons (spring and autumn), thus varying the in vitro digestibility (from 0·597 to 0·903) and tannin contents (from 3 to 130 g tannic acid equivalent/kg dry matter (DM)). Saliva was collected from four sheep and four goats fed alfalfa hay, and from four sheep fed the same alfalfa hay but supplemented with quebracho (rich in condensed tannins) for 60 d, through a cannula inserted in the parotid duct, and rumen fluid was always from sheep fed alfalfa hay. The extent of degradation when browse foliage was pre-incubated in qSS was similar to that observed with control AS (0·449 v. 0·452, respectively), and 8% less than the value with pre-incubation in SS (0·490). In vitro fermentation kinetics (gas production parameters) of browse foliage were not significantly enhanced with pre-incubation in qSS compared with SS, whereas in vitro digestibility and extent of degradation in the rumen were significantly reduced with qSS compared with SS. After pre-incubation in sheep and goat saliva, the extent of browse foliage degradation was significantly increased by 4–8% compared with pre-incubation in the control AS. Fermentation efficiency of browse foliage was increased (P<0·05) with pre-incubation in GS compared with SS. Sheep or goat saliva may have some activity to affect in vitro rumen fermentation of the foliage samples incubated, enhancing extent of degradation of tannin-rich browse. However, a relationship between the magnitude of this effect and the tannin content of the browse foliage could not be established, suggesting that sheep and goat saliva may not be particularly important in neutralizing tannins.

Conservation of salivary secretion and facial nerve function in partial superficial parotidectomy

Conventional total superficial parotidectomy (TP) has commonly been used, but partial superficial parotidectomy (PP) offers the possibility of better preserving glandular function and avoiding palsy of the facial nerves. In this study, the extent to which saliva secretion and facial nerve function were conserved in patients who received TP vs. PP was compared. Data were collected from patients who received a PP (n=163) or a TP (n=105) for benign primary tumours in the superficial lobe of the parotid glands between 1995 and 2009 at a single hospital. The incidence of transient facial paralysis was significantly lower in patients who received PP than in those who received TP. Secretory function was preserved for patients with a conserved Stensen's duct, whereas patients in whom the duct had been ligated lost secretory function. Partial superficial parotidectomy reduces the incidence of postoperative facial nerve dysfunction and is conducive to preserving Stensen's duct and saliva secretion.

Pneumoparotide : une étiologie rare de tuméfaction parotidienne récidivante

Pneumoparotid is a rare cause of recurrent parotid swelling. It is often fortuitous, caused by an action inducing intraoral pressure, increased or self-induced. An 8-year-old boy presented with recurrent right unilateral parotid swelling for 2 years. A CT-scan was performed, outside of the acute phase, which revealed the presence of intraparotid air bubbles. Pneumoparotitis results from air flowing back into Stensen's duct, due to an anatomical abnormality and a significant increase of intraoral pressure. The diagnosis is made on clinical examination, often completed by a morphological examination (cervicofacial CT-scan or parotid ultrasound investigation). The outcome is most often favorable, with symptomatic treatment, and sometimes antibiotic prophylaxis. Patient education is the best means to prevent recurrence.

English

INTRODUCTION: Face is essential to express emotion, consciously or unconsciously. The face plays a crucial role in determining a person’s character with a single glance. Given that the face plays an important part in an individual’s life. Surgeries performed on any part of the face, be it a parotid glad removal, facial reconstructive surgery or a cosmetic surgery, have become quite frequent and incredibly popular. The popularity continues to rise with general surgeon, oro-maxillo-facial surgeons, dental surgeons, oto-rhinolaryngologists, and plastic surgeons performing a wide range of operations such as parotidectomy, rhytidectomy, surgeries in the submandibular region and mandibular ramus fractures. MATERIALS: Study on the intraparotid course of facial nerve had been conducted in 50 specimens of face. Of 17 male and 8 female cadavers, in the Institute of Anatomy, Madras Medical College, Chennai. RESULTS: There was only one trunk in all the specimens (100%). The facial nerve in all the specimens had two major division, upper temporofacial and lower cervicofacial division. In 92% of specimens the buccal branch arose from these two divisions. In 8% of specimen the buccal branch had an additional contribution by a central branch which came directly from the trunk. In 64% of specimens the buccal branch was found to be inferior to parotid duct. The buccal branch was below the line joining the tragus and ala of nose. The marginal mandibular (MMB) branch was one to four in number. The marginal mandibular branch was usually below the inferior border of mandible. The mean distance between the marginal mandibular branch and inferior border of mandible was 10.76 mm. The marginal mandibular branch crossed the facial artery mostly superficially. The MMB had no anastomosis with other branches, but minimal percentage of anastomosis with the buccal and cervical branches. The temporal branch was within the line joining the tragus and lateral palpebral commissure. The extra parotid ramification (branching of facial nerve) was approximately 55% of LPL. CONCLUSION: Knowledge of the results obtained in this study may help to decrease the iatrogenic injury to the facial nerve during removal of Parotid gland, and face lifting surgeries.

Minor Salivary Gland Neoplasm in Children

In this article, we present a review of the literature, and we focus on 2 particular cases of cancer of the salivary glands accessory in pediatric patients The accessory parotid is the site of congenital and acquired lesions. In adults, the acquired lesions are often neoplastic and are usually similar to those seen in the main parotid gland. The disorders in children are less well defined, as only a few cases have been reported.The accessory parotid gland, or accessory parotid, is a nodule of normal salivary tissue separated from the main parotid gland, located on the masseter muscle, to which it is bound by an extension of the masseteric fascia and connected to the Stensen duct at that level. In contrast to the extensive literature on acquired lesions of the accessory parotid in adults, very few cases of malignant or benign lesions of the accessory parotid in children could be found in the literature. A review of several articles reporting lesions of the accessory parotid in adult patients, reporting 3 or more cases each for a total of 71 patients, showed 24 malignant neoplasms, 39 benign neoplasms, and 8 nonneoplastic lesions. Lesions of the accessory parotid are quite rare in children but should be considered when facing mass located in the cheek.

RECURRENT OBSTRUCTIVE PAROTITIS SECONDARY TO CONGENETAL KINK OF STENSEN’S DUCT

Parotitis is an inflammation of one or both parotid glands located on either side of the face. The parotid gland is the salivary gland most commonly affected by inflammation. Causes of parotitis include infections, blockage, autoimmune and diseases of uncertain etiology. Chronic parotitis is an insiduous inflammatory disorder involving the parotid gland. It is characterized by a recurrent and painful swelling of the affected salivary gland. Pain may be worse while eating due to the stress placed on the inflammed gland to secrete saliva. Blockage of the main parotid duct, or one of its branches, is often a primary cause of recurrent parotitis. The blockage may be from a salivary stone, a mucous plug, or, more rarely, by a tumor, usually benign. A very rare cause of blockage of pancreatic duct is kink in the duct may be due to congenital course of duct or due to hypertrophy of masseter muscle causing its kink. Sialography is most reliable technique to diagnose the cause and site of blockage. We present a case of 45-year-old female patient presented with recurrent pain and swelling of right parotid region. Her X-Ray lateral side of face was unremarkable. Her sialography revealed a kink in its course with dilatation of Stensen’s duct proximal to kink along with beaded appearance of duct.

Percutaneous Approach for Sialolith Removal in a Donkey

Salivary duct lithiasis is a condition characterized by the partial or total obstruction ofa salivary gland or its excretory duct due to the formation of sialoliths. A 9-year-old female donkey, belonging to the unique and endangered indigenous breed of donkey in Portugal, was diagnosed with a sialolith in the rostral portion of the right parotid duct based on clinical, oral, dental, and radiographic examination results. Surgical removal of the sialolith was done through a percutaneous approach.

Rhinosporidiosis in the parotid duct: a rare case report

Endemic to South India and Sri Lanka, Rhinosporidiosis is a chronic granulomatous infection caused by an agent of uncertain taxonomy: Rhinosporidium seeberi. Although it commonly manifests as a proliferative nasal lesion, many cases of Rhinosporidiosis have been reported where it has appeared as an extranasal lesion. The reported extranasal sites include the eye, ear, trachea, and parotid duct. However, the involvement of the parotid duct is quite rare, even among extranasal sites. The case presented is an adult female from the non-endemic zone of East India with a proliferative mass in the parotid duct. Although Rhinosporidiosis was not taken into consideration in the clinical differential diagnosis, eventual histopathological diagnosis confirmed Rhinosporidiosis. As this appears to be the second case of Rhinosporidiosis in the parotid duct in East India in 4years, we encourage clinicians to be flexible in the differential diagnosis of proliferative growth in the parotid duct, even in those from non-endemic areas.

Neonatal suppurative parotitis over the last 4 decades: Report of three new cases and review

Neonatal suppurative parotitis is a rare disease. Only 32 cases were reported in the English-language literature between 1970 and 2004. We searched Medline for acute, neonatal, bacterial, suppurative, parotitis, facial, preauricular swelling starting from 1970, limiting our search to the English-language literature. We reviewed all the reported cases together with three more managed in our department. We identified nine new cases since 2004. The total number of patients reviewed was 44, including our patients. Most of them were male (77%). The majority developed unilateral inflamed parotid swelling (77%) and exuded pus from the ipsilateral Stensen duct. Fever was seen in fewer than half of them (47%). Premature babies constituted a third of the patients. Staphylococcus aureus was the leading causative agent (61%). Most patients responded well to conservative treatment with antibiotics (77%). The most frequently used combination of antibiotics was an anti-staphylococcal agent with either an aminoglycoside or a third-generation cephalosporin. A minority required surgical drainage. No deaths were reported in the group studied after 1970. Neonatal suppurative parotitis is rare but easy to diagnose and if readily treated with appropriate antibiotics the outcome is excellent.

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.

Short- to medium-term effects of consumption of quebracho tannins on saliva production and composition in sheep and goats1

Eight Merino sheep (49.4 ± 4.23 kg BW) and 8 Alpine goats (53.2 ± 2.51 kg BW) were used to study the effect of ingestion of quebracho tannins on salivation. Four sheep and 4 goats were individually fed a daily allotment of 20 g DM of alfalfa hay/kg BW (Control). Another 4 sheep and 4 goats were also given 20 g DM of alfalfa hay/kg BW supplemented with 50 g of quebracho/kg DM (Tannin) for a period of 64 d. The saliva secretion from the left parotid gland was collected by insertion of a polyvinyl chloride catheter into the parotid duct and the amount of parotid saliva produced recorded over three 48-h periods on d 1 and 2 (P1), d 31 and 32 (P2), and d 61 and 62 (P3) after the tannin feeding was initiated. The total amount of saliva produced was estimated from rumen water kinetics determined on d 4, d 34, and d 64 of the experiment. Experimental design was completely randomized, with repeated measures on each experimental unit, performing separate analysis for sheep and goats. Parotid saliva production was not affected by the sampling period in either animal species receiving the Control diet. Corresponding values for sheep were 2.04, 2.12, and 2.27 L/d (P = 0.89) and for goats 1.65, 1.79, and 1.86 L/d (P = 0.95). Sheep fed the Tannin diet produced 55, 73, and 107% of the amount of saliva recorded in sheep fed the Control diet on P1, P2, or P3, respectively. Corresponding values in goats were 88, 130, and 134% on P1, P2, or P3, respectively. Estimated total saliva production was not affected (P = 0.50 for sheep and P = 0.97 for goats) by the ingestion of quebracho. There was no difference (P > 0.10) in osmotic pressure, P, Mg, Ca, urea, and protein concentrations in parotid saliva. There were, however, differences in Na and K concentrations in response to the ingestion of quebracho tannins, with Na concentrations increasing (P = 0.05) and K concentrations decreasing (P = 0.04) in sheep saliva and pH increasing (P = 0.05) in goat saliva. In conclusion, the inclusion of quebracho at 50 g/kg DM for 64 d does not appear to alter saliva production in sheep and goats.

Study of human adult parotid duct in the area of penetration through buccinator muscle and their functional relationship as a sphincter.

The adult human parotid duct is roughly 6-8 cm long. From the parotid gland, parotid duct traverses through masseter muscle, penetrates through buccinator muscle, and opens into the oral cavity. This unique form of the parotid duct is likely correlated with the function of the duct, directly affected by the movement of the buccinator muscle during mastication and swallowing. Histological structure of the duct is known to be different in each region, and details of smooth muscle present in the parotid duct are mostly unclear. In this study, we conducted SEM and histological observations of the area where the parotid duct penetrates the buccinator muscle, and an observation of smooth muscle to investigate its existence using alpha-smooth muscle antibody. We confirmed the presence of an abundance of skeletal muscle bundles likely originating from the buccinator muscle under the epithelium of the parotid duct wall in the region where it penetrates the buccinator muscle. We also observed that some of the muscle fibers were completely attached to the epithelium. We observed a lack of smooth muscle in this region of the duct wall. From these results, we suggest that the area of the duct penetrating buccinator muscle plays a role in regulating the salivary passage through the contraction of the surrounding buccinator muscle fibers.

Stone of Stensen's Duct Removal by Modified Blair Incision

타석증은 대부분 만성 타액선염과 동반되어 나타나는데, 환 자의 75%가 50~80대이고 남자에서 좀 더 호발하며 소아에서 는 드물다. 정확한 원인은 밝혀지지 않았으나 타액의 정체, 타 액관 상피의 염증과 손상, 칼슘염의 침착을 유발하는 생물학 적 요인 등이 제기되고 있다. 타석의 80%는 악하선에, 19%는 이하선에, 1~2%는 설하선 과 소타액선에 발생한다. 타석이 악하선에 더 많이 생기는 이유 는 몇 가지가 있다. 악하선관이 더 길고 직경이 크며 중력에 반 하여 각이 져 있어 타액의 흐름이 느리다. 또한 타액의 점도가 더 높고, 칼슘과 인 함량이 높은 것도 그 요인이 될 수 있다. 이하선에 타석이 생기는 경우는 흔하지 않아 임상에서 쉽 게 접할 수가 없다. 저자들은 반복되는 이하선 동통과 종창을 주소로 내원한 52세 여성에서 발견된 편측 이하선관 중복성 타 석증 1예를 이하선은 보존하고 외부 접근법으로 타석만을 제 거하여 문헌 고찰과 함께 보고하는 바이다. 증 례