Parotid Duct Research Articles

Reconstruction of parotid duct using autologous vein graft and venous coupler

t a c e d d c esection of the parotid duct close to its orifice may be ecessary during ablative surgery particularly for buccal carinomas and malignant tumours in the buccal mucosa of the inor salivary glands. Management of the parotid gland after artial excision of the duct includes non-surgical conservative reatment,1 parotidectomy, or preservation of the remaining uct with microsurgical anastomosis2 using autologous vein rafts.3 Surgical repair of the duct avoids complications of sialocele and salivary fistula,4 and autologous vein grafts ave been successfully used to reconstruct the urethra, ureter, nd Stensen’s duct.5 We describe reconstruction of the parotid uct using an autologous vein graft anastomosed to the stump f the duct with a venous coupler after partial resection for a inor salivary gland tumour close to the orifice.

Sialoendoscopic Findings in Non‐lithiasic Sialoadenitis

Objective: Inflammatory swelling of the salivary glands without radiological findings of sialolithiasis may present a serious diagnostic challenge. A case study of 49 diagnostic sialoendoscopies performed on 44 patients (age: 10-62 years) affected by recurrent inflammatory swelling of salivary glands without radiological evidence of salivary stones is reported. Method: Intraoperative findings of 49 diagnostic sialoendoscopies attempted on 44 patients were reviewed. All patients experienced episodes of swelling of salivary glands. All patients showed no signs of salivary stones at the preoperative ultrasonography. The patients were contacted by telephone to investigate changes in the symptoms approximatively 6 months after sialoendoscopy. Results: Sialendoscopy revealed the presence of obstructive mucous plugs in 23 glands (14 submandibulars, 9 parotids) while ductal stenosis was found in 7 cases (2 submandibulars, 5 parotids). A combination of mucous plugs and stenosis was described in 12 glands. Parotid duct sialodochitis was diagnosed in 2 cases. In 1 case the avascular appearance of Stenson’s duct allowed the diagnosis of juvenile recurrent parotitis. Endoscopy revealed no disorders in 4 cases. Thirty-eight patients (77.5%) referred symptom relief at interview. Conclusion: Sialendoscopy is the procedure of choice in diagnosing chronic non-lithiasic sialoadenitis. Salivary duct dilation by irrigation alleviates the symptoms in these conditions.

Multiple calcifications within the parotid gland of patients with Sjögren's syndrome

PurposeThe purpose of this study was to investigate computed tomography (CT) and clinical features relating to calcifications within the parotid gland of patients with Sjögren's syndrome (SS). MethodsData from 30 patients with SS who had been examined by CT were extracted from our radiological information database accumulated from 2001 to 2011, and their CT images were reread carefully. Of these patients, 14 (all female; age range 20–95years; mean age 61.4years) with calcifications within the parotid gland were retrospectively investigated with CT findings. The relationship between calcification occurrence and clinical symptoms including parotid swelling and/or saliva colic was investigated. The degree of destruction of the parotid gland on CT images was also evaluated. ResultsAll calcifications of 14 patients were located within the parotid gland, not in the parotid duct. CT images of all calcifications showed small and regular round shapes. Multiple occurrences of calcifications were recognized in 10 patients, and a solitary occurrence was seen in 4 patients. Seven patients had bilateral calcifications. There was little relationship between the occurrence of calcifications and clinical symptoms, and the severity of destruction of the parotid gland. ConclusionThe presented CT and clinical features would be peculiar to SS because too many patients lacked the typical features of sialoliths within the parotid gland.

Dacryo salivary fistula. Unusual case of salivary fistula draining into the inferior fornix of the eye

Salivary fistula after a traumatic injury in the buccal region is not common. It is most commonly encountered in injuries involving the pre auricular region or soft tissues along the course of the parotid duct. It is more frequent in the parotid because its anatomical location is superficial; traumatic salivary fistulae of the other two major salivary glands are rare. This report presents an unusual case of a salivary fistula that occurred following trauma to the infraorbital region and drained into the inferior fornix of the left eye. A review of cases reported in the literature is presented. This is the only case of such a presentation the authors have found after a thorough search of the relevant English language literature.

Video-Assisted Resection in Mediofacial Lateral Tumors

Tumors that developed into the soft tissues of the cheek rising from the anterior prolongation of the parotid gland, minor salivary glands, and the masseter muscle are the most profitable with the use of video-assisted surgery.In the Department of Plastic Surgery at Argerich Hospital in Buenos Aires, Argentina, from 1999 to 2010, video-assisted approaches were used in the treatment of 158 patients, 16 of them presented tumors that developed into the tissues of the cheek.Intraoral approach such as natural orifice surgery was performed in 13 cases; in the other 3 cases, a preauricular incision was performed. Minor complications such as hematoma and transitory paresis of the superior buccal nerve were detected.Video-assisted technique offers both good illumination and excellent magnification, permitting not only a safe anatomic dissection by means of surgical maneuvers in avascular planes but also contributed to avoid injuries of facial nerve branches and secondary obstruction of the Stensen duct. On the other hand, when intraoral incisions are used, visible scarring is avoided; the uses of transoral areas are the most feasible approaches of natural orifice surgery.The outcome achieved with endoscopic techniques in mediofacial lateral areas has permitted to consider it as the first election in the surgical treatment in tumors that developed into the soft tissues of the cheek, offering more advantages than the classic approaches.

Acute bacterial suppurative parotitis of the neonate: A case report and review

We report a case of acute suppurative parotitis in a 16-day old infant presenting to an Emergency Department. Only 32 cases have been reported in English literature in the last 35 years. This is the first documented case in the United Kingdom. Clinical diagnosis was made on the basis of parotid swelling with purulent discharge from Stensen's duct. Samples sent for culture grew methicillin-resistant Staphylococcus aureus . The aetiology, pathogenesis and management of this infection are discussed.

Four-duct ligation in children with drooling

ObjectivesThe objective of this study is to assess the improvement in drooling in children undergoing 4-duct ligation procedure for excessive drooling and to study its effect on their quality of life. Materials and methodsA prospective, nonrandomized interventional study was done between November 2009 and September 2011. Thirty drooling children of both sexes aged 4 to 15 years underwent 4-duct ligation, that is, ligation of bilateral submandibular ducts and bilateral parotid ducts. Comparison of preoperative and postoperative drooling scores using Thomas-Stonell and Greenberg classification was done. Glasgow Children's Benefit Inventory Score was used to assess the improvement in the quality of life. ResultsSuccess rate in terms of improvement in drooling was 93.33%. A complication rate of 16.67% was found. The mean improvement in total drooling score after 12 months was 4.43. The paired t test applied on preoperative and postoperative combined drooling scores showed P < .001. The mean Glasgow Children's Benefit Inventory score was 36.15. In the postoperative period, transient swelling of cheeks, transient swelling of submandibular glands, change in the consistency of saliva, cheek abscess, collection of saliva in the cheek, and parotid duct fistula were observed. ConclusionsFour-duct ligation causes marked improvement in drooling and significantly increases the quality of life in drooling children. It has few complications, which can be managed effectively.

3D-FIESTA MRI at 3 T demonstrating branches of the intraparotid facial nerve, parotid ducts and relation with benign parotid tumours

To investigate the usefulness of three-dimensional (3D) fast imaging employing steady state precession (FIESTA) magnetic resonance imaging (MRI) at 3 T in evaluating the intraparotid components of the facial nerve and parotid ducts, and to compare the MRI images with surgical findings. Thirty-one cases of benign parotid tumours were studied with conventional and 3D FIESTA MRI sequences at 3T using a head coil. The most clinically useful 3D FIESTA images were acquired at parameters of 4.9 ms repetition time (TR); 1.5 effective echo time (TEeff); a flip of 55°, a field of view of 18 to 20 cm, a matrix of 512 × 320, an axial plane, no gaps, and a section thickness of 1 mm. Post-processed multiplanar images were obtained with an Advantage Windows (AW sdc 4.3) workstation. Parotid ducts, facial nerves, and tumours were identified on these images. The relationship of the tumours to the facial nerves and parotid ducts was confirmed at surgery. The facial nerves appeared as linear structures of low intensity. The main trunk of the facial nerve was identified bilaterally in 93.5% of the 3D-FIESTA sequence images. Parotid ducts appeared as structures of high intensity on multiplanar 3D-FIESTA images (100%). The relationships of the tumours with the cervicofacial and temporofacial divisions of the facial nerve were correctly diagnosed in 26 of 31 cases (83.9%) using 3D-FIESTA sequence images. 3D-FIESTA MRI at 3 T depicted the main trunk, cervicofacial and temporofacial divisions of the facial nerve, and the main parotid duct. It is useful for preoperative evaluation of parotid gland tumours.

Migratory sialocele after fine needle aspiration of the parotid gland

Sialocele is a subcutaneous collection which contains saliva. This collection is mainly developing at the area of parotid gland and it is evolving after trauma in this region or after a surgical procedure. During these procedures, a disruption of a duct or injury of the parenchyma promotes extravasation of the saliva and the formation of this collection in glandular or periglandular tissues [1]. This condition usually is a self-limited phenomenon and conservative measures are efficient in most of the times. Rarely, interventional measures like drainage of the collection and botulinum toxin injection or surgical management are needed [2, 3]. In this report, a case of a patient who developed a migrating sialocele after fine needle aspiration (FNA) for a Warthin tumor of the parotid gland is presented. This male patient 60-year old had a progressive bulge in his both parotid glands for approximately the last 10 years. The patient presented in our department with a painful swelling of his left gland after a diagnostic FNA 48 h before. This bulge was movable and the parotid duct in the affected side was normal and salivary flow had normal physical aspects without debris or purulent discharge. Imaging studies were performed. Ultrasound of the region revealed lesions in both of the glands. In the left gland, the lesion seems to be collection or abscess (Fig. 1). Moreover, a computed tomography (CT) of the cervix revealed a 3-cm tumor in the right parotid gland and two tumors in the left parotid gland approximately 1.0 and 1.3 cm in diameter (Fig. 2). CT and FNA results both confirmed that these tumors were Warthin tumors of the parotid gland type 2B. The patient was hospitalized and antibiotic therapy was administered. The fourth day after the FNA, this reddish bulge of the patient which located in the preauricular region in the left side of the patient moved distally to the cervix. The migration of this red bulge was continued and in approximately 6 h the bulge was located in the left sternocostal space. After this position, the bulge was progressively diminished. The presumptive diagnosis of this bulge in the left parotid gland site was initially the abscess from the previously performed FNA. But the rapid migration and disappearing of the bulge with complete loss of the symptoms and signs of inflammation just in few hours made the diagnosis of a sialocele as the most appropriate one. It seems that FNA generated an injury in Warthin tumor or the healthy part of the parotid gland and produced the collection of the saliva.

Stensen Duct Relocation After Cheek Mucosa Tumor Resection

Cheek mucosa cancer might surround Stensen meatus requiring preservation and relocation of the duct. Sialodochoplasty is necessary to avoid subsequent stricture, cheek swelling, and obstructive sequelae that could make following oncologic follow-up difficult. We report a simple successful technique of parotid duct cannulation and relocation in a 77-year-old woman who underwent cheek mucosa tumor resection for squamous cell carcinoma and free fasciocutaneous forearm reconstruction. Ability of milk clear saliva from the duct orifice after 6 weeks from surgery was assessed clinically, and no fistula or swelling was experienced. Stensen duct cannulation and relocation are a useful adjunctive procedure in the treatment of oral mucosa cancer, preserving salivary gland function while not compromising cancer resection.

Quadruple Salivary Duct Diversion for Drooling in Cerebral Palsy

Drooling complicates many neurologic disorders including cerebral palsy. It is socially debilitating for the patient and very tedious for the caregiver. Surgical treatment consists mainly of ablative (excision/ligation) or physiological (diversion) methods; combined techniques have also been proposed. We have applied bilateral diversion of both submandibular and parotid ducts in 12 cerebral palsy patients (age range, 7-15 years). Preoperative drooling severity was grade 4/5 in 10 cases and grade 5/5 in 2 of the cases. All patients underwent physiotherapy for a minimum of 6 months and were consulted with a dentist, otolaryngologist, and a speech therapist before surgery. No bleeding, hematoma, or infection has been observed in any of the patients. Two patients had early postoperative tongue edema that regressed with conservative treatment. All patients except one regressed to grade 2/5 drooling by the first postoperative month. In 1 patient who had previously been classified as grade 5/5, surgery provided limited improvement with only 1 grade of step-down. Satisfactory results for the patients and their families could be achieved and sustained for a median 18 months (7-20 months) of follow-up. In conclusion, the quadruple duct diversion method is an effective physiological surgical method in the control of drooling in cerebral palsy.

Infected Sialocele

Radiofrequency coagulation was introduced to reduce the volume of masseter muscle. Radiofrequency procedure causes focal necrosis in masseter muscles, which leads to muscle hypoplasia and a slender lower face. We present a case of a 24-year-old woman who underwent radiofrequency coagulation to reduce masseter muscles. The patient experienced progressive erythematous swelling and noticed the mass around the right cheek 5 days after the procedure. On radiologic evaluation, a round cavity of 4-cm diameter containing air and fluid was observed. Incision and drainage was performed, and antibiotics were administrated intravenously. Blood-tinged purulent fluid was obtained, which was subsequently found to have a high amylase level. The swelling subsided, and there is no relapse up to 6 months after drainage. There are several complications of radiofrequency coagulation reported such as mucoserous fluid collections, late bleeding, infections, long-lasting pain, Stensen duct injury, facial nerve injuries, and limitation of temporomandibular joint movement. A well-designed operation plan and skilled technique are required to avoid these complications.

Stent Reconstruction of an Injured Parotid Duct in a Thoroughbred Colt

To report successful use of stent repair for a chronically injured parotid duct in a thoroughbred colt. Clinical report. A 2-year-old thoroughbred colt. Chronic injury to the parotid duct was identified 4-cm caudal to the facial vessel notch on the ventral border of the right mandible. After careful surgical dissection of the surrounding firm fibrous tissue, the defect was temporarily stented using an 8-Fr human ureteral catheter (223600 ERU(®) SOFT URETERAL(®) , Laboratoires pharmaceutique, Betschdorf, France) to bridge the tissue loss. The rostral end of the catheter exited the oral cavity through a buccotomy stab incision at the level of the second premolar tooth of the maxilla. Primary wound healing occurred and the stent was maintained for 5 weeks with saliva drainage visible when the colt was fed. After stent removal, function was restored with good cosmesis. A tissue defect in the parotid duct can be repaired successfully by temporary use of a stent until wound healing occurs.

A preliminary answer to the question of whether cribbing causes salivary secretion

Abstract It has been hypothesized that cribbing, the equine oral stereotypy, may increase salivary production and, therefore, reduce gastric acidity in a species prone to gastric ulcers. To test the hypothesis that cribbing stimulates salivary secretion, parotid salivary duct fistulas were surgically created in 2 horses. In the first experiment, saliva was collected while the number of crib bites was counted. There was no significant relation ( r 2 = 0.022) between the numbers of crib bites and the volume of saliva produced. The second experiment involved measuring salivary output when one horse was cribbing and when he was eating, but could not crib. Before feeding, the horse produced 1 (0-2) mL of saliva while displaying 20 crib bites. The horse produced 31 (2-212) mL of saliva while eating 200 g of grain. After eating, the horse produced 2 (1-10) mL of saliva while displaying 20 crib bites. There was a significant difference in saliva production associated with eating (Kruskal–Wallis statistic=12.42, P

Pneumoparotitis: A case report

Pneumoparotid is a rare cause of parotid enlargement. Pneumatic enlargement of the gland is caused by retrograde insufflation via Stensen's duct. Most reported cases have been managed conservatively, thus running a short course. We report on a case of a 48-year-old man with a chronic painful right facial swelling and symptoms of repeated infection. Clinical examination found a parotid swelling with surgical emphysema and a dilated Stensen's duct. Pneumoparotitis with cystic changes and dilated intraparotid ducts was confirmed by CT. The patient proceeded to undergo excision of the gland, with subsequent resolution of symptoms. Repeated retrograde movement of air and contaminated saliva leads to chronic infection and sialectasis. Management is aimed at preventing these sequelae by identifying and addressing the insult early; however, repeated pneumoparotid leads to chronic pneumoparotitis, the management of which is excision of the gland.

Partial ligation of the transposed parotid duct at the level of the parotid gland for excessive salivary secretions

To determine the outcome and effect of a partial ligation of the transposed parotid duct at the level of the parotid gland in four dogs with excessive salivation and ocular irritation. Four dogs were previously diagnosed with absolute keratoconjunctivitis sicca. After a parotid duct transposition (PDT) surgery, these dogs experienced excessive saliva production and abundant salivary precipitates, which resulted in epiphora, moist dermatitis, blepharospasm, and keratitis. In an effort to decrease saliva production, a partial ligation of the transposed duct at the level of the parotid gland was performed. Two or three accessory branches to the primary parotid duct were ligated at the level of the salivary gland. The four cases were three Yorkshire terriers and a Chihuahua. The average age of the four patients was 2.5 years. Partial ligation of accessory branches of the parotid duct at the level of the parotid gland after a PDT in this study demonstrated improved ocular comfort, decreased salivary precipitates, and adequate Schirmer tear test results without marked epiphora in three of the four animals. The male Yorkshire had epiphora after the initial partial ligations of two accessory branches were placed at the level of the parotid gland. To correct the excessive salivary flow, two additional ligatures were placed at a later date, which resolved the epiphora. Partial ligation of the parotid duct at the level of the parotid gland proved to be an effective technique in moderating the salivation in these four patients with excessive salivary secretions after PDT.

Computational fluid dynamics for investigation of saliva pressure in parotid obstruction

OBJECTIVES/HYOTHESIS: Parotid obstruction is one of the most common problems affecting the parotid gland. We aimed to investigate the blockage ratio (BR) and the intraductal pressure change of Stensen's duct using computational fluid dynamics. Retrospective review of 16 patients who had undergone interventional sialendoscopy for parotid obstruction from 2009 to 2011. The three-dimensional configurations of Stensen's duct were reconstructed from computed tomography (CT) sialographic images. Finite volume modeling in fluid dynamics of parotid obstruction was used to analyze the pressure distribution under conditions of rest and stimulation. Intraductal pressure increased with increasing distance from the orifice. The upstream pressure was higher than that of downstream pressure in the same BR (P < .05). The upstream pressure increased as the BR increased. Statistically, the pressure turning point was indicated when BR = 60%. Only when the BR was much greater than 90% did the pressure reach 811.64 Pa, at which point patients could feel the painful swelling under the rest condition. Under the stimulated condition, the upstream pressure increased from 1.3- to 2.9-fold of that of the no blocking state when the BR increased from 80% to 90%, which may aggravate the obstructive symptoms. There was no significant difference observed for downstream pressure under the same condition (P > .05). CT sialography was effectively used for analysis of the intraductal pressure distribution in patients with parotid obstruction. Analysis of salivary fluid dynamics in Stensen's duct may provide a further pathophysiological mechanism for obstructive diseases.

Sihler-stain study of buccal nerve distribution and its clinical implications

The aim of this study was to elucidate the precise distribution of the buccal nerve (BN) and its anatomic relationship with the infraorbital nerve (ION) and mental nerve (MN). Eight human specimens were subjected to Sihler staining, which is a highly accurate method for visualizing the distribution of nerve fibers without alteration of the nerve. It was found that the BN mainly proceeded medially from its point of entrance near the parotid duct opening to the angular area of mouth, giving off tiny branches along its trajectory. Some of these branches were distributed in upper angular area, over the cheilion, intermingling with branches of the ION. Intermingling of the BN and the MN was also observed in the premolar area of the lower lip. This new information regarding the distribution of BN should be taken into consideration when evaluating the possible effects of BN damage.

Salivary duct carcinomas: clinical and CT and MR imaging features in 20 patients

Salivary duct carcinoma (SDC) is an uncommon high grade adenocarcinoma of the salivary gland with a grave prognosis. The aim of this study was to investigate the clinical and CT and MR imaging features of SDC. We retrospectively evaluated the clinical and CT and MR imaging findings in 20 patients (14 men and six women; mean age, 59years) with histologically proved SDC. We also tried to correlate clinicoradiological tumor staging with pathologic tumor staging in 17 patients who underwent surgery. The tumor originated in the parotid gland (n = 11; 55%), the submandibular gland (n = 7; 35%) and the buccal space along the distal Stensen's duct (n = 2; 10%). Locoregional recurrence occurred in 41% and distant metastasis in 47%. Fifty-eight percent died of the disease with a mean survival period of 32months after diagnosis. On CT and MR images, SDC was mostly seen as an ill-defined (85%) and infiltrative (60%) mass with frequent calcification (50%) and necrosis (80%). Although various signal intensities were seen on MR images, six of nine tumors contained the areas of marked hypointensity on T2-weighted images. Clinicoradiological tumor staging correlated well with pathologic tumor staging in 82% of the patients. Ill-defined, infiltrative mass with calcification on CT scans and the areas of marked hypointensity on T2-weighted MR images may be useful radiologic features to suggest the diagnosis of SDC. CT and MR imaging are useful for staging of SDC.

Foreign Body Reaction to Facial Dermal Fillers: Case Report

We present a patient who developed a delayed granulomatous reaction after injections of hyaluronic acid and bovine collagen glutaraldehyde that were introduced 6 and 4 years, respectively, previous to her present visit. She was a healthy 65-year-old woman, who was seen in November 2010 at the Columbia University Salivary Gland Center with a tentative diagnosis of a left buccal facial swelling caused by a "blocked parotid duct." The swelling was only slightly painful and had developed 1 month previously after a periodontal surgical procedure that involved the maxillary left quadrant. Questioning indicated that the swelling did not fluctuate in size nor had it changed its configuration since its sudden inception 2 days after the periodontal surgery. Visibly, the swelling was slightly erythematous. Palpation caused only mild discomfort and revealed the swelling to be quite firm in tone. The lesion involved the left facial buccal tissues, with its extraoral center corresponding to the intraoral location of the parotid duct orifice. The swelling was diffuse, with no definitive outline. It measured approximately 3 cm horizontally and 3.5 cm in height. Posteriorly, palpation of the left parotid gland revealed the gland to be painless, normal in tone, and not swollen. No swelling or discomfort was evident on the right side. No trismus was present.