Parotid Fistula Research Articles

Successful treatment of parotid fistula with tympanic neurectomy

Parotid fistula is a cause of great distress and embarrassment to the patient. A host of treatment modalities have been described in past but no unanimity exists regarding the most satisfactory of all. Tympanic neurectomy is an effective procedure for persistent parotid fistula with no significant side effects. To describe our experience with tympanic neurectomy for the treatment of persistent parotid fistula and discuss the other treatment modalities described. Tertiary care referral centre. Two cases with post traumatic parotid fistula recalcitrant to conservative therapy were treated with tympanic neurectomy between 2004-2005. The cases were followed up regularly for any recurrence of fistula. Successful and immediate cessation of flow from parotid fistula with no recurrence in subsequent followup. Tympanic neurectomy is a safe and effective procedure for the successful treatment of persistent parotid fistula.

Parotid Fistula Complicating Surgical Excision of a Basal Cell Carcinoma: Successful Treatment with Botulinum Toxin Type A

The cheek is a common site for the development of cutaneous neoplasms requiring surgical management. It is one of the regions of the face least susceptible to procedural morbidity but deep dissections overlying the parotid gland or in the region of the parotid (Stenson’s) duct may cause trauma precipitating the formation of a parotid fistula to the skin surface. The parotid duct lies along a line drawn between the tragus and the middle of the cutaneous upper lip. The buccal branch of the facial nerve runs in close proximity to the parotid duct.

Using Botox to Treat a Mohs Defect Repair Complicated by a Parotid Fistula

Surgery near the parotid may disrupt its parenchyma or duct and cause either a sialocele or salivary fistula. The management of parotid sialoceles and salivary gland fistulas has been generally difficult with numerous methods described. Botulinum toxin A has many uses in the practice of oral and maxillofacial surgery. This case report describes the management of a parotid gland fistula complicating a Mohs defect repair of a squamous cell carcinoma (SCC). On our patient we used an “aggressive conservative” therapy with a pressure dressing, glycopyrrolate, and botulinum toxin A. The use of botulinum toxin A is increasing in the practice of oral and maxillofacial surgery. Besides its well-known use for cosmetic purposes, botulinum toxin can be used for multiple other indications including the treatment of bruxism, masseteric hypertrophy, muscle spasm, oromandibular dystonia, orofacial motor tics, and myofascial pain disorder. 1-3 By inhibiting the release of presynaptic acetylcholine at the neuromuscular junction, botulinum toxin A also can be used to treat salivary gland disorders including sialorrhea, salivary gland fistulas, and sialoceles. 4-8

Combined transdermal scopolamine and botulinum toxin A to treat a parotid fistula after a face-lift in a patient with siliconomas

A parotid fistula is a rare, extremely unpleasant disease. Patients with chronic pathologies of the facial soft tissues have a high complication rate after aggressive treatments. Alternative conservative treatments have recently been reported for this condition. The case is described of a parotid fistula following a face-lift in a patient affected by facial siliconomas. A 41-year-old Caucasian who had undergone repeated facial silicone injections developed a diffuse granulomatous reaction accompanied by facial disfigurement. Thirteen surgical operations were performed to remove the siliconomas and correct the deformities, the last of which was a face-lift. After this procedure, the patient developed a parotid fistula. Conservative treatment, consisting of a combination of transdermal scopolamine and botulinum toxin A injections, was adopted. These antisialogogues gradually reduced saliva secretion, thereby preparing the wound bed for a skin graft and eventual healing. The choice of conservative therapy, as opposed to a surgical approach, was made to avoid further risks in what was already a highly complicated condition. The use of this conservative approach is recommended to treat complicated cases of parotid fistula.

Dental sinus with parotid duct fistula: An unusual presentation

ABSTRACTinjury to the parotid duct is commonly missed which may lead to a fistula subsequently. an external duct fistula is distressing to the patient because of continuous dribble of saliva during mastication. management of established duct fistula is controversial with a variety of methods both conservative and operative being reported in the literature, each having varying degrees of success. reconstruction of the duct is not a good option because of its modest results. internal diversion of the opening is an innovative, simple method to correct this problem. we report the successful use of this technique in a case of distal parotid duct fistula associated with apical root abscess of maxillary molars with cutaneous sinus-an unusual presentation, with a brief review of the literature on the management of parotid fistula.

Dental sinus with parotid duct fistula: An unusual presentation

Injury to the parotid duct is commonly missed which may lead to a fistula subsequently. An external duct fistula is distressing to the patient because of continuous dribble of saliva during mastication. Management of established duct fistula is controversial with a variety of methods both conservative and operative being reported in the literature, each having varying degrees of success. Reconstruction of the duct is not a good option because of its modest results. Internal diversion of the opening is an innovative, simple method to correct this problem. We report the successful use of this technique in a case of distal parotid duct fistula associated with apical root abscess of maxillary molars with cutaneous sinus-an unusual presentation, with a brief review of the literature on the management of parotid fistula.

The role of botulinum toxin in postparotidectomy fistula treatment. A technical note

Purpose Parotid fistula is a well-known complication of parotidectomy or penetrating injury of the parotid gland. The management of parotid fistula has been controversial, and numerous conservative and surgical treatment methods have been described. Methods We report 3 cases of parotid fistula after partial parotidectomy, which were treated by botulinum toxin injection under electromyographic control into the residual substance of parotid gland. Results Complete healing of the fistula was achieved with a single botulinum toxin treatment in all patients. No side effects were observed after the treatment. The patients are disease-free after 21, 18, and 14 months, respectively. Conclusions In the considered cases, the localized injection of botulinum toxin into the parotid gland resulted to an effective and long-lasting treatment of postparotidectomy fistula.

Parotid fistulas: a review.

A series of 17 cases of parotid fistulas seen at one hospital over a 10-year period is presented with detailed analysis of aetiological factors, clinical presentation and therapy. Distinctions between glandular and ductal fistulas have been enumerated and the poorer prognosis of the ductal fistulas, especially of the proximal part, is emphasized. Two-thirds of the fistulas were iatrogenic. Malignancy and oral leucoplakia were unusual causes. Direct duct suture is rarely successful. Ablative surgery carries a significant risk of facial nerve injury. A wide choice of treatment exists for glandular and distal duct fistulas, while for the proximal duct injuries excision is usually necessary. A new alternative operation of vein grafting for such cases is described. Successful closure is obtained in only 50 per cent of patients with long standing fistulas with any method of treatment.

Radiation Therapy for Post Parotidectomy Fistula

The incidence of parotid fistula following the surgery has been reported to be about 14%. The parotid fistula can be a very troublesome problem for the patient as it compromises the quality of life. It may result in wound dehiscence, and infection. Though several treatment modalities have been described in the literature but there is no consensus. The various management options include complete parotidectomy, tympanic neurectomy, radiation therapy, pressure dressings, anticholenergics and, of late, local injection of botulinum toxin. Radiation therapy had been in use as early as in 1936, but the number of cases is too scanty to make this as established modality. We describe a case of postparotidectomy fistula successfully treated by external beam radiation therapy.

Effect of Parotid Saliva Secretion on Dry Forage Intake in Goats

Research was carried out to clarify whether a suppression of dry forage intake during the early stages of feeding in ruminants is caused by feeding induced hypovolemia which is produced by the accelerated secretion of parotid saliva. Goats with a parotid fistula were fed roughly crushed alfalfa hay cubes, commercial ground concentrate feed and NaHCO 3 twice daily (10:00-12:00, 16:00-18:00). The animals were free access to drinking water all day prior to, during and after experiments. The animals were intraruminally infused every day prior to the morning feeding period with parotid saliva collected from the parotid fistula over a 24 h period. The present experiment consisted of two treatments, non-infusion (RNI) and intraruminal infusion of parotid saliva (RSF). In the RSF treatment, 4-5 kg of parotid saliva (280-290 mOsm/l) collected over a 24 h period was intraruminally infused 1 h prior to the commencement of the morning feeding. During feeding, eating and parotid saliva secretion rates were measured. Blood samples were also periodically collected from the jugular vein. During and after 2 h feeding, water intakes were measured, respectively. These measurements were used to define thirst levels. It is thought that rumen fill in the RSF treatment was higher than the RNI treatment. Plasma osmolality in the RSF treatment increased in the first half of the 2 h feeding period due to the intraruminal infusion of parotid saliva. Therefore, parotid saliva secretion rates in the RSF treatment were lower than the RNI treatment for 30 min period from 30 to 60 min after the commencement of feeding. On the other hand, plasma total protein concentration and hematocrit in the RSF treatment decreased by 3.2 and 3.3% prior to the commencement of feeding due to the intraruminal infusion of parotid saliva. In the first half of the 2 h feeding period, plasma total protein concentration and hematocrit in the RSF treatment showed a tendency to decrease compared to the RNI treatment. Thirst level in the RSF treatment during feeding was approximately 31.3% less than the RNI treatment. Upon the completion of the 2 h feeding period, cumulative feed intake in the RSF treatment was significantly larger (19.7%) than the RNI treatment. The results suggest that a suppression of dry forage intake during the early stages of feeding in goats is partly caused by feeding induced hypovolemia, which is produced by the accelerated secretion of parotid saliva.

Effects of Intraruminal Saliva Flow on Feed Intake in Goats Fed on Alfalfa Hay Cubes

Research was carried out to ascertain whether or not the volume of saliva flowing into the rumen regulates dry forage intake in ruminants. Goats with a parotid fistula were fed roughly crushed alfalfa hay cubes, concentrated beef cattle feed and NaHCO3 twice daily (10:00-12:00, 16:00-18:00). Except for the days on which experiments were conducted, the animals were free access to drinking water. The animals were intraruminally infused every day prior to the morning feeding period with parotid saliva collected from the parotid fistula over a 24 h period. The present experiment consisted of three treatments, non-infusion (NI), intraruminal infusion of parotid saliva (RSI), and intraruminal infusion of warm water (RWI). In the RSI treatment, approximately 4-5 kg of parotid saliva (280-290 mOsm/l) collected over a 24 h period was intraruminally infused 1 h prior to the commencement of morning feeding. In the RWI treatment, parotid saliva was substituted for warm water (36°C). After infusions, the animals were fed on roughly crushed alfalfa hay cubes for 2 h. During feeding, eating and saliva secretion rates were measured. Blood samples were also periodically collected from the jugular vein. After 2 h feeding, water intake was measured for 30 min. These measurements were used to define thirst levels. On the day of the experiment, the animals were not access to drinking water during the morning feeding. It is thought that rumen fill in RSI and RWI treatments was higher than the NI treatment. In comparison with the NI treatment however, cumulative feed intake increased by 39.3% with RSI treatment and by 45.9% with RWI treatment after completion of the 2 h feeding period. After 2 h feeding, thirst level in the RSI treatment showed only a 10% decrease compared to the NI treatment, but thirst level in the RWI treatment decreased 49.8%. Despite the significant differences in thirst levels between RSI and RWI treatments, the cumulative feed intake in both treatments was similar. When comparing accumulated saliva secretion volumes 2 h after feeding, volumes in the RSI treatment were significantly 35.9% lower than the NI treatment while volumes in the RWI treatment were unchanged. However, the volumes of saliva and fluid flowing into the rumen were greater in both RSI and RWI treatments when compared to the NI treatment. The results indicate that the amount of saliva flowing into the rumen is a factor regulating feed intake in ruminants fed on dry forage. (Asian-Aust. J. Anim. Sci. 2002. Vol 15, No. 12 : 1738-1746)

Late Radiation Side-Effects in Three Patients Undergoing Parotid Irradiation for Benign Disease

We report three patients in whom standard radiation therapy was given and serious late radiation damage was seen.The first patient suffered recurrent parotiditis and a parotid fistula. He was treated initially with 20Gy in ten fractions via a 300kV field. Further irradiation was required 1 year later and 40Gy was given in 2Gy fractions by an oblique anterior and posterior wedged photon pair. Ten years later he developed localized temporal bone necrosis. The second patient, with pleomorphic salivary adenoma, developed localized temporal bone necrosis 6 years after 60Gy had been given using standard fractionation and technique. The third patient received 55Gy in 25 fractions for a pleomorphic salivary adenoma and after 3 years developed temporal bone necrosis. Sixteen years later the same patient developed cerebellar and brainstem necrosis.All patients developed chronic persistent infection during or shortly after the radiation therapy, which increased local tissue sensitivity to late radiation damage. As a result, severe bone, cerebellar and brainstem necrosis was observed at doses that are normally considered safe. We therefore strongly recommend that any infection in a proposed irradiated area should be treated aggressively, with surgical debridement if necessary, before radiotherapy is administered, or that infection developing during or after irradiation is treated promptly.

A device for applying postsurgical pressure to the lateral face

Objective. The purpose of this study was to improve the effect of pressure applied on the lateral face after operations, particularly after parotid surgery for prevention of complications, especially the formation of salivary fistula. Study Design. A pressure instrument (face pad) was designed to fit all types of facial morphology. The blood flow velocity of the superficial temporal artery was measured by means of a Doppler detector in 30 healthy volunteers under 2 different conditions, with and without the face pad. Values for 2 parameters, peak velocity and average peak velocity, were determined for the purpose of selecting an appropriate pressure. Each of 47 patients who had undergone regional parotidectomy received pressure with the face pad for 3 days; the results were compared with those in a control group of 44 patients who had undergone similar operations but received traditional packing dressings. Results. The peak velocities of the superficial temporal artery with and without the face pad were not significantly different ( t = 1.541, P = .132) when a pressure value of 4 to 5 N was applied. However, the average peak velocity of the superficial temporal artery increased significantly ( t = 3.678, P = .001) with the face pad. The 47 patients with the face pad had no postoperative parotid fistula; in contrast, salivary fistula developed in 5 of the 44 control cases, for an overall fistula rate of 11.36%. A significant difference existed between the 2 groups ( P = .023). Conclusions. The face pad worked quantitatively and was stable and comfortable. A pressure of 4 to 5 N on the lateral face did not influence the blood flow of the superficial temporal artery. The higher peak velocity was correlated with regional stenosis of the temporal vein caused by pressure. Evidently, the face pad can reduce postoperative complications after parotidectomy; moreover, it makes pressure dressing easy and shortens the in-hospital days of the patient as well. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:303-6)

Frey syndrome before Frey: the correct history.

To review the chronology of publications on gustatory sweating before Frey's landmark publication. Reports on Frey syndrome were reviewed, and all references given to publications before 1950 were obtained and examined. References to prior publications in the obtained articles were similarly reviewed. The cases described in these publications were analyzed for their compatibility with the accepted clinical symptoms of Frey syndrome. Despite numerous references, the case described by Duphenix in 1757 is most probably a traumatic parotid fistula. The first reported case of Frey syndrome should be attributed to Baillarger in 1853.

Carbenoxolone does not cause a syndrome of mineralocorticoid excess in sheep

These studies investigated whether treatment with carbenoxolone (CBX), an inhibitor of 11β-hydroxysteroid dehydrogenase (11β-HSD), resulted in an enhanced mineralocorticoid response to endogenous or infused cortisol. In conscious sodium replete sheep with a parotid fistula, infusion of CBX (40 mg/h for 10 days) did not increase mean arterial pressure, or change sodium and potassium status or plasma renin concentration, but significantly increased the half-life of 1, 2[ 3H] cortisol from 18.6 ± 4.0 to 38.8 ± 3.9 min ( p < 0.05) and reduced the blood clearance rate of cortisol (BCR) from 31 ± 3 to 15 ± 4 L/h ( p < 0.01). The reduction in cortisol BCR was associated with reduction in cortisol secretion rate from 433 ± 116 to 181 ± 79 nmol/h ( p < 0.01). Cortisol (8 mg/h) for 5 days increased mean arterial pressure (from 83 ± 2 to 101 ± 5 mmHg, p < 0.001) and caused natriuresis, hypokalaemia and hyperglycaemia. These responses were unaltered when cortisol was infused from the fifth to the tenth day of CBX infusion. These findings suggest that in sheep, carbenoxolone is either a less potent inhibitor of 11β-HSD2 than in other species or 11β-HSD2 may not be the only mechanism, which determines the specificity of the MR.

Forebrain lesions that disrupt water homeostasis do not eliminate the sodium appetite of sodium deficiency in sheep

Brain structures located within the anterior wall of the third brain ventricle (subfornical organ, median preoptic nucleus and organum vasculosum of the lamina terminalis) are known to be involved in thirst as well as other aspects of body fluid and electrolyte balance. The present studies evaluated the role of these structures in the Na appetite of mildly or moderately Na-depleted sheep (sheep with a parotid fistula deprived of Na solution for 22 or 46 h). In addition, the role of these structures was tested in mildly Na-depleted sheep in which the Na appetite was enhanced by decreasing cerebrospinal fluid and brain extracellular fluid Na concentration (i.e., i.c.v. infusion of hypertonic saccharide solution) or was decreased by systemic infusion of hypertonic saline. The results indicated that sheep with lesions which reduced or eliminated daily water intake or water intake in response to hypertonicity of body fluids had, in all situations tested, appropriate changes in Na appetite (i.e., similar to their prelesion changes). Thus, the present experiments demonstrated that the brain areas involved in thirst as well as other aspects of body fluid and electrolyte balance are anatomically different from those involved in regulating Na appetite.

MANAGEMENT OF TRAUMATIC PAROTID SIALOCELES AND FISTULAE: A PROSPECTIVE STUDY

A prospective study of 13 patients with traumatic parotid fistulae or sialoceles showed that 54% resolved on conservative management within a 3 week period. Those that did not were treated by internal surgical drainage with uniform success, although care had to be taken with the catheter placement. No factors predictive of those cases requiring operative drainage other than failure of conservative management were found.

Sodium and water intake of sheep, rabbits and cattle during ICV infusion of eledoisin

The present study reports the effects of ICV administered eledoisin, the most potent anti/dipsogenic member of the tachykinin family, in three species. Sheep with chronic parotid fistula lost daily 200–400 mmol sodium in 3–41 of saliva. During ICV infusion of eledoisin, 2 to 50 ng/min, a decrease in sodium intake was observed. If water was withheld for 22 hours, sheep normally drank 5.41 water on presentation. During ICV infusion of eledoisin, 50 ng/min, water intake increased significantly. Wild rabbits lost 5 mmol sodium in 50 ml of urine after injection of furosemide. During ICV infusion of eledoisin, 30 ng/min, a decrease in sodium intake and an increase in water drinking was observed. Cows prepared with parotid fistula had access to sodium solution every other day to replace salivary sodium loss. During ICV infusion of eledoisin, 50 and 150 ng/min, a decrease in sodium intake occurred, and water intake was unaffected. These results confirm that central administration of eledoisin specifically influences ingestive behaviour in mammals and draws attention to some species differences in the observed effects.

The effects of sodium appetite on the responses of cells in the zona incerta to the sight or ingestion of food, salt and water in sheep

Single-unit recordings were made from neurones in the zona incerta (ZI) of conscious sheep in response to the sight/visual approach or ingestion of various foods, salts and water. Animals were given parotid fistulae so that effects of sodium appetite, induced by not replacing the sodium lost in the saliva, could be assessed. When sodium depletion was prevented by giving the animals 1% sodium bicarbonate in their drinking water, the majority of cells (45 out of 49) responded most strongly to the sight or visual approach of food compared to water or salt. Four cells responded best to the sight of water, but none to the sight of salt and salt solutions. When a sodium appetite was stimulated, by removing the 1% sodium bicarbonate replacement for 4–6 days, there was a significant change in response profiles of ZI cells. The majority of cells responded most strongly to the sight of salts or salt solutions (35 out of 49) and significantly fewer cells responded most strongly to food (8 out of 49). The number of cells responding primarily to water was not affected (6 out of 49). For 3 cells responding to salts it was shown that, after repeated ingestion of salt over several hours, food became a more potent stimulus. A similar decreased response to foods during sodium depletion, and an increased one to salts, was seen in ZI cells which responded to the ingestion of both solids and liquids. These results show that changing an animal's motivational state produces significant changes in the responses of cells in the ZI responding to the sight or visual approach of substances. It is clear that the effects of sodium appetite, on at least some cells, is to reduce the potency of food as a stimulus and to increase that of salt, suggesting that they are not substance specific. However, a minority of cells still respond specifically to foods, or liquids, and there is the possibility that there is additional recruitment of cells responding specifically to salt.

A parotid fistula and sialocele complicating temporomandibular joint surgery

A case of a persistent parotid fistula and sialocele following temporomandibular joint surgery is described. This rarely reported complication is postulated to result from pre-existing bucco-masseteric obstruction of parotid outflow causing raised intraductal pressure in the patient. Following unsuccessful conservative management, the patient was cured by a 5-day course of restricted oral intake and propantheline bromide.