Iatrogenic salivary duct injury in head and neck cancer patients: report of four cases

Introduction: The lesions of the salivary ducts may be idiopathic, post-traumatic, or iatrogenic and lead to sialocele formation with persistent painful facial swelling or cutaneous fistula formation. The options of treatment of sialocele include needle aspiration, pressure dressings, antisialogogue therapy, or radiotherapy, botulinum toxin and surgical approaches as duct repair, diversion, ligation, different drainage systems and even parotidectomy/submaxilectomy. The management and special features of iatrogenic sialoceles in patients with oral cancer who underwent head and neck reconstructive surgery has not been described yet.

Materials and methods: Four cases of resection of squamous cell oral carcinoma with iatrogenic lesion of salivary ducts are described (cases of reconstruction with radial, temporal flaps and direct closure). The formation of sialocele was observed in three of four cases. In one case the parotid sialocele has resolved spontaneously by fistulization into oral cavity. In one case transoral drainage with a fixed intraoral cannula was performed. In one case the submandibular sialocele resulted from laser resection of the cancer of the floor of the mouth: the margin of resection resulted affected, thus the extension of surgical margins with bilateral selective neck dissection involving submandibular sialocele has been performed. In one case of surgery for oral mucosa cancer the silastic drain was fixed to the border of the surgical wound in oral mucosa after resection of distal end of Stensens duct thus avoiding sialocele formation.

Conclusions: The iatrogenic lesions of salivary ducts are to be taken into account in patients with oral cancer as the distal ends of salivary ducts could be involved in the margins of surgical resection. If the surgical trauma to the salivary duct is foreseen during the intervention the drain placement in the intraoral wound can facilitate the intraoral fistulization of saliva and prevent sialocele formation.

Key words: sialocele; oral cancer

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Jan 21, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Iatrogenic salivary duct injury in head and neck cancer patients: report of four cases
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