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.

Case reports and technique: We report two cases with left sided swelling of the cheek following a penetrating injury to the same area which had occur 1 month earlier, skin was distended and had a thin friable appearance. Ultrasonography and aspiration of the fluids content confirmed the presence of a sialocele. Each of these cases was treated with surgical drainage using a transoral approach under general anesthesia. Local anesthesia was infiltrated into the buccal mucosa. Intravenous tubing was inserted through the parotid papilla on the first case and towards the back on the second. The free end was sutured to the oral mucosa using non absorbable suture (nylon 4-0) and it was left in place for 3 and 2 months respectively to allow maturation of a new salivary tract directing saliva intraorally. The sialoceles resolved with no recurrence over a follow up period of 1 year on the first case and 2 months on the second.

Discussion : Many treatment modalities have been mentioned in the literature. They basically consist of a conservative or a surgical approach. When conservative management fails, or when the viability of the skin is imminently at risk, surgical treatment is indicated.

Conclusion: This procedure is quick and easy to perform, has a low morbidity rate and is highly effective.

Key words: parotid sialocele; intravenous tubing; salivary fistula

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Jan 21, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Management of parotid sialocele after facial trauma creating a transoral salivary fistula: two case reports
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