The anatomy of the buccal region of the face is complex and injuries in this region can lead to significant complications. Trauma in this region can easily injure the parotid duct and facial nerve. The management of parotid duct injuries is usually by microsurgical anastomosis, diversion of salivary flow by creating an oral fistula, or suppression of salivary gland function. The authors present a case of parotid duct injury treated by using an epidural catheter.
Sharp penetrating trauma of the face besides causing a cosmetic defect, may also injure deeper anatomical structures . Common causes of parotid duct injury are stab injuries from sharp instruments, glass, razors , gunshot wounds and surgical procedures . Failure to recognize a parotid duct injury may result in the formation of a sialocele, cutaneous fistula, or salivary cyst . To avoid these complications it is necessary to identify the injury and treat it.
Case report and technique
A 34-year-old male presented with the chief complaint of swelling on the left side of the face following being hit by the handle of a bore well whilst working on a farm. There was no history of loss of consciousness, ear bleeding or discharge, nasal bleeding or discharge. There was a history of bleeding from the oral cavity. There were no other injuries and no history of major illness, surgery or known drug allergies.
Following thorough clinical and radiological examinations the patient was diagnosed with symphysis, left subcondylar fractures of the mandible and laceration of the left parotid duct. The diagnosis of the duct injury was confirmed by drooling saliva ( Fig. 1 ). There was no injury to the facial nerve.
The fractures were treated by open reduction and internal fixation. The wound over the left cheek was explored and debrided. The cut ends of the duct were identified and through the parotid papilla a 16 gauze epidural catheter was passed and taken out at the cut distal end. The catheter was passed to the proximal part of the duct and anastomosis was carried out using polypropylene 6-0 ( Figs. 2 and 3 ). The cheek wound was closed with a trapezoidal flap. Intraorally the cannula was secured to the buccal mucosa. The patient was given antibiotics for 7 days.