Application of Delayed Surgical Managements in Patients with Stensen's Duct Injury / 华中科技大学学报（医学）（英德文版）

The study aimed to retrospectively evaluate surgical treatment outcomes after delayed parotid gland and duct injuries.Nine patients subjected to parotid gland and duct injuries with 1-to 3-month treatment delay were retrospectively evaluated with special reference of etiology,past medical history,and injury location.Conservative treatment,microsurgical anastomosis,and diversion of salivary flow or ligation were chosen for delayed parotid gland and duct injuries concerning to their site of injury,time of repair and procedures.Assistant treatment as pressure dressing was adopted thereafter.All patients experienced an uneventful recovery at the time of finalizing the study.Two patients received Stensen's duct ligation,5 received microsurgical anastomosis and 2 accepted salivary flow diversion for 5 patients with sialoceles and 4 patients with fistulas,and no re-occurrence was found.Facial paralysis occurred after surgery in 4 patients,and 3 of them recovered after the nerve nutrition treatment.Our study suggested that appropriate surgical treatment is efficient for the re-establishment of the tissue function and facial aesthetic for delayed injury of the parotid and its duct.

Application of Delayed Surgical Managements in Patients with Stensen's Duct Injury / 华中科技大学学报（医学）（英德文版）

The study aimed to retrospectively evaluate surgical treatment outcomes after delayed parotid gland and duct injuries.Nine patients subjected to parotid gland and duct injuries with 1-to 3-month treatment delay were retrospectively evaluated with special reference of etiology,past medical history,and injury location.Conservative treatment,microsurgical anastomosis,and diversion of salivary flow or ligation were chosen for delayed parotid gland and duct injuries concerning to their site of injury,time of repair and procedures.Assistant treatment as pressure dressing was adopted thereafter.All patients experienced an uneventful recovery at the time of finalizing the study.Two patients received Stensen's duct ligation,5 received microsurgical anastomosis and 2 accepted salivary flow diversion for 5 patients with sialoceles and 4 patients with fistulas,and no re-occurrence was found.Facial paralysis occurred after surgery in 4 patients,and 3 of them recovered after the nerve nutrition treatment.Our study suggested that appropriate surgical treatment is efficient for the re-establishment of the tissue function and facial aesthetic for delayed injury of the parotid and its duct.

Treatment of intractable parotid sialocele occurred after open reduction-fixation of mandibular subcondylar fracture

A sialocele is a subcutaneous cavity containing saliva, most often caused by facial trauma or iatrogenic complications. In subcondylar fractures, most surgeons are conscious of facial nerve injury; however, they usually pay little attention to the parotid duct injury. We report the case of a 41-year-old man with a sialocele, approximately 5×3 cm in size, which developed 1 week after subcondylar fracture reduction. The sialocele became progressively enlarged despite conservative management. Computed tomography showed a thin-walled cyst between the body and tail of the parotid gland. Fluid leakage outside the cyst was noted where the skin was thin. Sialography showed a cutting edge of the inferior interlobular major duct before forming the common major duct that seemed to be injured during the subcondylar fracture reduction process. We decided on prompt surgical treatment, and the sialocele was completely excised. A duct from the parotid tail, secreting salivary secretion into the cyst, was ligated. Botulinum toxin was administrated to block the salivary secretion and preventing recurrence. Treatment was successful. In addition, we found that parotid major ducts are enveloped by the deep lobe and extensive dissection during the subcondylar fracture reduction may cause parotid major duct injury.

Sialocele post-trauma sin lesión penetrante / Sialocele post-trauma without penetrating injury

El sialocele es una colección de saliva en los tejidos que rodean al conducto de la glándula o del parénquima sin un drenaje adecuado. Su causa más común es la extravasación de saliva producto a una disrupción del parénquima o conducto parotídeo secundario a un trauma cortante. Si el tratamiento del sialocele no se realiza en forma oportuna se puede generar una fístula externa, cicatrices faciales e infecciones secundarias. Un hombre de 24 años ingresado al Hospital con múltiples fracturas faciales sin trauma cortante. Luego de la disminución del edema, continuó el aumento de volumen en la región geniana en forma localizada, fluctuante, ovalada. La piel se encontraba distendida, asintomática, sin secreciones, con alteración de la función motora y sensorial en la región geniana derecha. Se realizó la aspiración del contenido del aumento de volumen. Después de 2 días recidivó. Se solicitó una Tomografía computarizada y se volvió a realizar aspiración del contenido para enviarlo a cultivo citológico. Se hizo el diagnóstico de sialocele post-trauma de la parótida y se realizó un vaciamiento del contenido y drenaje tipo penrose intraoral. Se controló al siguiente día sin recidivas y se retiró el drenaje a los 2 meses. Es importante tener en cuenta que se puede generar un sialocele post-trauma sin necesariamente ser cortante.

Sialocele is a collection of saliva in the tissues surrounding the duct of the gland or parenchyma without proper drainage. The most common cause is the extravasation of saliva product to a disruption of the parenchyma or parotid duct secondary to a cutting trauma. If sialocele treatment is not performed in a timely manner it can generate an external fistula, facial scars and secondary infections. Male admitted to hospital with multiple facial fractures. After the reduction of edema, continued increased volume in the preauricular region localized, fluctuating, oval. The skin was asymptomatic, without secretions, with impairment of motor and sensory function in the right genial region. The aspiration of the increase in volume under a hypothesized hematoma was performed. After 2 days recurred. A tomography scan was requested and returned to realize the aspiration of which was sent to cytological exam. The diagnosis was post-trauma sialocele parotid and was performed emptying the contents and drainage type penrose intraoral. Was control the next day without relapses and the drain was removed after 2 months. It ́s important to know that can generate a post-trauma sialocele without necessarily cutting trauma.

A Case of Intraoral Drainage of Iatrogenic Parotid Sialocele after Sialendoscopy / 대한이비인후과학회지

A variety of treatment methods have been proposed for parotid sialocele. These include multiple aspirations and compression dressings, reconstruction of the duct, creation of a controlled internal fistula, superficial or total parotidectomy, radiation therapy and ductal ligation, etc. Most of these procedures are invasive with variables and often with poor success rates. This paper presents an unusual incidence of iatrogenic parotid sialocele after sialendoscopy and its management by a relatively simple, safe and effective technique, which is constituted of draining saliva into the intraoral.

Sialocele como Complicação de Acesso Retromandibular: Relato de Caso / Sialocele as a complication of the retromandibular approach: a case report

A sialocele é o acúmulo de extravasamento salivar numa cavidade subcutânea, ocorrendo, principalmente, após, um episódio traumático ou infeccioso no parênquima da glândula parótida, lesão do ducto parotídeo ou estenose ductal com subsequente dilatação. A realização do correto diagnóstico e o tratamento imediato das lesões traumáticas da glândula parótida tornam-se importantes para evitar complicações. Várias modalidades de tratamento são mencionadas na literatura, e a escolha dependerá do tempo de evolução desde a lesão à região acometida. O presente caso envolve um paciente do gênero masculino vítima de acidente motociclístico que evoluiu com uma sialocele pós-operatória devido à abordagem retromandibular para redução cruenta de fratura condilar. O tratamento realizado foi a instalação de um cateter provisório, criando um novo trajeto para secreção da glândula parótida.

The condition known as sialocele is an accumulation of salivary extravasation in a subcutaneous cavity occurring mainly after a traumatic or infectious episode in the parenchyma of the parotid gland, a parotid duct injury or stenosis with subsequent ductal dilatation. The correct diagnosis and treatment of traumatic lesions of the parotid gland are important in order to avoid complications. Several treatment options are mentioned in the literature and the choice will depend on the time elapsed since injury and the affected region. The patient in the case reported is a male victim of a motorcycle accident who developed a postoperative sialocele due to the use of the retromandibular approach for open reduction of a condylar fracture. The treatment performed was the insertion of a temporary catheter creating a new pathway for secretion of the parotid gland.

Giant sialocele following facial trauma

Injuries in the parotid and masseter region can cause serious impairment secondary to damage of important anatomical structures. Sialocele is observed as facial swelling associated with parotid duct rupture due to trauma. The aim of this paper is to report a case of a giant traumatic sialocele in the parotid gland, secondary to a knife lesion in a 40-year-old woman. Conservative measures could not promote clinical resolution and a surgical intervention for the placement of a vacuum drain was selected. Under local anesthesia, a small incision was performed adjacent to parotid duct papilla, followed by muscular divulsion and draining of significant amount of saliva. An active vacuum suction drain was placed for 15 days, aiming to form a new salivary duct. This technique was shown to be a safe, effective and low-cost option, leading to complete resolution and no recurrence after 28 months of follow up.

Lesões na região parotídea e massetérica podem causar danos importantes secundariamente à injúrias de estruturas anatômicas nobres. A sialocele é observada como um aumento de volume facial associado a ruptura do ducto parotídeo devido a trauma. O objetivo deste artigo é relatar um caso de sialocele parotídea gigante traumática, por arma branca, em uma paciente de 40 anos de idade. Em virtude do insucesso de medidas conservadoras de tratamento, uma intervenção cirúrgica por meio de instalação de um dreno à vácuo foi proposta. Sob anestesia local, uma pequena incisão foi realizada adjacente ao ducto da papila parotídea, seguida de divulsão do plano muscular e drenagem de quantidade significativa de saliva. Um dreno à vácuo foi instalado e mantido por 15 dias objetivando formar um novo ducto salivar. Esta técnica se mostrou segura, efetiva e de baixo custo, proporcionando a completa resolução do caso; não sendo observada recidiva em acompanhamento de 28 meses.

Sialocele: An unusual case report and its management.

A post traumatic parotid sialocele is an acquired lesion that arises from extravasation of saliva into glandular or periglandular tissues secondary to disruption of the parotid duct or parenchyma. Facial trauma and surgery in the parotid region are the most common causes of this rare condition. This paper presents an unusual incidence of post traumatic parotid sialocele after Le-Fort II fracture reduction and its management by relatively simple and cost-effective technique which can be carried out in routine dental surgery suite. The results achieved justify our recommendation of scalp vein cannula for the treatment of sialocele in clinical practice.

Management of a parotid sialocelein a young patient: case report and literature review

Sialocele is a subcutaneous cavity containing saliva, caused by trauma or infection in the parotid gland parenchyma, laceration of the parotid duct or ductal stenosis with subsequent dilatation. It is characterized by an asymptomatic soft and mobile swelling on the parotid region. Imaging studies are useful and help establishing the diagnosis, such as sialography, ultrasonography, computed tomography and magnetic resonance imaging. This paper describes a recurrent case of a parotid sialocele in a young female patient. She presented a 6 cm x 5 cm swelling on the left parotid region. The ultrasonographic scan of the area revealed a hypoechoic ovoid well defined image suggesting a cyst. A sialography of the left parotid showed a cavitary sialectasia in a panoramic and anteroposterior view. A conservative management was adopted by percutaneous needle aspiration of the swelling, which was useful to provide material for analysis and helped healing. Dentists should be aware of this pathology and the importance in adopting a conservative treatment whenever it is possible.

A Case of Parotid Sialocele / 대한이비인후과학회지

Stensen's duct is located at the anterior border of the parotid gland below the zygomatic arch. It crosses the area between the masseter muscle and buccal fat pad, opening opposite to the second upper molar teeth. Because of such anatomical association by the Stensen's duct, we should search for any injuries on the Stensen's duct when there is deep facial laceration. This paper reports on a case of parotid sialocele which was caused by laceration of Stensen's duct. For treamtemnt, we made an internal fistula to the oral cavity in order to drain the sialocele