Superficial Parotidectomy: Impact of Postoperative Drainage.

BACKGROUND: Use of suction drain after superficial parotidectomy (SP) is based on national consensus considered best practice, but there is no evidence on the effect of the treatment. The aim of the present study is to evaluate the effectiveness of drainage after SP by evaluating the rate of complications after SP in relation to the (ie, duration) of drainage and tumor size. METHODS: Retrospective analysis was performed involving data from all consecutive patients undergoing SP at the Ear, Nose, and Throat department, Regional Hospital West Jutland, Denmark, between January 1, 2011, and December 31, 2017. Demographics including comorbidity, medication, tumor size, postoperative secretion through the drainage, as well as complications (hematoma, seroma, infection, fistulas, Frey syndrome, facial nerve palsy) were registered. Patients with secretion below 25 mL were compared to patients with secretion above 25 mL, that is, drainage less than 24 hours versus longer than 24 hours. Results: Two hundred five consecutive patients undergoing SP were enrolled. The overall risk of postoperative infection was 16.2%. Ten of 33 patients with infection were also diagnosed with an hematoma or seroma. The risk of infection increased with secretion above 25 mL (27.2%) compared to patients with less than 25 mL (13.1%; P = .0318). The same accounts for the risk of seromas/hematomas (P = .0055). We found no evidence that demographics or comorbidity correlated to the secretion in the drainage, but there is a tendency toward male gender having a higher risk off secretion above 25 mL (odds ratio 1.39). CONCLUSION: Overall, the risk of complications after SP increased with secretion beyond 25 mL (ie, drainage for more than 24 hours). This applied in particular to infections and seromas/hematomas demanding treatment. The use of routine drainage after SP is questionable, and a randomized trial is warranted to unravel the necessity of postoperative drainage.

Bilateral spontaneous salivary otorrhoea: Case report and a review of the literature.

Spontaneous salivary otorrhoea is an extremely rare clinical entity. Most of the times, salivary otorrhoea results from various forms of trauma. It has also been attributed to the patent foramen of Huschke, and fissures of Santorini. Here, we present a rare case of an 8 year old child presenting with salivary discharge from both the ears. The diagnosis was established on the basis of biochemical and radiological investigations. The patient was managed by surgical exploration and ligation of the fistulous tract.

Submandibular Duct Fistula Caused by a Large Sialolith: Incidental Finding in a Barium Swallow Study.

BACKGROUND: This case report details an incidental finding of a submandibular duct fistula to a patient's posterior mouth floor found on a barium swallow examination that was performed to rule out gastrological causes of substernal chest pain. The radiologist was unable to determine the cause of the filling defect at the time of the study. The patient's history revealed that a large calculus of unknown size had been passed spontaneously through the floor of the mouth, rupturing the proximal gland duct and creating the fistula. DISCUSSION: Sialolithiasis is the formation of calculi in the salivary gland and is the most common disease of the salivary glands, with the submandibular glands affected more often than others. The condition is more common in men than in women and most often affects individuals aged between 30 and 60 years. CONCLUSION: In general, the etiology of sialolithiasis is unknown. However, examining comorbidities and possible risk factors, such as tobacco use, and how they alter the saliva and the function of the salivary glands might lead to a better understanding of their cause.

Submandibular ductal fistula: an obstacle to sialendoscopy.

IMPORTANCE: Submandibular fistula is a rare condition that presents diagnostic and treatment challenges. Accurate diagnosis may be achieved by means of thorough physical examination, proper imaging, and usually surgical exploration. We describe the clinical significance of aberrant submandibular ductal fistula or ostium and discuss our dilemmas during sialendoscopy in 2 patients with repeated submandibular glandular swelling. OBSERVATIONS: Two patients had submandibular ductal abnormalities. The first patient was found to have the ostium of the submandibular duct in an unusual anatomical location at the posterior floor of the mouth, which was identified during surgical exploration of the floor of the mouth. The second patient was found to have a submandibular ductal fistula into the floor of the mouth proximal to a calculus in the main duct (which was severely atrophic and could not be cannulated). CONCLUSIONS AND RELEVANCE: The precise etiology and pathogenesis of sialo-oral fistula formation are currently unknown but could be extrapolated from previously described syndromes involving ductal obstruction and inciting damage in other regions of the body. Consideration of submandibular fistula in the differential diagnosis may spare the patient morbidity of redundant invasive procedures.

Submandibular hydatid cyst fistulized into the oral cavity.

UNLABELLED: Hydatid cysts of the head and neck are rare, even in regions where echinococcal infestation is endemic. Although complications, like cyst rupture and infection, may occur, an external fistula is extremely rare. This study examined a case of hydatid cyst that had fistulized in the right submandibular region of the oral cavity, which eroded the mandible. CASE REPORT: A 45 year-old female patient visited our clinic with complaints of a discharge that left a bad taste in her mouth that persisted for 1 month and a painless swelling in the right submandibular region that had slowly expanded over the past 5 months. A physical examination revealed a cystic mass located in the right submandibular region that had fistulized in the oral cavity. The results were consistent with a hydatid cyst. We performed submandibular gland exeresis and a marginal mandibulectomy to excise the hydatid cyst together with the fistulous tract.

[Salivary stone in parotid gland with a cutaneous fistula]. / Spytsten i glandula parotis med kutan fisteldannelse.

Parotid fistulas are very rare and arise from various causes such as trauma, operative complications, infection, malignancy and stone. They may also be congenital. A rare case of cutaneous salivary fistula is presented. A 59-year-old man had a recurrent inflammatory parotid disease which disappeared after the expulsion of the calculus.

Dacryo salivary fistula. Unusual case of salivary fistula draining into the inferior fornix of the eye.

Salivary fistula after a traumatic injury in the buccal region is not common. It is most commonly encountered in injuries involving the pre auricular region or soft tissues along the course of the parotid duct. It is more frequent in the parotid because its anatomical location is superficial; traumatic salivary fistulae of the other two major salivary glands are rare. This report presents an unusual case of a salivary fistula that occurred following trauma to the infraorbital region and drained into the inferior fornix of the left eye. A review of cases reported in the literature is presented. This is the only case of such a presentation the authors have found after a thorough search of the relevant English language literature.

[Congenital cervical salivary fistula: a case report]. / Fistules salivaires cervicales congénitales: à propos d'un cas.

Cyst and fistulas of the gills grooves and thyro-glossal tracts are well documented. On the contrary, congenital neck salivary fistulas are uncommon.

An unusual complication following rhytidectomy: iatrogenic parotid injury resulting in parotid fistula/sialocele.

Rhytidectomy is a common surgical procedure performed by today's aesthetic surgeons. Newer trends and techniques leading to deeper and more aggressive dissection have placed the parotid gland at increased risk for injury during this procedure. Despite there being a relative abundance of literature on traumatic parotid injury, there is a relative paucity of information on iatrogenic parotid injury after rhytidectomy. In addition, there is no consensus on management of these complications. In this article, the authors discuss 3 case reports, review the relevant literature, and propose a treatment algorithm. Early diagnosis and appropriate treatment are essential to properly manage this complication.

A case of congenital fistula from an accessory parotid gland: diagnosis and treatment.

The author reports a case of congenital fistula from an accessory parotid gland and describes its diagnosis and treatment. The patient was referred to the author's clinic for evaluation of a continuous serous discharge from a small orifice in the left cheek near the angle of the mouth. A left preauricular appendix was also noted. Fistulography detected an aberrant duct leading to an accessory parotid gland. The main parotid gland and its duct were normal. The anomalous duct was dissected in continuity with a small ellipse of skin and sutured to the buccal mucosa. The patient's recovery was uneventful. The author also discusses the embryologic origin of this rare anomaly.

Accessory parotid gland with ectopic fistulous duct--diagnosis by ultrasonography, digital fistulography, digital sialography and CT fistulography. A case report and review of current literature.

Accessory parotid glands are a common clinical occurrence and usually drain into the main Stenson's duct by small ductules and thereby, into the buccal cavity. Presence of an accessory parotid gland with an ectopic fistulous duct is a rare occurrence. We present the imaging findings in a case of right accessory parotid gland with ectopic fistulous duct associated with bilateral pre-aural appendages. Diagnostic workup was done by ultrasonography, sono-fistulography, contrast digital fistulography, contrast digital sialography and computed tomography fistulography. Imaging showed a right accessory parotid gland lying anterior to and separate from the main parotid gland draining via an ectopic fistulous duct opening over the right cheek. The child was managed surgically by internalisation of the duct to open into the buccal mucosa and excision of pre-aural appendages.

Traumatic diseases of parotid gland and sequalae. Review of literature and case reports.

Parotid gland injuries are accompanied by a large number of sequelae. The aim of this paper is to highlight the importance of thorough management of these parotid glandinjuries especially at initial presentation in order to minimize the complications that accompany these injuries. A review of the aetiology and management of the existing cases of parotid gland injuries obtained from published journals and internet search as well as a report of two cases managed in our centre is presented in this paper. A total of about 70 cases in the previous literatures were reviewed of which assault was responsible for almost 90% of the cases. Sialoceles and fistulae were the main sequelae of these injuries. More than half of the cases (54%) were managed by conservative methods. Surgical drainage was done in about 44% cases; where the Stenson's ducts were accessible, primary repair was done. Excision of the gland was done in very few cases. The two cases managed in our centre were due to assault from broken bottles and road traffic accident respectively and both were managed by conservative methods. The first patient was a case of sialocele following the injury, which resolved within 3 weeks after the cyst formation with reduction in food intake, aspirations and external surgical drainage; while the second patient was a case of persistent fistula which healed after about 5 weeks following the trauma. Follow-up of both patients for about 3 months revealed no further leakage or accumulation of saliva. Management of these injuries involves a thorough understanding of the structure and function of the parotid gland and closely related tissues.

Fístula salivar congênita: relato de três casos / Congenital salivary gland fistula: report of three cases

As fístulas salivares de origem congênita são má formações de incidência rara. Devem ser diferenciadas de fístulas de 2° arco branquial, pelas características clínicas distintas, como a ausência de episódios de infecção e drenagem abrupta, que aumenta durante a alimentação. Dúvidas ainda existem com relação à sua etiologia. As hipóteses existentes cogitam a migração anormal de tecidos embrionários e a heteroplasia de células ectodérmicas, que regridiriam no processo de diferenciação celular. A fistulografia da lesão mostra fundo de saco arboriforme e ajuda no diagnóstico diferencial da lesão. O tratamento é cirúrgico, com ressecção do trajeto da lesão e da glândula que a originou. Apresentamos três casos de fístulas salivares congênitas.

Salivary gland fistulas are rare malformations and should be differentiate from others draining sinuses pathologies, especially from the second branchial cleft sinuses. Precise pathogenesis is not fully understood. Clinically, the episodes of drainage are usually associated with a sense of fullness in the affected area and the amount of drainage usually increases during eating or mastication. A preoperative sinugram is helpful. The treatment is its excision. We present three cases of unusual salivary gland fistula.

[Submandibular sialolith: case report and review of the literature]. / Nagyméretü submandibularis nyálkö és sialo-oralis fistula Esetismertetés és irodalmi áttekintés.

Sialolithiasis is a common disease of the salivary glands and a major cause of salivary gland dysfunction. The dominance of submandibular sialoliths is widely investigated. Giant stones (>15 mm) are rare, approximately every tenth or twelfth of the stones belong to this category. Sialo-oral or sialo-cutaneous fistula formation promotes the growth of an excessive size. In their presentation, the authors would like to introduce the diagnostic and therapeutic process of a giant (27 mm) submandibular sialolith and give a review of the literature.

Non tuberculous mycobacteria infection of the parotid region: two familiar cases.

OBJECTIVE: We review two cases of non tuberculous mycobacteria infections of the parotid region in members of the same family. The parotid region represents a peculiar location for the disease and it is exceptional to discover cases in members of the same family. METHODS: Two unusual case reports of non tuberculous mycobacteria infections in two members of the same family are presented. We discuss the diagnostic criteria and review pertinent recent literature. To our knowledge, these are the first English language reports of NTM infections in member of the same family. RESULTS: We performed surgical exeresis of the lesions in parotid region together with the skin affected by the fistula; regular check-ups for 24 months after surgery. CONCLUSIONS: Surgical exeresis of regional structures is the treatment for non tuberculous mycobacteria infections non responsive to antibiotic therapy.

Superficial parotidectomy as first choice for parotid tumours.

Parotid neoplasms represent 3% of all head and neck tumours, and most are benign. Malignant tumours account for 14-25% of cases. Surgery is the treatment of choice, with options ranging from simple enucleation to radical parotidectomy. Sixteen patients presented with a history of a painless parotid lump. Diagnosis was achieved by ultrasound scan and MRI. Fifteen superficial parotidectomies and 1 nerve-sparing total parotidectomy were carried out. At histology, 10 pleomorphic adenomas, 4 Warthin's tumours, 1 lymphoepithelial cyst and 1 sebaceous adenocarcinoma were detected. In the single case of carcinoma, the 6 peri-glandular lymph nodes included in the specimen were metastasis-free. In 3 patients (20%) a transient paresis of the facial nerve was noted. The capsule appeared breached in only 1 case of pleomorphic adenoma. Four patients (26%) were diagnosed as suffering from Frey's syndrome. A salivary fistula was recorded in 2 patients (13%). During follow-up ranging from 3 to 96 months no tumour recurrence was recorded. Superficial parotidectomy seems to be the best choice of treatment for benign parotid tumours, since it allows complete excision of the tumour with sparing of the facial nerve. A radical procedure is, however, needed if malignancy is confirmed at frozen section.