Iatrogenic Parotid Sialocele After Excision of Malignant Melanoma of the Cheek

Parotid fistula complicating postauricular basal cell carcinoma excision

“…Investigations used to diagnose a parotid fistula include cannulating the parotid duct and injecting methylene blue dye to see if there is a leakage, 6 aspirating the draining fluid and sending it for salivary amylase levels 4,5 or a sialography involving infusion of radio‐contrast dye into the parotid duct followed by plain radiography, computed tomography or magnetic resonance imaging 5 . As demonstrated in this patient, histology can also reveal the underlying parotid glandular or duct tissue.…”

“…These have all been in the cheek region with none in the postauricular area (Table 1). 3–6 This patient's experience shows that the parotid glands can extend around to the postauricular region, although this is a rare variant. A parotid fistula can arise from cutting the gland itself or its duct.…”

“…If a parotid glandular or duct injury is recognised at the time of surgery then it should be surgically repaired at that time. For parotid fistulas that present after 24 h, the literature supports conservative management initially with observation and pressure dressings, as most of them will resolve within 1–6 weeks 3–7 . A sialocele usually requires intermittent aspiration.…”

“…A sialocele usually requires intermittent aspiration. Treatments that suppress parotid salivary secretions can be used and include oral anticholinergics, intra‐parotid injections of botulinum toxin type A and the elimination of oral intake under hospitalisaton 3–5 …”

“…As demonstrated by this patient's experience, it can extend posterior to the ear. Only four cases have been reported of parotid fistulas complicating cutaneous surgery, none of which were in the postauricular region 3–6 . If the parotid gland or duct is cut and a fistula develops, the dermatological surgeon should be able to identify it and have an understanding of its management.…”