Iatrogenic salivary duct injury in head and neck cancer patients: report of four cases and review of the literature

Abstract

Introduction: The lesions of the salivary ducts may be idiopathic, post- traumatic, or iatrogenic and lead to sialocele formation with persistent painful facial swelling or cutaneous fistula formation. No consensus on treatment of this condition exists: the options of treatment include needle aspiration, pressure dressings, antisialogogue therapy, radiotherapy, botulinum toxin and surgical approaches as duct repair, diversion, ligation, different drainage systems and even parotidectomy/submaxilectomy. The management and special features of iatrogenic salivary duct injury in patients with oral cancer who underwent head and neck reconstructive surgery has not been described yet. Material and Methods: We present four cases of iatrogenic lesions of salivary ducts and its management in patients with oral cancer. Conclusions: The iatrogenic lesions of salivary ducts are to be taken into account in patients with oral cancer as the distal ends of salivary ducts could be involved in the margins of surgical resection. Different options of treatment of this complication are described. Key words:Sialocele, oral cancer, salivary duct.

Primary treatment of early fistula of parotid duct with botulinum toxin type A injection

“… 4 The way the fistula will be handled will depend on when it appears, on its complexity, on the area, and on the lesion's etiology. 1 …”

“…The eliminated secretion was collected and examined, revealing high amylase levels, confirming its salivary nature. 1 Therefore, the patient was diagnosed with parotid duct lesion with skin fistula. On the 17 th day after surgery, the patient received a BoNT-A (Botox®, Allergan, Inc.) injection.…”

“…Salivary duct lesions may be idiopathic, iatrogenic, or post-traumatic, and may result in sialocele with painful facial edema or in the formation of skin fistulas. 1 The onset of salivary fistula post-parotidectomy occurs in 4-14% of the cases, the majority of which are self-limiting and respond well to conservative treatment. 2 Several techniques have been employed to treat this complication: percutaneous aspiration, compression bandage, anticholinergic drugs, radiation therapy, botulinum toxin, and surgical repair.…”

“… 2 Several techniques have been employed to treat this complication: percutaneous aspiration, compression bandage, anticholinergic drugs, radiation therapy, botulinum toxin, and surgical repair. 1 …”

A national overview of surgical misadventures in head and neck surgery: “Oh No, You Cut It”

“…1,5 The complex anatomy of the head and neck region and the proximity of multiple vital structures make most surgical interventions carry an inherent risk of accidental injury of nearby structures, such as the facial nerve, recurrent laryngeal nerve, thoracic duct, salivary duct, sigmoid sinus, tegmen, jugular bulb, and carotid artery. [6][7][8][9][10][11] No previous study has addressed the overall prevalence of such injuries in otolaryngology practice at the national level. The purpose of this study was to provide a general perspective on accidental intraoperative injury of nearby structures reported in head and neck surgeries in the United States.…”