Parotid Gland Trauma

Abstract

Parotid trauma can lead to both short and long-term complications such as bleeding, infection, facial nerve injury, sialocele, and salivary fistula, resulting in pain and disfigurement. Facial injuries inferior to a line extended from the tragus to the upper lip should raise concern for parotid injury. These injuries can be stratified into three regions as they relate to the masseter muscle. Injuries posing the greatest risk of damage to Stensen's duct include those anterior to the posterior border of the masseter and necessitate exploration. When the duct is disrupted, emphasis should be placed on primary repair or re-creation of the papilla; however, proximal ductal lacerations can be treated by ligation of the proximal segment. Isolated parenchymal injury can be treated with more conservative means. Sialocele and salivary fistula can frequently be managed nonoperatively with antibiotics, pressure dressings, and serial aspiration. Anticholinergic medications and the injection of botulinum toxin represent additional measures before resorting to surgical therapies such as tympanic neurectomy or parotidectomy.

The use of botulinum toxin B in the treatment of a post-traumatic sialocele in a 4-year-old child: A case report

“…Penetrating injury to the parotid gland is another common etiology of sialocele, either from direct trauma to the parotid duct or the gland itself. It has been previously estimated that the parotid duct is injured in 21% of cases of penetrating trauma to the parotid gland, which mandates that all injuries to the parotid gland be explored to assess the integrity of the duct 11 . The presentation of a sialocele is typically delayed, becoming evident 8-14 days after the initial injury as an inflammatory pseudocapsule surrounds and contains the extravasation of saliva 12 .…”

A multidisciplinary approach to management of extensive facial injuries resulting from the use of an angle grinder

“…It is largely accepted and been documented that when managing facial soft and hard tissue injuries-lacerations, facial fractures, orbital, nerve and salivary gland/duct injuries, early intervention will lead to optimal recovery and reduce the incidence of long term morbidity, aesthetic deformity or functional deficiency. 5,14,13,8,6 …”

An Unusual Complication Following Rhytidectomy: Iatrogenic Parotid Injury Resulting in Parotid Fistula/Sialocele

“…This aggressive approach for facial rejuvenation puts the parotid gland at increased risk for injury. [2][3][4][5] Parotid injury is a known occurrence after parotid surgery/ parotidectomy, 6-10 trauma, 6,[10][11][12][13][14][15][16] and other surgical procedures to the face, 6,[17][18][19] but this complication after rhytidectomy is rare. There are only 12 previously documented reports in the literature, covering 20 total cases [2][3][4][5][20][21][22][23][24][25][26][27] (Table 1).…”

“…It is bounded superiorly by the zygoma, anteriorly by the masseter, and posteriorly by the external auditory canal, and it has an inferior extension of a parotid tail that curves around the mandibular ramus. 11 Stensen's duct forms at the anterolateral portion of the gland and travels along a line from the tragus to the midportion of the upper lip, superficial to the masseter. It pierces the buccinator muscle to enter the oral cavity at the maxillary second molar.…”

“…It pierces the buccinator muscle to enter the oral cavity at the maxillary second molar. 11 The buccal branch of the facial nerve and the transverse facial artery both traverse close to this duct along its course. Innervation to the parotid gland is of parasympathetic origin from the inferior salivary nucleus in the central nervous system (CNS), which becomes the tympanic branch of the glossopharyngeal nerve.…”