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

Abstract

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.

Diagnosis and management of multiple salivary gland anomalies

“…Swelling, characterised by a collection of extraglandular saliva, was not associated with a history of trauma or previous surgery in the face 15 or exposure to radioactive iodine 13 , which would trigger cystic cavities.…”

“…Sialocele or salivary pseudocyst is a rare clinical condition in which saliva leaks into the periglandular tissue due to inadequate salivary excretion due to rupture of the glandular parenchyma leading to swelling of the affected glandular region 15 . Although ultrasonography has reported diffuse dilation of the parotid duct and ductal ectasia, the cystic cavity has not been reported.…”

“…Among these, repeated fine-needle aspiration, compression, the use of anticholinergics, or botulinum toxin are cited. Alternatively, when the major duct of the deep parotid lobe is affected, the proposed treatments are intraoral drainage by catheter, surgical excision of the cyst, and parotidectomy associated with conservative treatment 15 .…”

Manejo cirúrgico de fratura mandibular cominutiva por projétil de arma de fogo / Surgical management of comminuted mandibular fracture by firearm projectile

“…Para o tratamento de sialoceles, condutas mais invasivas podem ser utilizadas, a exemplo da instalação de drenos, injeções de toxina botulínica ou uso de medicamentos que visam bloquear a liberação de acetilcolina 22,23 . No entanto, o presente relato foi tratado com êxito de forma mais conservadora apenas com punção aspirativa e curativo compressivo.…”

Intraductal Salivary Gland Infusion With Botulinum Toxin

“…In addition to the less common direct intraoperative BTX administration to the salivary glands, percutaneous needle injection into the salivary parenchyma is more commonly performed using ultrasound to direct needle placement, using electromyography to avoid injecting adjacent musculature, or by palpation with orientation by anatomic landmarks . To date, there have been no reports of intraductal delivery of BTX to the salivary parenchyma.…”