When parotid duct or gland is lacerated and functional primary repair is not accomplished, three potential complications can occur : sialocele, extraoral salivary fistula and salivary cyst. Sialocele is subcutaneous cavity of saliva which is
extravasated from traumatized duct or gland.
When the primary injury causing the sialocele is an injured duct, three basic methods of treatment are possible. Basically, the salivary flow must be directed intraorally as extraoral pressure is applied to the region of subcutaneous saliva
extravasation, preventing an extraoral fistula. Concomitant daily aspirations of the sialocele may be required. If a sialocele occurs, one should fist attempt the insertion of a catheter via Stensen's duct into the region of the sialocele to
direct
drainage intraorally, aspirate the sialocele as necessary, and apply an external pressure dressing. If this fails, reexploration and anastomosis of the duct should be attempted. If anastomosis of the duct proves impossible, the proximal duct
should
be
ligated with several silk sutures. The following case illustrates the effective treatment of sialocele by these methods.
A 50-year-old man was sent to our department for evaluation of right preauricular swelling. He had deep facial laceration after automobile accident. One week after primary closure, 3.0cm×3.0cm×2.0cm-sized flucturant mass developed. At
aspiration,
clear yellowish serous water was seen. Sialogram showed accumulation of contrast media at right parotid gland and remnant of contrast media at excretory duct which represents pocket formation. We attempted duct exploation and excision of
sialocele.
A
pressure elastic bandage was applied for 15 days after operation. He had no further complication nor recur after that treatment.
|