Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Hwang, Jungil (Department of Plastic Surgery, Kyung Hee University Medical Center, Kyung Hee University School of Medicine) ;
  • You, Yong Chun (Department of Plastic Surgery, Kyung Hee University Medical Center, Kyung Hee University School of Medicine) ;
  • Burm, Jin Sik (Department of Plastic Surgery, Kyung Hee University Medical Center, Kyung Hee University School of Medicine)
  • Received : 2018.03.02
  • Accepted : 2018.06.08
  • Published : 2018.06.25
Download PDF
⟨ Previous Next ⟩

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 $5{\times}3cm$ 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.

Keywords

References

  1. Fehrenbach MJ, Herring SW. Illustrated anatomy of the head and neck. St. Louis: Elsevier; 2012.
  2. Richards AT, Digges N, Norton NS, Quinn TH, Say P, Galer C, et al. Surgical anatomy of the parotid duct with emphasis on the major tributaries forming the duct and the relationship of the facial nerve to the duct. Clin Anat 2004;17:463-7. https://doi.org/10.1002/ca.20011
  3. Araujo MR, Centurion BS, Albuquerque DF, Marchesano LH, Damante JH. Management of a parotid sialocele in a young patient: case report and literature review. J Appl Oral Sci 2010;18:432-6. https://doi.org/10.1590/S1678-77572010000400019
  4. Parekh D, Glezerson G, Stewart M, Esser J, Lawson HH. Post-traumatic parotid fistulae and sialoceles: a prospective study of conservative management in 51 cases. Ann Surg 1989;209:105-11. https://doi.org/10.1097/00000658-198901000-00015
  5. Balaji SM. Parotid fistula from transparotid approach for mandibular subcondylar fracture reduction. Ann Maxillofac Surg 2013;3:182-4. https://doi.org/10.4103/2231-0746.119214
  6. Ellis E 3rd, Dean J. Rigid fixation of mandibular condyle fractures. Oral Surg Oral Med Oral Pathol 1993;76:6-15. https://doi.org/10.1016/0030-4220(93)90285-C
  7. Ghezta NK, Bhardwaj Y, Rani P, Ram R. Efficacy of retromandibular transparotid approach for the management of extracapsular subcondylar mandibular fractures using 2-mm titanium miniplates: a prospective clinical study. J Oral Maxillofac Surg 2016;74:1613-21. https://doi.org/10.1016/j.joms.2016.03.045
  8. Gerbino G, Boffano P, Tosco P, Berrone S. Long-term clinical and radiological outcomes for the surgical treatment of mandibular condylar fractures. J Oral Maxillofac Surg 2009;67:1009-14. https://doi.org/10.1016/j.joms.2008.06.009
  9. Yang L, Patil PM. The retromandibular transparotid approach to mandibular subcondylar fractures. Int J Oral Maxillofac Surg 2012;41: 494-9. https://doi.org/10.1016/j.ijom.2011.09.023
  10. Vesnaver A, Gorjanc M, Eberlinc A, Dovsak DA, Kansky AA. The periauricular transparotid approach for open reduction and internal fixation of condylar fractures. J Craniomaxillofac Surg 2005;33:169-79. https://doi.org/10.1016/j.jcms.2005.01.008
  11. Croce A, Moretti A, Vitullo F, Castriotta A, Rosa de M, Citraro L. Transparotid approach for mandibular condylar neck and subcondylar fractures. Acta Otorhinolaryngol Ital 2010;30:303-9.
  12. Arnaud S, Batifol D, Goudot P, Yachouh J. Nonsurgical management of traumatic injuries of the parotid gland and duct using type a botulinum toxin. Plast Reconstr Surg 2006;117:2426-30. https://doi.org/10.1097/01.prs.0000219132.34809.ae
  13. Hong SE, Kwon JW, Kang SR, Park BY. The effect of botulinum toxin on an iatrogenic sialo-cutaneous fistula. Arch Craniofac Surg 2016;17:237-9. https://doi.org/10.7181/acfs.2016.17.4.237