Endoscopic tympanic neurectomy in the management of persistent parotid fistulae

Review of the caroticotympanic nerves: Anatomy, function and pathology

“…In 1962, Golding-Wood revived the tympanosympathectomy technique, changing the procedure to its current name of tympanic neurectomy, which is used to relieve deep ear pain. Nowadays, tympanic neurectomy is indicated in the treatment of medically recalcitrant otalgia (Roberts et al, 2016) and has been documented as advantageous in cases of parotid sialectasis (Daud & Pahor, 1995), parotid fistulae (Marfatia et al, 2021) and Frey's syndrome (gustatory sweating) (Davis, 1985). Additionally, endoscopic tympanic neurectomy has been shown to alleviate pain in otologic neuralgia, defined as F I G U R E 1 Schematic drawing of the vessels and nerves of the skull base near the internal carotid plexus (yellow nerve fibres travelling along the internal carotid artery as they give rise to the caroticotympanic nerve (upper yellow arrow).…”

Extracapsular dissection by the sternocleidomastoid muscle–parotid space approach reduces the risks of postparotidectomy sialocele and salivary fistula

“…3 Routine sialocele/fistula preventive measures in parotidectomy are cumbersome to patients; these generally involve pressure dressing against the surgical region for 1-2 weeks 4 and the consumption of a bland diet. 5,6 Treatment modalities are initially conservative Lin Lan and Diancan Wang have contributed equally to this study. and uncomplicated; they include needle aspiration, drainage, pressure dressing, and anticholinergic medication.…”

“…and uncomplicated; they include needle aspiration, drainage, pressure dressing, and anticholinergic medication. However, refractory salivary fistulas require invasive and radical treatments, such as an intra-oral approach using a pig-tail catheter, 7 botulinum toxin injection, 8,9 tympanic neurectomy, 5 repeat parotidectomy, and (in some cases) low-dose radiotherapy. 10 We recently introduced extracapsular dissection by the sternocleidomastoid muscle-parotid space approach (ECD-SMPSA) as a minimally invasive technique for the treatment of clinically benign tumors in the parotid tail 11 and some tumors in the deep lobe of the parotid gland.…”

“…A recent systematic review indicated that the rates of sialocele and salivary fistula formation were 4.5% and 3.1%, respectively 3 . Routine sialocele/fistula preventive measures in parotidectomy are cumbersome to patients; these generally involve pressure dressing against the surgical region for 1–2 weeks 4 and the consumption of a bland diet 5,6 . Treatment modalities are initially conservative and uncomplicated; they include needle aspiration, drainage, pressure dressing, and anticholinergic medication.…”

“…Treatment modalities are initially conservative and uncomplicated; they include needle aspiration, drainage, pressure dressing, and anticholinergic medication. However, refractory salivary fistulas require invasive and radical treatments, such as an intra‐oral approach using a pig‐tail catheter, 7 botulinum toxin injection, 8,9 tympanic neurectomy, 5 repeat parotidectomy, and (in some cases) low‐dose radiotherapy 10 …”