Post-Traumatic Parotid Fistulae and Sialoceles. A Prospective Study of Conservative Management in 51 Cases

Abstract

The management of parotid sialoceles and fistulae have been unsatisfactory in the past, and numerous methods of treatment with varying success and morbidity have been described. The present prospective study reports results of conservative therapy in 51 patients over a 3-year period. In 50 patients, the injury healed upon conservative management. During the early phase of the study, a limited conservative regimen through which the patients received nothing orally for 5 days only was used. During the latter part of the study, patients were administered nothing orally until complete healing of the injury. In terms of the time it took for healing of the injury, the differences of the two regimens (24 +/- 4 vs. 9.4 +/- 0.9 days) was highly significant (p less than 0.001). The response to conservative management depended on the severity of injury as demonstrated by sialography. Injury to minor intraparotid ducts (G1) healed in significantly less time compared with that to a major intraparotid duct (G2) or ductal injuries (p less than 0.001). There was no difference between the healing of G2 injury (10.3 +/- 1.8 days) and partial ductal transections (10.5 +/- 2.2 days) (p greater than 0.05). There was a significantly greater delay in healing with complete duct transections (21.5 +/- 3.7 days) compared with partial duct transections and G2 injuries (10.2 +/- 2.1 days) (p less than 0.01). There was no difference in the mean period for healing between salivary fistulae and sialoceles (p greater than 0.05). It is concluded that a new classification of parotid fistulae based on sialographic findings has prognostic and therapeutic value. Furthermore, the excellent results achieved with conservative therapy in this study suggest that it may be the initial treatment of choice for parotid fistulae.

Use of Botulinum Toxin Type A Injection Under Ultrasonographic Guidance for Management of Parotid Sialocele: A Case Report and Literature Review

“…Antisialogogue medications including anticholinergic agents are also administered to inhibit the action of acetylcholine at the postganglionic nerve endings of the parasympathetic nervous system. However, side effects can included xerostomy, constipation, photophobia, tachycardia, and urinary retention [5]. When conventional conservative management fails, BTX is considered.…”

A novel technique in the treatment of post traumatic parotid duct sialocele

“…2 Studies have reported that correction of these complications may require surgical or medical treatments like use of anti sialogogues, radiation therapy, parasympathetic denervation (tympanic denervation), cauterization of the fistulous tract and reconstruction of the duct, superficial or total parotidectomy. 3,8 A significant delay in the healing of complications was noted when there was total transaction of duct. 9 Immediate microsurgical anastomosis of the parotid duct injury is one such modality of treatment, which will possibly prevent such complications.…”

Successful treatment of parotid fistula with tympanic neurectomy

“…Conservative management has been recommended [4,5] as the treatment of choice for post traumatic fi stula. It is when fi stula does not respond by these measures that further active intervention is required.…”