Successful treatment of parotid fistula with tympanic neurectomy

Abstract

Background Parotid fi stula is a cause of great distress and embarrassment to the patient. A host of treatment modalities have been described in past but no unanimity exists regarding the most satisfactory of all. Tympanic neurectomy is an effective procedure for persistent parotid fi stula with no signifi cant side effects.

Endoscopic tympanic neurectomy in the management of persistent parotid fistulae

“…It originates in the inferior salivatory nucleus in the medulla. 2 It enters the floor of the middle ear and traverses the promontory and exists anteriorly as the lesser superficial petrosal nerve. It synapses at the otic ganglion and postganglionic fibers then enter the parotid gland via the auriculotemporal nerve.…”

“…There is no uniform consensus regarding the treatment of choice for chronic parotid fistulae and different modalities of management have been proposed ( Table 1 ). 2 Tympanic neurectomy has been shown to be useful in persistent parotid fistulae. 2 The wide angle view of the endoscope is useful for transcanal endoscopic tympanic neurectomy.…”

“… 2 Tympanic neurectomy has been shown to be useful in persistent parotid fistulae. 2 The wide angle view of the endoscope is useful for transcanal endoscopic tympanic neurectomy. The nerve divides on the promontory into an anterior branch that courses up towards the eustachian tube and a posterior branch that passes vertically, anterior to the round window niche.…”

“… 3 These branches lie in a groove and are either covered by mucosa only or lie in a bony canal. 2 Endoscopy has opened up new avenues to approach this nerve as the endoscope helps in precise identification of branches of the nerve. 4 …”

Endoscopic tympanic neurectomy for otic neuralgia—a case series

“…The complications of the tympanic neurectomy have not be described in the literature, however, this procedure can cause a reduction in salivary flow rates (19,20) which in theory increases the risk of sialolithiasis. The other possible complications include unresolved otalgia, conductive or sensorineural hearing loss, tympanic membrane perforation, disequilibrium and tinnitus.…”