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Objective: The aim of this study was to evaluate the long-term results of a simultaneous application of botulinum toxin to the parotid gland in conjunction with the microsurgical repair of the duct in an acute setting and to encourage using botulinum toxin as a first-line option to prevent future complications associated with glandular involvement. Material and Methods: Three patients who were referred to the Plastic Surgery Clinic by the emergency room of the Hacettepe University Hospital after maxillofacial trauma are reviewed in this study. Exploration of the facial nerve and Stensen’s duct was planned for all patients within the first 72 hours after their injuries. After intraoral catheterization of the Stensen’s duct through the papilla using an epidural catheter, microsurgical end-to-end anastomosis was performed. Concurrently, 100 units of botulinum toxin A was injected at standardized eight points to the parotid gland. Results: Postoperative magnetic resonance (MR) sialography revealed patency in all patients at the end of postoperative first year. The mean postoperative parotid volume of the injured and non-injured sides were 19.82±10.55 cm3 and 17.79±10.98 cm3, respectively, and the results were found to be comparable. Fibrillation potentials in the postoperative electromyography recordings and clinical examination demonstrated nerve regeneration. Conclusion: Botulinum toxin A appears to be effective in treating duct injuries accompanied by glandular involvement in an acute setting, as well as in preventing long-term complications.

This review will focus on the key steps in the recognition of parotid gland and duct injuries focusing on the important steps needed at the initial assessment. Management planning is presented in the way that trauma surgeons interact with patients, highlighting the important parts of the informed consent conversation followed by the key information that must be communicated to the anesthesia and operating room teams, which ensures proper monitoring and equipment needs are in place. Short-term and long-term outcomes for patients with persistent sequelae of the trauma and their management are reviewed., (Copyright © 2023 Elsevier Inc. All rights reserved.)

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Cyclophosphamide (CYP) is an alkylating agent that is used on a wide range as a treatment of malignancies and autoimmune diseases. Previous studies have shown the promising role of hesperidin (HSP) as an antioxidant agent against various models of toxic agents. The protective effect of the HSP against CYP-induced parotid damage was evaluated in this study. Forty rats (180-200 g) were divided into four equal groups: Group I (received normal saline), Group II (HSP-treated at a dose of 100 mg/kg/day for 7 consecutive days), Group III (CYP-treated at a dose of 200 mg/kg single intraperitoneal injection on the 7th day of the experiment), Group IV (CYP + HSP); HSP-treated at a dose of 100 mg/kg/day for 7 consecutive days and CYP (200 mg/kg) single intraperitoneal injection on the 7th day of the experiment. Afterwards, the oxidative stress and inflammatory markers, the histopathological and immunohistochemical alterations of the parotid tissues in the studied groups were evaluated. CYP intoxication induced a significant parotid tissue injury represented by the elevation in the values of malondialdehyde (MDA), tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) and decrease in the catalase activity and glutathione peroxidase (GPx). Histologically, extensive histopathological alterations e.g., widely spaced serous acini with irregular shapes and congested blood vessels as well as downregulated ki-67 and alpha-smooth muscle actin (α-SMA) immunoexpression were induced by CYP. HSP administration markedly improved the biochemical and the histopathological studies. We can conclude that HSP elicited protective effects against the CYP-induced parotid toxicity., (© 2023. The Author(s).)

Iatrogenic injury or trauma to the salivary gland duct is one of the most common causes of parotid sialoceles, which are usually superficial, soft, and filled with saliva. The enrolled 7 patients with parotid sialocele were divided into two groups: trauma group (4 cases) and iatrogenic group (3 cases). No evidence of recurrence or cranial nerve injuries were observed. With persisted parotid sialocele, intraoral drainage for two weeks as a safe and inexpensive method is recommended., (© 2022. Huazhong University of Science and Technology.)

Purpose: Facial nerve paralysis from head and neck tumors can result from disease progression or iatrogenic causes, leading to litigation. The aim of this study was to investigate lawsuits regarding facial paralysis as a consequence of these tumors to understand and better educate physicians behind the reasons for litigation., Methods: Jury verdict reviews were obtained from the Westlaw database from 1985 to 2018. Gathered data, including verdicts, litigation reasons, defendant specialties, and amounts awarded, were analyzed via Statistical Package for the Social Sciences., Results: Of the 26 lawsuits analyzed, the leading reason for litigation was failure to diagnose (53.8%), followed by iatrogenic injury (34.6%). The average award was $2,704,470. Otolaryngologists were the most common defendants. Defendants that included an otolaryngologist had shorter delays of diagnosis compared to those that did not (p < 0.05)., Conclusion: Failure to diagnose parotid injury was the leading cause of litigation. In instances where the jury found for the plaintiff, the amount was material. There were equivalent incidences of cases in favor of plaintiffs and defendants., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Thread-lifting is as a minimally invasive procedure with limited scarring, rapid recovery, and fewer complications compared with the standard incisional surgery for facial rejuvenation. Using absorbable thread-like polydioxanone is a relatively simple procedure that is also performed by nonmedical professionals in Korea. Although several acute or delayed complications after using nonabsorbable thread types were also reported, it is uncommon to find cellulitis caused by a delayed complication after thread-lifting. A 41-year-old woman presented to our clinic with inflamed multiple palpable masses. She underwent 3 courses of acupoint embedding therapy at a Korean oriental medical clinic. She was treated with combination antibiotic therapy; however, the inflammation did not subside. Consequently, excisional biopsy was performed under local anesthesia. During the procedure, threads were detected and removed. Dimpling, thread exposure, alopecia, under-correction, asymmetry, and parotid gland injury also can occur as early complications of the procedure. Fortunately, these reactions are predominantly mild to moderate in intensity, and can be corrected by a relatively simple procedure. Chronic inflammatory reactions in the thread-lifting area, as identified in the authors' case, are an infrequent complication. It is recommended to consult with experts in the field for the implementation of this procedure. In addition, experts also need to notify the above side effects and solutions in advance to ensure safe and satisfactory procedures for their patients.

The study aimed to retrospectively evaluate surgical treatment outcomes after delayed parotid gland and duct injuries. Nine patients subjected to parotid gland and duct injuries with 1- to 3-month treatment delay were retrospectively evaluated with special reference of etiology, past medical history, and injury location. Conservative treatment, microsurgical anastomosis, and diversion of salivary flow or ligation were chosen for delayed parotid gland and duct injuries concerning to their site of injury, time of repair and procedures. Assistant treatment as pressure dressing was adopted thereafter. All patients experienced an uneventful recovery at the time of finalizing the study. Two patients received Stensen's duct ligation, 5 received microsurgical anastomosis and 2 accepted salivary flow diversion for 5 patients with sialoceles and 4 patients with fistulas, and no re-occurrence was found. Facial paralysis occurred after surgery in 4 patients, and 3 of them recovered after the nerve nutrition treatment. Our study suggested that appropriate surgical treatment is efficient for the re-establishment of the tissue function and facial aesthetic for delayed injury of the parotid and its duct.

Rationale: Penetrating neck trauma has a mortality of 3% to 6% and is associated with serious complications, mainly due to the high density of vital structures in this area and the lack of corresponding protection from bone., Patient Concerns: A 55-year-old man who suffered neck trauma involving the parotid gland, caused by a rebar, after suffering a fall from the second floor of a building., Diagnoses: Penetrating neck trauma., Interventions: The patient underwent a neck exploration under general anesthesia in the emergency operating room and tracheotomy was performed prophylactically., Outcomes: The foreign object was ultimately removed successfully with no complications., Lessons: We concluded that computed tomography (CT) and three-dimensional reconstruction of the CT images can be a viable method to exclude macrovascular injury for patients who are in an emergency condition and are not eligible for computed tomography angiography (CTA). A chest tube could be used as an option for the removal of foreign bodies in the case of sharp or rough objects (such as spiral foreign bodies), when fully exposing the foreign body and its track.

Background Aims: Parotid hypofunction causes life-disrupting effects, and there are no effective medications for xerostomia. We hypothesized that mesenchymal stem cells (MSCs) have repairing effects on parotid glands of ovariectomized (OVX) rats., Methods: Forty-five adult female rats were divided into three equal groups: group I (Control group), group II (OVX-group) and group III (OVX rats that received MSCs at 4 and 8 weeks post-ovariectomy). At 12 weeks post-ovariectomy, histological (Masson's trichrome and periodic acid-Schiff with alcian blue stains), immunohistochemical (caspase-3 and CD44) and morphometric studies and salivary flow rate and saliva pH determination were carried out., Results: Histologically, the OVX group displayed numerous irregular vacuolated acini, thickened septa with marked cellular infiltration and vascular congestion. Degenerated organelles and few or irregular secretory granules with a different density were observed. Caspase-3-positive cells were highly expressed. MSC-treated glands exhibited a considerable degree of preservation of glandular architecture with numerous CD44-expressing and few caspase-3-expressing cells. Significant decrease of the salivary flow rate in the OVX group was detected, which reverted to normal levels in group III., Conclusions: MSCs ameliorated the damaging effects of ovariectomy on the parotid glands., (Copyright © 2017 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.)

Salivary duct injury can be idiopathic, iatrogenic, or post-trauma and may result in sialocele or fistula. Most injuries regress spontaneously and botulinum toxin A is one of several therapeutic possibilities. We report a case of iatrogenic injury to the parotid duct after Mohs' micographic surgery for a squamous cell carcinoma excision in the left jaw region, treated by injection of botulinum toxin type A. Although the fistula by duct injury can be self-limiting, botulinum toxin injection by promoting the inactivity of the salivary gland allows rapid healing of the fistula.

We describe the novel use of sialendoscopy in a 51-year-old man to identify a large and long-standing foreign body (wood) within the facial soft tissues that had eluded detection on previous imaging and surgical exploration. The identification of this foreign body was elusive on both computed tomography and magnetic resonance imaging, illustrating the limitations of imaging in identifying vegetable matter within soft tissues.

Fas and its ligand FasL, members of tumor necrosis factor receptor superfamily, have been implicated in the process of cell apoptosis. FasL consists of two forms, membrane FasL (mFasL) and soluble FasL (sFasL). sFasL can be produced by mFasL cleaved by matrix metalloproteinases (MMP) and also reveals a role for binding to Fas which is expressed on cell surface. Although Fas/FasL axis has been implicated in a variety of diseases, its role in Sjogren's syndrome still remains ill defined. In this study, we investigated the potential of sFasL in the pathogenesis of Sjogren's syndrome (SS). We found that the serum levels of sFasL in SS patients were significantly lower than healthy subjects. Moreover, serum levels of sFasL in patients with mild disease activity were higher than patients with severe disease activity. There is a positive correlation of the serum level of sFasL with uptake index of parotid gland in our expectation. In addition, liver injury involvement in SS patients showed decreased level of sFasL. Furthermore, we here also observed that the protective cytokine IL-10 expression was positively correlated with sFasL expression. Thus, our results here suggest a potential of sFasL in maintaining gland organ homeostasis., Competing Interests: The authors declare no conflict of interests regarding the publication of this paper.

Purpose: It has been long known that sialendoscopy has both diagnostic and therapeutic benefits in the identification and treatment of sialadenitis. Sialendoscopy can also be used to triage patients with traumatic injury or foreign bodies lodged in the parotid gland., Procedures: We present a case of traumatic insertion a fishbone into the parotid gland parenchyma that was evaluated with sialendoscopy and successfully managed on the basis of stable endoscopy findings that correlated with improving symptomatology., Main Findings: We find that sialendoscopy presents a useful tool to help guide management., Conclusions: We demonstrate that in an asymptomatic patient, foreign body impaction with absence of ductal obstruction on endoscopy can successfully be followed with simple observation., (Copyright © 2016 Elsevier Inc. All rights reserved.)

We are presenting the case of a patient who developed a parotid sialocele after sustaining a facial injury. The patient was treated by creating a controlled intraoral fistula that drained saliva into the oral cavity and led to resolution of the sialocele. Articles were reviewed for discussion of current treatment methods in managing parotid sialocele and fistula. The articles reported successful management of parotid sialocele and fistula using both nonsurgical and surgical methods. Treatment depends upon the location of the injury (ductal injury vs. parenchymal injury) and the time of treatment (delayed vs. immediate).

Parotid sialoceles are bothersome complications of parotidectomy and penetrating injury to the parotid gland. Though typically self-limited and responsive to conservative management, they can be particularly difficult to manage in the pediatric population where even conservative interventions are less well tolerated. We present the case of a 4-year-old child with a post-traumatic parotid sialocele that was successfully managed with a single injection of botulinum toxin B. To our knowledge, this is the first reported case of the use of botulinum toxin for this purpose in the pediatric population., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background and Purpose: This study was conducted to determine whether a secretome from mesenchymal stem cells (MSC) modulated by hypoxic conditions to contain therapeutic factors contributes to salivary gland (SG) tissue remodeling and has the potential to improve irradiation (IR)-induced salivary hypofunction in a mouse model., Materials and Methods: Human adipose mesenchymal stem cells (hAdMSC) were isolated, expanded, and exposed to hypoxic conditions (O2 < 5%). The hypoxia-conditioned medium was then filtered to a high molecular weight fraction and prepared as a hAdMSC secretome. The hAdMSC secretome was subsequently infused into the tail vein of C3H mice immediately after local IR once a day for seven consecutive days. The control group received equal volume (500 μL) of vehicle (PBS) only. SG function and structural tissue remodeling by the hAdMSC secretome were investigated. Human parotid epithelial cells (HPEC) were obtained, expanded in vitro, and then irradiated and treated with either the hypoxia-conditioned medium or a normoxic control medium. Cell proliferation and IR-induced cell death were examined to determine the mechanism by which the hAdMSC secretome exerted its effects., Results: The conditioned hAdMSC secretome contained high levels of GM-CSF, VEGF, IL-6, and IGF-1. Repeated systemic infusion with the hAdMSC secretome resulted in improved salivation capacity and increased levels of salivary proteins, including amylase and EGF, relative to the PBS group. The microscopic structural integrity of SG was maintained and salivary epithelial (AQP-5), endothelial (CD31), myoepithelial (α-SMA) and SG progenitor cells (c-Kit) were successfully protected from radiation damage and remodeled. The hAdMSC secretome strongly induced proliferation of HPEC and led to a significant decrease in cell death in vivo and in vitro. Moreover, the anti-apoptotic effects of the hAdMSC secretome were found to be promoted after hypoxia-preconditioning relative to normoxia-cultured hAdMSC secretome., Conclusion: These results show that the hAdMSC secretome from hypoxic-conditioned medium may provide radioprotection and tissue remodeling via release of paracrine mediators.

Introduction: The aim of this study was to describe our experiences of a mini-preauricular transparotid approach for direct reduction and plating of condylar neck fractures., Materials and Methods: A retrospective study was conducted on 58 patients from 2009 to 2011 with 69 condylar neck fractures in Chang Gung Memorial Hospital. The fractures were treated surgically either with a 2-cm mini-preauricular and transparotid approach in 29 patients with 36 fractures, or via endoscope-assisted intraoral, or facelift or retromandibular approaches in a control group of 29 patients with 32 fractures. The postoperative hospital stay, occlusion status, mouth opening and facial nerve and parotid gland related complications were compared between the two groups., Results: In both groups around 90% of patients had good restoration of preinjury occlusion. Postoperative mouth opening was 39.8 mm and 39.9 mm in the mini-preauricular approach and the other approaches group, respectively. Facial symmetry was achieved in all of the patients. There was no incidence of facial nerve palsy, infection or hemorrhage in the mini-preauricular group. One patient in the control group had a persistent weakness due to frontal nerve palsy., Conclusion: Based on the results, the mini-preauricular approach can be an alternative, safe and effective method in the management of condylar neck and high subcondylar fractures., (Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Penetrating trauma to the parotid gland may present unique challenges especially when Stensen duct, neurovascular structures, and/or collateral organs are involved. Especially ballistic injuries caused by high-velocity projectiles or fragments of grenades and improvised explosive devices are often associated with massive tissue damage and a high risk of infections and other posttraumatic complications. Because penetrating parotid trauma is not very common, only limited information on the primary treatment of such injuries is available. This article gives a short overview about actual aspects on diagnosis and treatment strategies especially focusing on ballistic parotid injuries., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

To find out if adipose-derived stem cells (ASC) and platelet-rich fibrin (PRF), alone or combined, had any effect on the repair of maxillofacial soft tissue defects in irradiated minipigs, ASC were isolated, characterised, and expanded. Twenty female minipigs, the right parotid glands of which had been irradiated, were randomly divided into 4 groups of 5 each: those in the first group were injected with both ASC and PRF (combined group), the second group was injected with ASC alone (ASC group), the third group with PRF alone (PRF group), and the fourth group with phosphate buffer saline (PBS) (control group). Six months after the last injection, the size and depth of each defect were assessed, and subcutaneous tissues were harvested, stained with haematoxylin and eosin, and examined immunohistologically and for apoptosis. Expanded cells were successfully isolated and identified. Six months after injection the defects in the 3 treated groups were significantly smaller (p<0.001) and shallower (p<0.001) than those in the control group. Those in the combined group were the smallest and shallowest. Haematoxylin and eosin showed that the 3 treated groups contained more subcutaneous adipose tissue than the control group, and also had significantly greater vascular density (p<0.001) and fewer apoptotic cells (p<0.001). Both ASC and PRF facilitate the repair of defects in maxillofacial soft tissue in irradiated minipigs, and their combined use is more effective than their use as single agents., (Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objective: To explore the effects of 30 Gy of (60)Co γ-rays on apoptosis and reactive oxygen species (ROS) levels in minipig parotid cells as a possible mechanism for radiation-induced parotid injury., Study Design: Experimental study., Setting: Department of Radiotherapy, First Affiliated Hospital, Guangxi Medical University, Nanning, China., Subjects and Methods: Forty male minipigs were divided into control and irradiated groups. Terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick-end labeling was used for detecting apoptosis in the parotid cells, immunohistochemistry, and western blots were used to test expression of the B-cell lymphoma 2 (Bcl-2) and BCL2-associated X (Bax) proteins, and reverse transcription polymerase chain reaction was used to analyze the expression of Bcl-2, Bax, p53, and caspase-3 messenger ribonucleic acid. An enzyme-linked immunosorbent assay was used to detect ROS levels in the parotid tissue., Results: At each time point, the apoptotic rates in the irradiated group were higher than those in the control group. Furthermore, the ROS and expression levels of Bax, p53, and caspase-3 messenger ribonucleic acid and proteins gradually increased and were higher than those in the control group. Conversely, the expression of Bcl-2 was decreased in the irradiated group (P < .05)., Conclusions: Ionizing radiation induces the production of ROS and promotes changes in the expression of several apoptotic proteins, which increases apoptosis and likely contributes to the mechanism of radiation-induced parotid injury., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.)

Background: The surface anatomy of the parotid duct is important when assessing facial lacerations and in facial rejuvenation surgery but is inconsistently described in reference texts. The aim of this study was to map the surface anatomy of the adult parotid duct using ultrasound., Methods: Fifty healthy adults (31 women; mean age, 33 years) were scanned by an experienced sonographer using a 13-5 MHz linear probe and a Siemens Sonoline Antares ultrasound machine. The caliber, length, and course of the parotid duct were recorded bilaterally., Results: The parotid duct was identified bilaterally in all participants. One subject had a double duct bilaterally. In the remaining 49 individuals (98 ducts), the duct had a mean maximum internal caliber of 0.6 ± 0.2 mm and length 42 ± 7.5 mm. Ninety-two (94 percent) ducts were below the most popular surface marking, which is reported as a line between the lower border of the tragus and mid philtrum. In 93 percent of individuals, the duct was within 1.5 cm of the middle half of a line between the lower border of the tragus and cheilion., Conclusion: A more accurate description of the surface anatomy of the parotid duct should assist with early diagnosis of parotid duct injuries and avoidance of iatrogenic injury., Clinical Question/level of Evidence: Diagnostic, IV.

Rhytidectomy is a common surgical procedure performed by today's aesthetic surgeons. Newer trends and techniques leading to deeper and more aggressive dissection have placed the parotid gland at increased risk for injury during this procedure. Despite there being a relative abundance of literature on traumatic parotid injury, there is a relative paucity of information on iatrogenic parotid injury after rhytidectomy. In addition, there is no consensus on management of these complications. In this article, the authors discuss 3 case reports, review the relevant literature, and propose a treatment algorithm. Early diagnosis and appropriate treatment are essential to properly manage this complication.

Objectives: To evaluate the necessity of adaptive planning in helical tomotherapy (TOMO) for head and neck cancer in terms of dosimetric influence on the parotid gland., Methods: Thirty-one patients underwent curative TOMO for head and neck cancer from April 2006 to April 2007. For each patient, neck diameter was monitored together with body weight at first cervical spine level through mega-voltage computed tomography during the TOMO course. Ten of 31 patients, with significant weight loss (>5%) and/or neck diameter decrease (>10%), were selected for dosimetric analysis, and parotid dose was recalculated at the fourth and last week of TOMO. Xerostomia was estimated by Radiation Therapy Oncology Group criteria., Results: The median dose was 69.96 Gy (range, 54 to 69.96 Gy) and there was no grade 3 or greater complication. Ten patients with significant neck diameter decrease and/or weight loss showed frequent grade 2 acute xerostomia (P=0.02). The volume percentage of daily fractional dose over 0.75 Gy for the parotid gland (V0.75 Gy) increased by 23.6% at the end of TOMO., Conclusions: For patients with significant anatomic contour change; neck diameter decrease (>10%) or weight loss (>5%), adaptive planning using mega-voltage computed tomography can identify dosimetric changes and reduce deleterious side effects such as xerostomia.

Objective: To report successful use of stent repair for a chronically injured parotid duct in a thoroughbred colt., Study Design: Clinical report., Animal: A 2-year-old thoroughbred colt., Methods: Chronic injury to the parotid duct was identified 4-cm caudal to the facial vessel notch on the ventral border of the right mandible. After careful surgical dissection of the surrounding firm fibrous tissue, the defect was temporarily stented using an 8-Fr human ureteral catheter (223600 ERU(®) SOFT URETERAL(®) , Laboratoires pharmaceutique, Betschdorf, France) to bridge the tissue loss. The rostral end of the catheter exited the oral cavity through a buccotomy stab incision at the level of the second premolar tooth of the maxilla., Results: Primary wound healing occurred and the stent was maintained for 5 weeks with saliva drainage visible when the colt was fed. After stent removal, function was restored with good cosmesis., Conclusions: A tissue defect in the parotid duct can be repaired successfully by temporary use of a stent until wound healing occurs., (© Copyright 2012 by The American College of Veterinary Surgeons.)

Injuries in the parotid and masseter region can cause serious impairment secondary to damage of important anatomical structures. Sialocele is observed as facial swelling associated with parotid duct rupture due to trauma. The aim of this paper is to report a case of a giant traumatic sialocele in the parotid gland, secondary to a knife lesion in a 40-year-old woman. Conservative measures could not promote clinical resolution and a surgical intervention for the placement of a vacuum drain was selected. Under local anesthesia, a small incision was performed adjacent to parotid duct papilla, followed by muscular divulsion and draining of significant amount of saliva. An active vacuum suction drain was placed for 15 days, aiming to form a new salivary duct. This technique was shown to be a safe, effective and low-cost option, leading to complete resolution and no recurrence after 28 months of follow up.

A foreign body lodged for decades in the parotid gland, entering through the oral cavity or the skin, is extremely rare. Even less common is the clinical presentation of a foreign body lodged in the parotid gland simulating a tumour. The authors report the finding of a fragment of shrapnel lodged in the parotid gland for 63 years. The case is unusual owing to the rare clinical presentation, the length of time between the injury and the occurrence of symptoms and the associated mandibular osteolysis in the panoramic radiograph. Initial diagnoses considered were a tumour emerging in the parotid gland, a large odontogenic cyst or an odontogenic tumour with soft tissue extension. Sometimes neither fine needle aspiration nor radiology is capable of providing an accurate diagnosis before surgery., (Copyright © 2011 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Purpose: To discuss the early diagnosis and treatment of injury to the parotid duct., Methods: Segmental epidural catheter was used to repair the injured parotid duct, if the broken ends of the parotid duct can't be anastomized end to end, facial vein transplantation and fascia parotideomasseterica flap were used for reconstruction., Results: In 22 cases, one case was lost to follow-up, nineteen cases had successful reconstruction of the parotid duct with good parotid secretions. Two cases had atrophy of the parotid gland., Conclusions: Early diagnosis is critical for treatment of injury of parotid duct. The efficacy of segmental epidural catheter is excellent for repair of parotid duct defect.

The anatomy of the buccal region of the face is complex and injuries in this region can lead to significant complications. Trauma in this region can easily injure the parotid duct and facial nerve. The management of parotid duct injuries is usually by microsurgical anastomosis, diversion of salivary flow by creating an oral fistula, or suppression of salivary gland function. The authors present a case of parotid duct injury treated by using an epidural catheter., (Copyright © 2011 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

A post traumatic parotid sialocele is an acquired lesion that arises from extravasation of saliva into glandular or periglandular tissues secondary to disruption of the parotid duct or parenchyma. Facial trauma and surgery in the parotid region are the most common causes of this rare condition. This paper presents an unusual incidence of post traumatic parotid sialocele after Le-Fort II fracture reduction and its management by relatively simple and cost-effective technique which can be carried out in routine dental surgery suite. The results achieved justify our recommendation of scalp vein cannula for the treatment of sialocele in clinical practice.

Parotid trauma can lead to both short and long-term complications such as bleeding, infection, facial nerve injury, sialocele, and salivary fistula, resulting in pain and disfigurement. Facial injuries inferior to a line extended from the tragus to the upper lip should raise concern for parotid injury. These injuries can be stratified into three regions as they relate to the masseter muscle. Injuries posing the greatest risk of damage to Stensen's duct include those anterior to the posterior border of the masseter and necessitate exploration. When the duct is disrupted, emphasis should be placed on primary repair or re-creation of the papilla; however, proximal ductal lacerations can be treated by ligation of the proximal segment. Isolated parenchymal injury can be treated with more conservative means. Sialocele and salivary fistula can frequently be managed nonoperatively with antibiotics, pressure dressings, and serial aspiration. Anticholinergic medications and the injection of botulinum toxin represent additional measures before resorting to surgical therapies such as tympanic neurectomy or parotidectomy., (© Thieme Medical Publishers.)

Case Report: We report the clinical course of a patient with a rare iatrogenic surgical complication of transposition of the Parotid duct into the maxillary sinus after tooth extraction., Discussion: Oroantral fistula occurs most frequently following maxillary molar or premolar extraction. Closure of an oroantral fistula is frequently closed using the buccal mucoperiosteal flap first described by Rehrmann in 1936. Transposition of the Parotid duct is a rare surgical complication of this technique., Conclusion: Differential diagnosis of nonspecific discharge from the nose should take this rare cause into account as it is a common symptom of this complication. A careful and full patient history and the correlation of nasal secretion with food intake can lead to the diagnosis., (Copyright © 2010 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

A 14-year-old patient had a low-energy facial blunt trauma that evolved to right facial paralysis caused by parotid hematoma with parotid salivary gland lesion. Computed tomography and angiography demonstrated intraparotid collection without pseudoaneurysm and without radiologic signs of fracture in the face. The patient was treated with serial punctures for hematoma deflation, resolving with regression and complete remission of facial paralysis, with no late sequela. The authors discuss the relationship between facial nerve traumatic injuries associated or not with the presence of facial fractures, emphasizing the importance of early recognition and appropriate treatment of such cases.

Evaluation of the parotid duct from trauma in an austere military environment can be challenging. Appropriate radiologic evaluation of a potential isolated parotid duct injury in this environment has not been reported. The use of a plain X-ray sialogram at the forward surgical team is demonstrated and may be beneficial in this setting.

Rejuvenation procedures, especially facelift are nowadays common type of cosmetic surgery. According to the statistical data, facelifts were the seventh most popular aesthetic surgery performed after liposuction, breast augmentation, blepharoplasty (eyelid surgery), abdominoplasty (tummy tuck), breast reduction and rhinoplasty. The most common complication after surgery is bleeding. Less common, but potentially serious, complications may include damage to the facial nerves and necrosis of the skin flaps, infection and damage of parotid duct. We present a case of 50 years old woman, who has undergone facelift surgery with damage of parotid duct and consequently formation of sialocele. Localisation of damage and repair of dissected Stensen's duct was performed using external approach. The duct was sutured end to end using intraductal stent. After 3 weeks stent was removed. We observed normal saliva flow from natural orifice of parotid gland.

Educational Objectives: At the conclusion of this presentation, the participants should be able to discuss how imaging and intra-operative facial nerve monitoring may be used in the removal of selected intraparotid foreign body without parotidectomy and dissection of the facial nerve., Objectives: 1) To present a rare case of a metallic intraparotid foreign body introduced as a projectile; 2) to discuss how CT images were used to guide the surgical exploration; and 3) To discuss the surgical approach used to retrieve an intraparotid foreign body without facial nerve dissection., Study Design: This is a clinical case report with a review of literature., Methods: We present the pertinent history and physical examination findings. We discuss the CT images. The technique of surgical exploration and foreign body retrieval is presented., Results: This is the case of a man who presented to the emergency department with a metallic foreign body lodged in the parotid introduced accidentally as a projectile. CT images were analyzed and the patient underwent successful removal of the intraparotid foreign body with out parotidectomy and facial nerve dissection via a posterior approach and using facial nerve monitoring., Conclusion: Selected intraparotid foreign bodies may be removed without parotidectomy and facial nerve dissection if imaging shows it can be approached safely and intra-operative facial nerve monitoring is used.

Objectives: siRNA-induced gene silencing in the salivary gland using microbubble-enhanced sonoporation was used to develop an in vivo gene knockdown technique., Methods: siRNA targeting rat glyceraldehyde-3-phosphate dehydrogenas (GAPDH) was mixed with echo-enhanced microbubbles and reverse-injected into rat parotid glands using transdermal ultrasound. To compare direct and transdermal ultrasound efficiencies, an incision was made on the lateral neck to expose the parotid glands for direct application. The efficiency of gene suppression was determined using quantitative reverse transcription-polymerase chain reaction 24-72 h after siRNA delivery. Cytotoxicity was assessed using histological analysis., Results: Expression of rat GAPDH in the parotid glands was silenced 48 h after siRNA was delivered by ultrasound (frequency: 1 MHz; intensity: 2 W cm(-2); exposure time: 2 min). High-intensity ultrasound induced tissue damage and apoptotic change. Echo-enhanced microbubbles significantly improved siRNA-induced gene silencing by 10-50%. Compared with transdermal application, direct-exposure ultrasound was only slightly effective, and no significant difference in gene expression was observed., Conclusion: The results indicate that microbubble-enhanced sonoporation can yield in vivo siRNA gene silencing in the rat parotid gland. This technique could be applied to provide gene knockdown organs for functional genomic analyses and to develop siRNA-based gene therapy.

Objective: To discuss the technique and outcome of this simple procedure and the management of post-traumatic parotid sialocoeles, and to review the literature regarding this condition., Case Report: We report the successful surgical treatment, by peroral drainage, of three patients with post-traumatic parotid sialocoele resistant to conservative management., Discussion: We discuss the method and outcome of the surgical procedure performed, along with the causes, presentation and management of parotid sialocoele., Conclusion: Correct initial management of a parotid duct injury may prevent the formation of a sialocoele. When conservative treatment of post-traumatic parotid sialocoele fails, we advocate the surgical technique described in this report as it is effective, simple and carries minimal risk to the patient.

Objectives: (1) To determine if a postparotidectomy sialocele occurs at a higher incidence with a partial superficial parotidectomy compared with a near-complete parotidectomy and (2) to determine if needle aspiration versus observation yield more persistent sialoceles beyond 1 month., Study Design: A single-surgeon, single-institution case series with a chart review., Methods: Comparing 100 consecutive partial superficial parotidectomy procedures and 20 consecutive near-total parotidectomy procedures for formation of a postoperative sialocele. Patients were evaluated at 1 week and 1 month postoperatively. The first 18 sialoceles were treated with one or more needle aspirations. The last 21 sialoceles were treated with observation., Results: There were 39 sialoceles in the partial superficial parotidectomy group (39/100, 39%) and none in the near-total parotidectomy group (0/20, 0%) (P < 0.05). All sialoceles resolved by the end of the first postoperative month whether aspirated or not aspirated., Conclusions: Sialoceles are common postpartial superficial parotidectomy, and they did not occur after near-total parotidectomy. Sialoceles can generally be treated by observation with an expectation of resolution within 1 month.

Parotid gland injuries are accompanied by a large number of sequelae. The aim of this paper is to highlight the importance of thorough management of these parotid glandinjuries especially at initial presentation in order to minimize the complications that accompany these injuries. A review of the aetiology and management of the existing cases of parotid gland injuries obtained from published journals and internet search as well as a report of two cases managed in our centre is presented in this paper. A total of about 70 cases in the previous literatures were reviewed of which assault was responsible for almost 90% of the cases. Sialoceles and fistulae were the main sequelae of these injuries. More than half of the cases (54%) were managed by conservative methods. Surgical drainage was done in about 44% cases; where the Stenson's ducts were accessible, primary repair was done. Excision of the gland was done in very few cases. The two cases managed in our centre were due to assault from broken bottles and road traffic accident respectively and both were managed by conservative methods. The first patient was a case of sialocele following the injury, which resolved within 3 weeks after the cyst formation with reduction in food intake, aspirations and external surgical drainage; while the second patient was a case of persistent fistula which healed after about 5 weeks following the trauma. Follow-up of both patients for about 3 months revealed no further leakage or accumulation of saliva. Management of these injuries involves a thorough understanding of the structure and function of the parotid gland and closely related tissues.