A 24-year-old otherwise healthy male patient reported with the chief complaint of watery discharge from a swelling on the right side of the face for the past 1 month. Patient had a history of mandibular condylar fracture from a road traffic accident, for which he was treated elsewhere with direct open reduction and internal fixation of the condyle. The surgical scar was observed on the post-ramus swelling, and there was fistula in one end of the scar that was about 0.5 cm in diameter [Figures and ]. The wound was 2 cm deep and had a healthy granulating margin with no obvious clinical signs of infection, but the wound continued to have a drain of a copious amount of clear, watery, and odorless fluid.\nOn examination of parotid papillae, intraorally, active secretion was present on the left side, but not on the right side. Neurological examination revealed no motor loss due to severance of any branch of facial nerve in the affected side. Location of the fistula and nature of the discharge suggested a laceration of the right parotid gland substance resulting in a sialocele and a right parotid fistula formation. Siaologram confirmed the clinical suspicion [Figures –].\nIn the present case, trauma in the parotid glandular substance lead to formation of sialocele by accumulation of extravasated saliva into glandular parenchyma. It was decided to create a controlled internal fistula with drainage intraorally under local anesthesia. After standard preparation, intraorally, a 1-cm long incision was placed on external oblique ridge behind the third molar. A small artery forceps was forced through the superficial fascia of masseter reaching the sialocele. With the help of this forceps, approximately 5-cm long, slender, sterile, punched plastic tube of diameter 4 mm was positioned with one end in the glandular substance and the other end in the mouth, seated along the vestibule, ensuring complete convenience. The tube was secured by suturing it to the mucosal surface of the cheek []. Extraorally, the wound was sutured primarily in layers, followed by compression dressing on the cheek. The patient was covered with Ciprofloxacin and Metronidazole for 5 days to prevent superadded infections. Saliva stopped draining by 10th postoperative day of surgery. The tube was subsequently removed to enable the internal fistula to close and salivary secretions to drain through the right Stenson's duct normally. The patient's recovery was uncomplicated and follow-up was done for 5 months and lost to follow-up.
A 32-year-old male patient presented with the complaints of watery discharge from a wound over the left parotid region for the past 8 months. The fistula had started 2 weeks after he had undergone superficial parotidectomy for pleomorphic adenoma. The patient was diagnosed as a case of postparotidectomy parotid fistula and initially treated conservatively with regular pressure dressing, anticholinergics, and antibiotics, but symptoms were not relieved. Subsequently, the patient had also developed features of Frey's syndrome 7 months after the surgery.\nThe patient was diagnosed with simultaneous parotid fistula and Frey's syndrome []. Forty units of BTA was injected subcutaneously in the parotid region. There were no complications such as facial nerve injury and facial artery or masseter muscle trauma. The parotid fistula got resolved within 4 days with complete closure of the fistulous opening and gustatory sweating (Frey's syndrome) ceased after 6 days []. There was no recurrence later, after a follow-up period of 1 year.