A white17-year-old female patient presented with a 4-month history of swelling over her\nleft cheek anteriorly to the ear. She referred 3 previous episodes, the last one having\nstarted 1 month before the appointment. She denied trauma to the region, had not have\nepisodes of fever lately and her medical history was not contributory. There was no\nassociated pain or alteration of facial function as well as no motor or sensory deficits\nwere observed.\nThe swelling measured about 6 cm in length and 5 cm in width. On bimanual palpation an\nill-defined and resilient mass was noticed (). This mass was evident extra orally with a considerable bulging of the skin\nin the left parotid region. The lesion was normal and no lymphadenopathy was detected.\nOn intraoral examination, oral mucosa and teeth were healthy. The parotid duct in the\naffected side was normal and salivary flow had normal physical aspects without debris or\npurulent discharge. The presumptive clinical diagnosis was an abscess associated to mild\ninflammation, considering the patient’s history and the previous episodes. Conventional\npanoramic radiography, ultrasonography and sialography were performed. The panoramic\nradiograph showed teeth and bones preserved without any evidence of abnormalities. The\nultrasonographic scan revealed a hypoechoic ovoid well defined image suggesting a cyst\n(). Sialography of the left parotid was\nperformed using Lipiodol® (Lipiodol; Guerbet, Jacarepaguá, RJ,\nBrazil) as a substance of contrast. A partial filling of the gland was enough to show\ncavitary sialectasia in a panoramic ()\nand anteroposterior view (), and the\ncontrast was retained in the gland for at least 24 hours ().\nA percutaneous needle aspiration of the swelling was performed 2 weeks after the\nsialography. It yielded 4 mL of a clear viscous fluid. The material was submitted to\nmicrobiological analysis and showed numerous polymorphonuclear leukocytes. The fluid did\nnot show any bacterial growth and presented high amylase levels (7,810 units/L). The\naspiration procedure was sufficient to empty the cavity. The patient was advertised to\ncompression dressing twice a day. Seven days after the percutaneous aspiration a great\ndecrease of the swelling was observed. The overlying skin showed a discreet erythema on\nthe surface of the mass, without signs of infection, and the patient did not refer pain\n(). At the 30-day follow-up visit,\ncomplete recovery was noticed, and the residual swelling had totally disappeared (). The patient was followed up during two\nyears and a half and no recurrence was detected.
A 38-year-old man reported to the department of oral and maxillofacial surgery with a history of fall. He was diagnosed with left subcondylar, left angle and right parasymphysis fractures. He was thoroughly investigated and open reduction and internal fixation was done under general anesthesia.\nA mini-retromandibular approach was used for the fixation of the subcondylar and angle fracture, while parasymphysis fracture was reduced intraorally. On the seventh postoperative day, a diffuse swelling was observed in the left parotid region and on compressing the swelling; a watery, odorless discharge was seen from the sutured surgical wound [].\nA diagnosis of parotid fistula was made on the basis of history, location of swelling and clinical inspection of the discharge. The pressure dressing was applied for first four days after the aspiration along with antisialagogues and antibiotics. There was no significant decrease in the size of swelling or discharge.\nAfterwards we decided to use hot hypertonic saline injections. A 3% hypertonic saline was poured in a clean steel bowl and was heated to a temperature of 60 degree in an autoclave previously set at the required temperature. The mentioned site was prepared by scrubbing with Betadine solution. Five milliliter of this hypertonic solution was injected into the parotid through fistulous opening, followed by pressure dressing. The patient was instructed to continue same medicines. This procedure was repeated for three days. On the fourth day the patient did not show any signs of swelling or salivary leak as the fistula closed spontaneously.\nPressure dressings and use of antisialagogues cause fibrosis of the gland in 2 to 3 weeks;[] hence closure of fistula in 4 days was attributed to warm hypertonic saline injections. Follow-up was done for 5 months with no morbidity seen. The facial nerve and its branches were evaluated and were found to be normal.