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.
A 79-year-old woman visited our emergency department with three stab wounds in her right preauricular area (). We found no abnormal finding during the retrograde irrigation test for Stensen duct that was performed in the ampulla. However, facial expressions such as the area around the mouth and blinking of the eyes were unnatural, so the possibility of facial nerve injury could not be ruled out. An emergency exploration was performed under general anesthesia in the operating room. To minimize additional injuries and conduct a more reliable exploration of the injured areas, the wounds were connected to expose all the injured areas. Even though more dead space was created due to this procedure, we definitely found injuries in the parotid glands and an injury at a marginal mandible branch of the facial nerve (). After neurorrhaphy for the facial nerve injury, the wound was sutured, and a closed 100-mL Jackson-Pratt drainage tube was inserted (). The injured parotid gland area was not wide in size and the tissue was soft, so it was not repaired.\nAs postoperative management, oral administration of 10 mg nortriptyline once daily for 3 weeks was started from the day of surgery to prevent secondary complication, such as infection due to persistent salivation. During treatment with nortriptyline, the patient complained of mouth dryness, which showed that the drug had an anticholinergic action. The drainage tube was removed on the 6th day after the surgery, when 5 mL per day or less drainage was collected for 3 days in a row. Due to the possibility of partial wound dehiscence, delayed stitch out was planned, and all sutures were removed on the 10th postoperative day. Complete and unremarkable wound healing was observed, and no complications were reported 7 weeks postoperatively ().