An 8-month-old male child presented with salivary discharge from the right cheek since birth. On inspection, there was a 1 mm external fistulous opening, 2 cm from the angle of the mouth with ipsilateral preauricular appendage. Intraoral examination was normal. On sinogram, no obvious tract could be identified. Under general anesthesia, cannulation of external fistulous opening was extremely difficult due to its very narrow caliber. A 24G plastic cannula could be passed for only 5 mm through which methylene blue dye was injected. Similar dissection was done as in the previous case with the tract being dissected externally and transposed intraorally. Diffuse intraoral discoloration by the dye was noted and insufficient length of cannula within the duct made identification of further intraoral tract difficult and the procedure had to be abandoned. The preauricular skin tag was excised. Postoperatively, there was local edema and a small dry ulcer over the cheek []. It eventually healed with secondary intention. At 1-year follow-up, there is no external salivary discharge with good cosmetic outcome.
A 35-year-old male, carpenter by profession, reported to us following a RTA. He was diagnosed with a panfacial fracture which included a LeFort 3, ZMC, naso-orbital-ethmoid, bilateral condylar, and symphysis fractures [Figures and ]. The right subcondylar-ramus fracture was approached through a periangular incision. The left dislocated condyle was then reduced and fixed through a preauricular approach. This was followed by the symphysis fracture reduction and fixation through an intraoral vestibular approach. The midface was finally reduced and fixed. This was followed by a postoperative orthopantomogram for assessment [].