A 37-year-old male patient reported to the Department of Oral and Maxillofacial Surgery with a chief complaint of pain, difficulty in closing the mouth, and swelling on the left side of the face following a road traffic accident. Direct open reduction and internal fixation via transparotid approach of the left condyle were performed []. Ten days later, the patient presented with a swelling on the left side of the face. On extraoral examination, there were no clinical signs of infection or drainage in the surgical wound and no local rise in temperature was noted. On intraoral examination, salivary secretion through the stenson's duct was relatively reduced on the left side. Neurological examination revealed that no motor loss due to severance of any branch of facial nerve in the affected side. Aspiration was done on dependable swelling which gained a 6 ml of clear, watery, and odorless fluid aspirate, giving an impression of saliva []. A laboratory test confirmed the presence of salivary amylase in the aspirate.\nIn this case, trauma in the parotid glandular substance leads to the formation of sialocele by the accumulation of extravasated saliva into the glandular parenchyma. Pressure dressing and antibiotics were given to prevent infection. Postoperatively, repeated aspiration along with compressive dressing was performed but did not result in healing. Hence, decided to place an intraoral drain under local anesthesia.\nAfter standard aseptic preparation, intraorally, a 1 cm long incision was placed on external oblique ridge behind the third molar. A small curved artery forceps were inserted through the superficial fascia of masseter reaching the sialocele. Approximately 5 cm long, slender, sterile, punched plastic tube of diameter 5 mm (intravenous cannula) [] was positioned with one end in the glandular substance and the other end in the mouth with the help of the forceps. The tube was secured along the vestibule by suturing it to the mucosal surface of the cheek, ensuring complete convenience to the patient []. After placing such a drain, there was no pooling of saliva in the glandular substance. This would have allowed healing of the gland and subsequent formation of structures necessary for drainage through the main Stensen's duct. The patient's recovery was uncomplicated, and follow-up was done for 5 months.
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.