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.
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.