A 24-year-old otherwise healthy male patient reported with the chief complaint of watery discharge from a swelling on the right side of the face for the past 1 month. Patient had a history of mandibular condylar fracture from a road traffic accident, for which he was treated elsewhere with direct open reduction and internal fixation of the condyle. The surgical scar was observed on the post-ramus swelling, and there was fistula in one end of the scar that was about 0.5 cm in diameter [Figures and ]. The wound was 2 cm deep and had a healthy granulating margin with no obvious clinical signs of infection, but the wound continued to have a drain of a copious amount of clear, watery, and odorless fluid.\nOn examination of parotid papillae, intraorally, active secretion was present on the left side, but not on the right side. Neurological examination revealed no motor loss due to severance of any branch of facial nerve in the affected side. Location of the fistula and nature of the discharge suggested a laceration of the right parotid gland substance resulting in a sialocele and a right parotid fistula formation. Siaologram confirmed the clinical suspicion [Figures –].\nIn the present case, trauma in the parotid glandular substance lead to formation of sialocele by accumulation of extravasated saliva into glandular parenchyma. It was decided to create a controlled internal fistula with drainage intraorally under local anesthesia. After standard preparation, intraorally, a 1-cm long incision was placed on external oblique ridge behind the third molar. A small artery forceps was forced through the superficial fascia of masseter reaching the sialocele. With the help of this forceps, approximately 5-cm long, slender, sterile, punched plastic tube of diameter 4 mm was positioned with one end in the glandular substance and the other end in the mouth, seated along the vestibule, ensuring complete convenience. The tube was secured by suturing it to the mucosal surface of the cheek []. Extraorally, the wound was sutured primarily in layers, followed by compression dressing on the cheek. The patient was covered with Ciprofloxacin and Metronidazole for 5 days to prevent superadded infections. Saliva stopped draining by 10th postoperative day of surgery. The tube was subsequently removed to enable the internal fistula to close and salivary secretions to drain through the right Stenson's duct normally. The patient's recovery was uncomplicated and follow-up was done for 5 months and lost to follow-up.
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.