A 1-yr-old girl presented with a salivary discharge at the facial skin of her right cheek. CT sialography was done and a sialo-cutaneous fistula from an accessory parotid gland was diagnosed (). She also had a skin tag on the tragus of the right ear. At that time, surgical excision was considered at a later age. At the age of five, she visited the outpatient clinic for definitive treatment. The clinical examination demonstrated a 1 mm-sized opening located at the facial skin 1 cm lateral to the angle of mouth. The salivary discharge was clear and serous. The salivary flow rate was calculated by a cotton ball test. It revealed that the flow from the accessory gland was about 10% of the total flow of a parotid gland. According to our previous experience (), fistulectomy was scheduled, but aesthetic considerations for the young girl made the surgical plan change to more conservative management. Under general anesthesia, the 6 cm-long fistula tract was identified with a lacrimal probe. Intraoperative ultrasonography was done to demarcate the accessory parotid gland. Although the accessory gland was too small to be clearly identified, 16 IU of botulinum toxin was injected to the accessory gland under ultrasound guidance. After thin adhesive film was attached on the buccal skin around the fistula opening to prevent spillage of corrosive agent from unwanted skin injury, about 2 mL of 40% TCA solution was injected into the tract with a small metal suction tip (). Thirty seconds later, all the solution was removed with suction and squeezing. This procedure of TCA cauterization was repeated twice. There was no immediate complication postoperatively.\nAfter several days, a tensely inflated sialocele formed and the opening was found to be completely closed up. Aspiration was done with long subcutaneous tunneling from behind so as not to make an iatrogenic sialo-cutaneous fistula. After 4 sessions of weekly aspiration, the sialocele did not recur. During one year follow-up, there was no more salivary leakage or sialocele. Moreover, the aesthetic result was very satisfactory.
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.