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 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.