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 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.