A 1-year-old girl presented with serous discharge from the right cheek since birth which increased on chewing. On examination, there was a 1 mm × 1 mm cutaneous opening over the right cheek, 2 cm lateral to the angle of the mouth along with bilateral preauricular skin tags []. Intraoral examination and duct opening of parotid and submandibular gland was normal on both sides. Sinogram with a 24G cannula showed a thin tubular tract directed posteromedially from the external opening on the cheek into the region of the Stensen's duct/parotid gland []. There was no communication with the oral cavity or mandible. Under general anesthesia, the external opening was cannulated with a 24G intravenous plastic cannula and methylene blue injected []. With circumferential fine dissection around the external opening, the fistula tract was separated from the skin and subcutaneous fat of the cheek and brought into the oral cavity. Further intraoral dissection showed the tract initially going vertically down for 2 cm then turning posteriomedially for 1 cm to finally opening into the right Stensen's duct near the lower part of the parotid gland []. The fistulous tract was transfixed and ligated at its origin in the duct and excised in toto []. At 1-year follow-up, she has a negligible scar with a good cosmetic outcome [].
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.