Parotid Injuries and Fistulae

Successful treatment of parotid injuries depends on early recognition and appropriate early intervention. Sequelae of inadequate diagnosis and treatment include parotid fistula and sialocele formation, which are inconvenient for the patient and more difficult to treat than the initial injury. A parotid fistula is a communication between the parotid gland (glandular fistula) or duct (ductal fistula) and the skin externally (external fistula) or to the oral cavity internally (internal fistula). A sialocele is a collection of saliva beneath the skin that occurs if the duct leaks but no fistula forms, or when the glandular substance, but not the duct, is disrupted. Management options include pressure dressings and use of anti-sialagogues, total parotidectomy, tympanic neurectomy, intra-oral transposition of the parotid duct, radiation therapy, the use of botulinum toxin A, and the use of fibrin glue.