G Model ANORL-310; No. of Pages 2
ARTICLE IN PRESS European Annals of Otorhinolaryngology, Head and Neck diseases xxx (2014) xxx–xxx
Available online at
ScienceDirect www.sciencedirect.com
Case report
Catheterization of post-traumatic parotid duct sialocele Q. Lisan ∗ , M. Raynal , Y. Pons , M. Kossowski Service d’ORL et de chirurgie cervico-faciale, hôpital d’instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France
a r t i c l e Keywords: Sialocele Parotid duct Parotid Catheterization
i n f o
a b s t r a c t Introduction: Parotid duct sialocele is a salivary cavity arising at the expense of the parotid duct. Many cases of parotid sialocele have been published, but very few cases of parotid duct sialocele have been reported. Case report: We report a case of post-traumatic parotid duct sialocele that was assessed by MR sialography. The parotid duct was catheterized via the oral cavity and the catheter was left in place for ten days. No recurrence was observed. Discussion: Published cases of parotid duct sialocele are rare, as only seven cases were identified in the literature. Several treatment options are available for sialocele involving the parotid gland or parotid duct. Subcutaneous injection of botulinum toxin is commonly used, with good results. Parotid duct catheterization has also been reported, mainly for parotid gland sialoceles. To the best of our knowledge, apart from the present case, the use of this technique for parotid duct sialocele has only been reported once before. This technique is minimally invasive, with very low morbidity and good results. © 2014 Elsevier Masson SAS. All rights reserved.
1. Introduction Sialocele is a cavity filled with saliva, usually as a result of trauma or an iatrogenic complication of surgery. Many cases of parotid sialocele have been reported in the literature, but only very few cases of parotid duct sialocele have been reported. We report a case of post-traumatic parotid duct sialocele and describe its management. In the light of this case report and a review of the literature, we discuss the various treatment options for sialocele. 2. Case report A 27-year-old patient with no notable history experienced multiple injuries following the explosion of a homemade explosive device. The initial clinical assessment revealed serious head injury associated with several transfixing wounds of the left cheek. The radiological work-up revealed a fracture of the left zygomatic bone with a complex fracture of the anterior wall of the left maxillary sinus and a fracture of the floor of the left orbit. Initial management consisted of debridement and suture of the wounds. The fracture of the floor of the orbit was reduced on the third day after the accident. On the tenth day after surgery, a left malar collection gradually appeared which was painless on palpation. Examination of the oral cavity was normal and a postoperative
DOI of original article: http://dx.doi.org/10.1016/j.aforl.2014.02.005. ∗ Corresponding author. E-mail address: quentin [email protected] (Q. Lisan).
Fig. 1. MR sialography of the left parotid gland, axial view. The sialocele presents a high-intensity signal over the left zygomatic bone on the T2-weighted sequence.
haematoma was suspected. No other abnormality was detected on examination. In particular, the orifice of the parotid duct was normal, with no spontaneous discharge or discharge in response to pressure on the malar collection.
1879-7296/$ – see front matter © 2014 Elsevier Masson SAS. All rights reserved. http://dx.doi.org/10.1016/j.anorl.2013.09.002
Please cite this article in press as: Lisan Q, et al. Catheterization of post-traumatic parotid duct sialocele. European Annals of Otorhinolaryngology, Head and Neck diseases (2014), http://dx.doi.org/10.1016/j.anorl.2013.09.002
G Model ANORL-310; No. of Pages 2
ARTICLE IN PRESS Q. Lisan et al. / European Annals of Otorhinolaryngology, Head and Neck diseases xxx (2014) xxx–xxx
2
Fig. 2. A. Operative view of parotid duct catheterization. B. Albertini drain in place, anchored in the mouth. After intra-oral dilatation of the orifice of the parotid duct, the Albertini drain was inserted atraumatically and then anchored in the mouth.
Due to persistence of this malar collection, MR sialography was performed, revealing a sialocele of the left parotid duct (Fig. 1), while the parotid glands were normal. Catheterization of the parotid duct using an Albertini drain was then performed under general anaesthesia (Fig. 2A), allowing drainage of the sialocele after dilatation of the parotid duct. The drain was left in place and anchored in the mouth by a nonresorbable suture (Fig. 2B). Mouthwashes and antibiotic therapy were prescribed. During the immediate postoperative period, spontaneous drainage was relatively ineffective, requiring regular malar massage to obtain satisfactory drainage. Good evacuation was gradually obtained, with a decreasing need for massage. The drain was removed on the tenth day. The malar swelling had almost completely disappeared at one month. No clinical recurrence of the sialocele was observed at two-month follow-up. Follow-up MR sialography was performed and revealed no signs of recurrence.
3. Discussion Parotid sialoceles are frequently reported in the literature and are essentially post-traumatic or iatrogenic after superficial parotidectomy. In contrast, only very few cases of parotid duct sialocele have been described, as only seven post-traumatic cases were found in a review of the English language literature since the 1950s [1–7]. One study reported an incidence of 21% of parotid duct sialocele, confirmed by methylene blue test, following parotid duct trauma [4]. MR sialography tends to be replacing conventional sialography as standard imaging examination for investigation of a swelling along the course of the parotid duct. As well as being less invasive and less irradiating, MR sialography is also more accurate and allows examination of the parotid parenchyma. Several treatments have been reported in the literature. Scopolamine has been used, but with poor results. Injection of OK-432 in combination with bleomycin and biological glue was recently described in 9 patients with parotid sialocele after parotidectomy and was successful in every case with no complications. However, these results are based on a single study and only limited follow-up is available concerning this technique and the use of OK-432. Subcutaneous injection of botulinum toxin, type A or B, is increasingly used with good results and no complications have been described, especially with respect to facial nerve function. Botulinum toxin has been used to treat parotid sialocele, but has not been reported for the treatment of parotid duct sialocele. This treatment is often used after failure of other treatment modalities (repeated needle aspiration, compressive dressing,
antisialogogues). At least one needle aspiration of the sialocele often needs to be performed after botulinum toxin injection. Some authors have described intra-oral marsupialization of the sialocele [5], frequently leaving a drain in the mouth. Another treatment consists of intra-oral parotid duct catheterization, as reported in the present case. This technique has been described in several articles [3,8–10] after trauma or after parotidectomy. Good results are reported with this technique, allowing resolution of the sialocele without recurrence. The drain is left in place for ten days to one month after catheterization [9,10] or marsupialization. To the best of our knowledge, apart from the present case, this technique [3] has only been reported once before in the context of parotid duct sialocele. Intra-oral parotid duct catheterization with a drain left in place for one month is a minimally invasive technique that could possibly be performed under local anaesthesia [10]. 4. Conclusion Post-traumatic parotid duct sialocele is a rare condition. Several treatments are currently available. Intra-oral parotid duct catheterization is a minimally invasive technique providing good results with low morbidity. This technique can be easily performed by head and neck surgeons. As the case reported here is only the second case published in the literature, the reliability of this technique needs to be confirmed in a larger series. Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. References [1] Laccourreye L, Malinvaud D, Bonfils P, et al. Sialocele geante post-traumatique du canal de Sténon. Fr ORL 2007;93:353–7. [2] Singh B, Awasthi PN, Dutta SN. Repair of traumatic pseudocyst of parotid duct. J Indian Dent Assoc 1979;51:89–90. [3] Meyer RA, Gordon RC. Method for repair of traumatic pseudocyst of parotid duct: report of case. Oral Surg 1969;27:281–3. [4] Lewis G, Knottenbelt JD. Parotid duct injury: is immediate surgical repair necessary? Injury 1991;22(5):407–9. [5] Monfared A, Ortiz J, Roller C. Distal parotid duct pseudocyst as a result of blunt facial trauma. Ear Nose Throat J 2009;88(8):E15–7. [6] Landry RM. Traumatic pseudocyst formation of the parotid duct, a safer method of obliteration. AMA Arch Surg 1958;76(1):97–9. [7] Gombos F, Laino G, Rullo R. An unusual case of a sialocele secondary to a traumatic lesion of Stensen’s duct. Arch Stomatol (Napoli) 1983;24(4):455–63. [8] Gahir D, Clifford N, Yousefpour A, et al. A novel method of managing persistent parotid sialoceles. Br J Oral Maxillofac Surg 2011;49(6):491–2. [9] Torre-León C, Canario Q, Garratón M. A novel approach in the treatment of a post-traumatic sialocele. Otolaryngol Head Neck Surg 2013;148(3):529–30. [10] Medeiros Júnior R, Rocha Neto AM, Queiroz IV, et al. Giant sialocele following facial trauma. Braz Dent J 2012;23(1):82–6.
Please cite this article in press as: Lisan Q, et al. Catheterization of post-traumatic parotid duct sialocele. European Annals of Otorhinolaryngology, Head and Neck diseases (2014), http://dx.doi.org/10.1016/j.anorl.2013.09.002
ARTICLE IN PRESS European Annals of Otorhinolaryngology, Head and Neck diseases xxx (2014) xxx–xxx
Available online at
ScienceDirect www.sciencedirect.com
Case report
Catheterization of post-traumatic parotid duct sialocele Q. Lisan ∗ , M. Raynal , Y. Pons , M. Kossowski Service d’ORL et de chirurgie cervico-faciale, hôpital d’instruction des armées Percy, 101, avenue Henri-Barbusse, BP 406, 92141 Clamart cedex, France
a r t i c l e Keywords: Sialocele Parotid duct Parotid Catheterization
i n f o
a b s t r a c t Introduction: Parotid duct sialocele is a salivary cavity arising at the expense of the parotid duct. Many cases of parotid sialocele have been published, but very few cases of parotid duct sialocele have been reported. Case report: We report a case of post-traumatic parotid duct sialocele that was assessed by MR sialography. The parotid duct was catheterized via the oral cavity and the catheter was left in place for ten days. No recurrence was observed. Discussion: Published cases of parotid duct sialocele are rare, as only seven cases were identified in the literature. Several treatment options are available for sialocele involving the parotid gland or parotid duct. Subcutaneous injection of botulinum toxin is commonly used, with good results. Parotid duct catheterization has also been reported, mainly for parotid gland sialoceles. To the best of our knowledge, apart from the present case, the use of this technique for parotid duct sialocele has only been reported once before. This technique is minimally invasive, with very low morbidity and good results. © 2014 Elsevier Masson SAS. All rights reserved.
1. Introduction Sialocele is a cavity filled with saliva, usually as a result of trauma or an iatrogenic complication of surgery. Many cases of parotid sialocele have been reported in the literature, but only very few cases of parotid duct sialocele have been reported. We report a case of post-traumatic parotid duct sialocele and describe its management. In the light of this case report and a review of the literature, we discuss the various treatment options for sialocele. 2. Case report A 27-year-old patient with no notable history experienced multiple injuries following the explosion of a homemade explosive device. The initial clinical assessment revealed serious head injury associated with several transfixing wounds of the left cheek. The radiological work-up revealed a fracture of the left zygomatic bone with a complex fracture of the anterior wall of the left maxillary sinus and a fracture of the floor of the left orbit. Initial management consisted of debridement and suture of the wounds. The fracture of the floor of the orbit was reduced on the third day after the accident. On the tenth day after surgery, a left malar collection gradually appeared which was painless on palpation. Examination of the oral cavity was normal and a postoperative
DOI of original article: http://dx.doi.org/10.1016/j.aforl.2014.02.005. ∗ Corresponding author. E-mail address: quentin [email protected] (Q. Lisan).
Fig. 1. MR sialography of the left parotid gland, axial view. The sialocele presents a high-intensity signal over the left zygomatic bone on the T2-weighted sequence.
haematoma was suspected. No other abnormality was detected on examination. In particular, the orifice of the parotid duct was normal, with no spontaneous discharge or discharge in response to pressure on the malar collection.
1879-7296/$ – see front matter © 2014 Elsevier Masson SAS. All rights reserved. http://dx.doi.org/10.1016/j.anorl.2013.09.002
Please cite this article in press as: Lisan Q, et al. Catheterization of post-traumatic parotid duct sialocele. European Annals of Otorhinolaryngology, Head and Neck diseases (2014), http://dx.doi.org/10.1016/j.anorl.2013.09.002
G Model ANORL-310; No. of Pages 2
ARTICLE IN PRESS Q. Lisan et al. / European Annals of Otorhinolaryngology, Head and Neck diseases xxx (2014) xxx–xxx
2
Fig. 2. A. Operative view of parotid duct catheterization. B. Albertini drain in place, anchored in the mouth. After intra-oral dilatation of the orifice of the parotid duct, the Albertini drain was inserted atraumatically and then anchored in the mouth.
Due to persistence of this malar collection, MR sialography was performed, revealing a sialocele of the left parotid duct (Fig. 1), while the parotid glands were normal. Catheterization of the parotid duct using an Albertini drain was then performed under general anaesthesia (Fig. 2A), allowing drainage of the sialocele after dilatation of the parotid duct. The drain was left in place and anchored in the mouth by a nonresorbable suture (Fig. 2B). Mouthwashes and antibiotic therapy were prescribed. During the immediate postoperative period, spontaneous drainage was relatively ineffective, requiring regular malar massage to obtain satisfactory drainage. Good evacuation was gradually obtained, with a decreasing need for massage. The drain was removed on the tenth day. The malar swelling had almost completely disappeared at one month. No clinical recurrence of the sialocele was observed at two-month follow-up. Follow-up MR sialography was performed and revealed no signs of recurrence.
3. Discussion Parotid sialoceles are frequently reported in the literature and are essentially post-traumatic or iatrogenic after superficial parotidectomy. In contrast, only very few cases of parotid duct sialocele have been described, as only seven post-traumatic cases were found in a review of the English language literature since the 1950s [1–7]. One study reported an incidence of 21% of parotid duct sialocele, confirmed by methylene blue test, following parotid duct trauma [4]. MR sialography tends to be replacing conventional sialography as standard imaging examination for investigation of a swelling along the course of the parotid duct. As well as being less invasive and less irradiating, MR sialography is also more accurate and allows examination of the parotid parenchyma. Several treatments have been reported in the literature. Scopolamine has been used, but with poor results. Injection of OK-432 in combination with bleomycin and biological glue was recently described in 9 patients with parotid sialocele after parotidectomy and was successful in every case with no complications. However, these results are based on a single study and only limited follow-up is available concerning this technique and the use of OK-432. Subcutaneous injection of botulinum toxin, type A or B, is increasingly used with good results and no complications have been described, especially with respect to facial nerve function. Botulinum toxin has been used to treat parotid sialocele, but has not been reported for the treatment of parotid duct sialocele. This treatment is often used after failure of other treatment modalities (repeated needle aspiration, compressive dressing,
antisialogogues). At least one needle aspiration of the sialocele often needs to be performed after botulinum toxin injection. Some authors have described intra-oral marsupialization of the sialocele [5], frequently leaving a drain in the mouth. Another treatment consists of intra-oral parotid duct catheterization, as reported in the present case. This technique has been described in several articles [3,8–10] after trauma or after parotidectomy. Good results are reported with this technique, allowing resolution of the sialocele without recurrence. The drain is left in place for ten days to one month after catheterization [9,10] or marsupialization. To the best of our knowledge, apart from the present case, this technique [3] has only been reported once before in the context of parotid duct sialocele. Intra-oral parotid duct catheterization with a drain left in place for one month is a minimally invasive technique that could possibly be performed under local anaesthesia [10]. 4. Conclusion Post-traumatic parotid duct sialocele is a rare condition. Several treatments are currently available. Intra-oral parotid duct catheterization is a minimally invasive technique providing good results with low morbidity. This technique can be easily performed by head and neck surgeons. As the case reported here is only the second case published in the literature, the reliability of this technique needs to be confirmed in a larger series. Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. References [1] Laccourreye L, Malinvaud D, Bonfils P, et al. Sialocele geante post-traumatique du canal de Sténon. Fr ORL 2007;93:353–7. [2] Singh B, Awasthi PN, Dutta SN. Repair of traumatic pseudocyst of parotid duct. J Indian Dent Assoc 1979;51:89–90. [3] Meyer RA, Gordon RC. Method for repair of traumatic pseudocyst of parotid duct: report of case. Oral Surg 1969;27:281–3. [4] Lewis G, Knottenbelt JD. Parotid duct injury: is immediate surgical repair necessary? Injury 1991;22(5):407–9. [5] Monfared A, Ortiz J, Roller C. Distal parotid duct pseudocyst as a result of blunt facial trauma. Ear Nose Throat J 2009;88(8):E15–7. [6] Landry RM. Traumatic pseudocyst formation of the parotid duct, a safer method of obliteration. AMA Arch Surg 1958;76(1):97–9. [7] Gombos F, Laino G, Rullo R. An unusual case of a sialocele secondary to a traumatic lesion of Stensen’s duct. Arch Stomatol (Napoli) 1983;24(4):455–63. [8] Gahir D, Clifford N, Yousefpour A, et al. A novel method of managing persistent parotid sialoceles. Br J Oral Maxillofac Surg 2011;49(6):491–2. [9] Torre-León C, Canario Q, Garratón M. A novel approach in the treatment of a post-traumatic sialocele. Otolaryngol Head Neck Surg 2013;148(3):529–30. [10] Medeiros Júnior R, Rocha Neto AM, Queiroz IV, et al. Giant sialocele following facial trauma. Braz Dent J 2012;23(1):82–6.
Please cite this article in press as: Lisan Q, et al. Catheterization of post-traumatic parotid duct sialocele. European Annals of Otorhinolaryngology, Head and Neck diseases (2014), http://dx.doi.org/10.1016/j.anorl.2013.09.002
