MINORS MANUAL
A parotid duct injury occurs when the duct that carries saliva from the parotid gland to the oral cavity is damaged. This injury can result from facial trauma, particularly to the lateral aspect of the face, leading to the leakage of saliva into the surrounding tissue (sialocele) or, in more severe cases, salivary fistulas.
Diagnosis
Diagnosis is based on a history of facial trauma and the location of the wound along the parotid duct pathway. Clinically, swelling may be observed in the preauricular region, with saliva leaking through the wound or the formation of a fluctuating swelling (sialocele). Additional tests may include sialography or ultrasound to visualise the extent of the duct damage.
Differential Diagnosis
Pathology | Key Characteristics |
|---|---|
Sialadenitis | Inflammation of the parotid gland, pain, and fever |
Salivary fistula | Continuous leakage of saliva through an opening in the skin |
Sialocele | Fluctuant mass in the parotid region without an external opening |
Facial trauma without duct injury | Haematoma or wound without saliva leakage |
Emergency Management
Haemorrhage control: Apply direct pressure if associated bleeding is present.
Wound exploration: Visually assess the parotid duct’s pathway to determine the extent of the injury.
Infection prevention: Irrigate the wound with sterile saline and administer antibiotic prophylaxis if necessary.
Sialocele decompression: If a sialocele has formed, it may require drainage through aspiration or appropriate drain placement.
Careful wound closure: In minor duct injuries, primary wound closure with sutures may be adequate, but care should be taken not to impair duct function.
Definitive Treatment
Surgical repair is the definitive treatment, particularly if the duct is completely severed. The surgeon may perform a ductal anastomosis or redirect the saliva flow. Botox may be used temporarily to reduce saliva production and aid healing.
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