Parotid Gland Injury

MINORS MANUAL

Parotid gland injury occurs due to trauma to the preauricular or lateral facial region, affecting both the glandular tissue and its associated structures, such as Stensen’s duct (parotid duct). These injuries can lead to saliva leakage, infection, or damage to the facial nerve, which passes through the gland, resulting in partial facial paralysis.

Diagnosis

Diagnosis is based on clinical evaluation, observing signs of inflammation, swelling, saliva leakage, or mass formation (sialocele) in the parotid region following trauma. Facial paralysis, localised pain, and saliva discharge through the wound are characteristic signs. Imaging studies such as ultrasound, sialography, or computed tomography (CT) can be used to assess the extent of the injury.

Differential Diagnosis

Pathology	Key Characteristics
Sialadenitis	Pain, inflammation, and fever without a history of trauma
Salivary fistula	Continuous saliva leakage through a wound or fistula
Parotid gland tumour	Painless, slow-growing mass, no trauma history
Mandibular fracture	Pain and mandibular instability, no saliva leakage

Emergency Management

• Haemorrhage control: Apply direct pressure at the injury site.

  
  

• Decontamination: Irrigate the wound with sterile saline to prevent infections.

  
  

• Neurological assessment: Check facial nerve function for signs of paralysis.

  
  

• Sialocele or fistula treatment: Aspiration or drainage if there is an accumulation of saliva in the surrounding tissues.

  
  

• Prophylactic antibiotics: Administer broad-spectrum antibiotics to prevent infections, particularly if a fistula or sialocele is present.

  
  

• Avoid premature wound closure: In cases of sialocele or fistula, it may be necessary to allow proper drainage before closing the wound.

  
  

Definitive Treatment

Surgical repair may include glandular tissue reconstruction, sialocele drainage, and, in cases of facial nerve or parotid duct damage, microsurgical correction. The use of botulinum toxin to reduce saliva production may facilitate healing in complex cases.