Table Causes of salivary gland injuries Penetrating injuries



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Table 1. Causes of salivary gland injuries


  1. Penetrating injuries3

      1. Assault with knife or bottle

      2. Automobile windshield

      3. Gunshot injuries

  2. Blunt trauma - Rupture of the parotid capsule without cutaneous defect or laceration4

  3. Complication of duct cannulation for sialography

  4. Intra operative iatrogenic injuries




Table 2. Anatomic classification of parotid gland duct injury by Van Sickel and Alexander




Site-A

Intraglandular or part of the duct lies posterior to masseter muscle

Site-B

Part of the duct overlies the masseter muscle: most common site of ductal injury, easiest to repair

Site-C

Part of the duct anterior to the masseter

Table 3. A New Classification of Parotid gland and duct Injury (Based on Sialographic Appearances)



1.Glandular Injury


2.Ductal Injury



  1. Type 1: Injury to the parenchyma or to minor ducts (G 1)

  2. Type 2: Injury to a major intraparotid duct (G2)




  1. Type l(a): Partial transection of the parotid duct [D1(a)]

  2. Type 1(b): Complete transection of parotid duct [Dl(b)]

  3. Type 2(a) Partial disruption of parotid gland-duct junction [D2(a)]

  4. Type 2(b) Complete disruption of parotid gland-duct junction [D2(b)]

Table 4. Incidences and Time of initial presentation of different sequelae of parotid

gland or duct injury 7




Sequelae of parotid injury

incidences

Time of initial presentations after trauma

Effusion

15%

1.5 days

Fistula

30%

7 days

Sialocele

58%

12 days

Table 5. Various treatment objectives for post traumatic sialocele or salivary fistula




METHODS

COMMENTS

Antisialagogue

A useful adjunct to reduce salivary flow. More effective in injury involving glandular portion of parotid gland

Radiation10

It induces fibrosis of gland parenchyma and lead to atrophy of the gland. Approximately 1800 rads is required to cause atrophy and it starts 6 weeks following radiation therapy with possibility of radiation induced malignancy.

Tympanic neurectomy11

Transtympanic sectioning of the Jacobson’s nerve. high failure rate in ductal injury. Glandular atrophy may take as long as 6 months to occur.

Superficial

or total parotidectomy



Increased morbidity due to scaring, fibrosis and granulation tissues caused by previous injury. 75% patients experienced facial palsy when underwent parotid surgery for post traumatic sialocele or fistula.

Table 6. Management of Parotid Sialoceles and Fistulae: A Classification of Reported Methods in the Literature:



1. Diversion of parotid secretion into the mouth



2. Depression of parotid secretion




A. Reconstructive methods

  1. Delayed primary repair of duct

  2. Reconstruction of duct with vein graft

  3. Mucosal flaps

  4. Suture of proximal duct to buccal mucosa

B. Formation of a controlled internal fistula

  1. T-tube or catheter drainage into the mouth

  2. Drainage of proximal duct by a catheter

C. Parotidectomy

D. Local therapy to the fistula



  1. Excision

  2. Cauterization

A. Surgical approaches

  1. Duct ligation

  2. Sectioning of the auricotemporal or Jacobsen's nerve

B. Conservative approaches

  1. Administering nothing orally to the patient until the fistula closes

  2. Drugs: atropine or Pro-banthine

  3. Radiotherapy

  4. Repeated aspiration and pressure dressing

  5. Botulinum toxin type A




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