eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Trauma

Parotid Duct Injuries: Workup

Author: Jose E Barrera, MD, Instructor, Department of Otolaryngology-Head and Neck Surgery, Stanford University
Coauthor(s): Don R Revis Jr, MD, Consulting Staff, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine; Michael Brent Seagle, MD, Associate Professor, Division of Plastic Surgery, University of Florida College of Medicine; Consulting Staff, Florida Surgical Center
Contributor Information and Disclosures

Updated: May 21, 2008

Workup

Laboratory Studies

Perform appropriate preoperative laboratory studies as dictated by patient's age, sex, and overall medical condition.

Imaging Studies

  • Appropriate preoperative chest radiography may be indicated as dictated by the patient's age, sex, and overall medical condition.
  • Sialography may be performed but is usually not necessary to establish the diagnosis of parotid duct injury. If performed, a water-soluble contrast material should be used because it is more easily drained and absorbed and it does not remain as an irritant to the gland. Sialography can be used to detect perforations, fistula tracts, calculi, and tumor, and it defines the ductal anatomy well. It is rarely used at present, however. If undertaken, it should be performed as sterilely as possible to prevent introduction of intraoral bacteria to the parotid duct.

Other Tests

  • The most straightforward way to diagnose a parotid duct injury in the emergency department is to cannulate the intraoral parotid duct papilla with a small (ie, 19-gauge) silastic tube and observe if the tube is visible in the wound.
  • This test does require patient cooperation; therefore, it may be difficult or impossible in children, intoxicated individuals, or individuals with mental disabilities.
  • If any question regarding the diagnosis remains, a small amount of saline may be injected through the tube and observed for flow through the wound.
  • Methylene blue probably should not be injected through the tube because it terribly discolors tissues and makes subsequent operation even more challenging.

More on Parotid Duct Injuries

Overview: Parotid Duct Injuries
Workup: Parotid Duct Injuries
Treatment: Parotid Duct Injuries
Follow-up: Parotid Duct Injuries
Multimedia: Parotid Duct Injuries
References
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References

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  2. Morestin H. Contribution a l'etude du traitement des fistules salivaraires consecutives aux blessures de guerre. Bull Soc Chir. 1917;43:845.

  3. Doctor VS, Rafii A, Enepekides DJ, Tollefson TT. Intraoral transposition of traumatic parotid duct fistula. Arch Facial Plast Surg. Jan-Feb 2007;9(1):44-7. [Medline].

  4. Arnaud S, Batifol D, Goudot P, Yachouh J. [Non-surgical management of parotid gland and duct injuries: interest of botulinum toxin]. Ann Chir Plast Esthet. Feb 2008;53(1):36-40. [Medline].

  5. Tachmes L, Woloszyn T, Marini C, Coons M, Eastlick L, Shaftan G, et al. Parotid gland and facial nerve trauma: a retrospective review. J Trauma. Nov 1990;30(11):1395-8. [Medline].

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  18. Neuhaus RW, Baylis HI. Parotid duct injury as a complication of differential seventh nerve ablation. Am J Ophthalmol. Jan 1982;93(1):124-5. [Medline].

  19. Potter BE, Yarington CT, Walike JW. Management of intraoral injuries. Am Fam Physician. Nov 1978;18(5):96-102. [Medline].

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Further Reading

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Keywords

parotid duct injuries, Stenson duct injuries, salivary gland, parotid fistula, sialocele, parotid duct, Stenson duct, parotid gland, salivary gland injuries, salivary gland injury

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Contributor Information and Disclosures

Author

Jose E Barrera, MD, Instructor, Department of Otolaryngology-Head and Neck Surgery, Stanford University
Jose E Barrera, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Academy of Sleep Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Don R Revis Jr, MD, Consulting Staff, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine
Don R Revis Jr, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, and American Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Michael Brent Seagle, MD, Associate Professor, Division of Plastic Surgery, University of Florida College of Medicine; Consulting Staff, Florida Surgical Center
Michael Brent Seagle, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society of Plastic and Reconstructive Surgery, and Southeastern Society of Plastic and Reconstructive Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Daniel G Becker, MD, Clinical Associate Professor, Department of Otorhinolaryngology-Head and Neck Surgery, Division of Facial Plastics and Reconstructive Surgery, University of Pennsylvania
Daniel G Becker, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American College of Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Robert M Kellman, MD, Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York, Upstate Medical University
Robert M Kellman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, and Medical Society of the State of New York
Disclosure: GE Healthcare Honoraria Review panel membership

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Advanced Headache Intervention Consulting fee Consulting; Covidien Corp Consulting fee Consulting

 
 
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