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 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.

Treatment & Management

Cho DY, Willborg BE, Lu GN. Management of Traumatic Soft Tissue Injuries of the Face. Semin Plast Surg. 2021 Nov. 35 (4):229-37. [QxMD MEDLINE Link]. [Full Text].
Nicoladoni. Ueber Fisteln des Ductus Stenonianus. Verh Dtsch Ges Chir. 1896. 81.
Morestin H. Contribution a l'etude du traitement des fistules salivaraires consecutives aux blessures de guerre. Bull Soc Chir. 1917. 43:845.
Gordin EA, Daniero JJ, Krein H, Boon MS. Parotid gland trauma. Facial Plast Surg. 2010 Dec. 26(6):504-10. [QxMD MEDLINE Link].
Weissler JM, Mohamed O, Gryskiewicz JM, Chopra K. An Algorithmic Approach to Managing Parotid Duct Injury Following Buccal Fat Pad Removal. Aesthet Surg J Open Forum. 2022. 4:ojac032. [QxMD MEDLINE Link]. [Full Text].
Hu CY, Shang ZJ, Qin X, Shao LN. Application of Delayed Surgical Managements in Patients with Stensen's Duct Injury. Curr Med Sci. 2018 Jun. 38 (3):519-23. [QxMD MEDLINE Link].
Mohan A, Velu D, Seshadri P, Pannerselvam E. Indigenous Management of Parotid Sialocele Using Foley's Catheter: A Report of Two Cases. J Maxillofac Oral Surg. 2020 Jun. 19 (2):225-9. [QxMD MEDLINE Link].
Sujeeth S, Dindawar S. Parotid duct repair using an epidural catheter. Int J Oral Maxillofac Surg. 2011 Jul. 40(7):747-8. [QxMD MEDLINE Link].
Koch M, Iro H, Bozzato A, Zenk J. Sialendoscopy-assisted microsurgical repair of traumatic transection of Stensen's duct. Laryngoscope. 2013 Oct 5. [QxMD MEDLINE Link].
Doctor VS, Rafii A, Enepekides DJ, Tollefson TT. Intraoral transposition of traumatic parotid duct fistula. Arch Facial Plast Surg. 2007 Jan-Feb. 9(1):44-7. [QxMD MEDLINE Link].
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. 2008 Feb. 53(1):36-40. [QxMD MEDLINE Link].
Awana M, Arora SS, Arora S, Hansraj V. Reconstruction of a traumatically transected Stensen's duct using facial vein graft. Ann Maxillofac Surg. 2015 Jan-Jun. 5 (1):96-9. [QxMD MEDLINE Link]. [Full Text].
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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. 1990 Nov. 30(11):1395-8. [QxMD MEDLINE Link].

Media Gallery

Anatomy of the parotid region. Line A connecting the tragus to the midportion of the upper lip estimates the general location of the parotid duct, which lies along the middle third of this line.
Laceration of the parotid duct over the masseter. Note that a stent has been placed through the intraoral papilla and can be visualized in the wound exiting the distal end of the transected duct.
Repair of the parotid duct over a silastic stent with interrupted sutures using loupe or microscopic magnification.

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Author

Jose E Barrera, MD Medical Director, Texas Center for Facial Plastic and Laser Surgery; Clinical Professor, Uniformed Services University of the Health Sciences; Clinical Associate Professor, University of Texas Health Science Center at San Antonio School of Medicine

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, American College of Surgeons

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Stryker, LLC.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 Head and Neck Society, American Rhinologic Society, Triological Society, American Neurotology Society, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Emeritus Professor of Otolaryngology, Dentistry, and Engineering, 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, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Neosoma; MI10;<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10 advisor.

Additional Contributors

Daniel G Becker, MD Assistant Professor, Department of Otorhinolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Pennsylvania School of Medicine

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, American College of Surgeons

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Don R Revis Jr, MD, and Michael Brent Seagle, MD, to the development and writing of this article.

Parotid Duct Injuries Workup

Laboratory Studies

Imaging Studies

Other Tests

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