Parotid Duct Injuries Workup

Updated: Mar 22, 2021
  • Author: Jose E Barrera, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
  • Print
Workup

Laboratory Studies

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

Next:

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.

Previous
Next:

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.

Previous