Concluded Case

Parotid fistula??

40 year old patient complains of discharge in front of right ear and swelling in same region since 4-5 weeks History History of undergoing treatment for mandible fracture ( right condyle and parasymphysis) 2 months back Physical Examination Tenderness and swelling in right preauricular region and discharge from same region.... Discharge increases on wide mouth opening. Diagnosis Parotid fistula post trauma?? Management Suggest diagnosis and treatment


Concluded answer

compression dressings after saline injection is already being tried.... no fruitful result till now.. parotidectomy should be the next line of treatment... I guess

All Answers

Parotid fistula has been described as rare complication after mandibular surgery Diagnosis is mostly based on clinical finding Treatment involves - non invasive treatment such as injection of warm hypertonic Saline Surgical procedures such as diversion of parotid secretion in mouth, tympanic neurectomy, low dose radiotherapy

If the fistula is small and superficial may heal over a period, have to wait and watch policy, if the leak is significant, canulate and get the fistulogram or sialogram and make out the anatomy and connection to the Stenson's duck, explore and ligate the fistulous connection. In very persisting cases may need superficial parotidectomy, care to be taken to protect the facial nerve.

Thanks for opinion sir

I think it post traumatic haematoma in relation to masseter muscle with secondary infection got burst with discharge and pus drains out during movement of masseter muscle. Pus to drained out by incision Pus for culture and sensitivity Antibiotic as per report of C& S Regular dressing.

It dosent look like hematoma ... There are no signs of infection too.... The swelling as such is totally painless... Even the discharge is more like serous fluid rather than pus.... C&S report.... Nothing relevant

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Appears unlikely to be a parotid such they are rare...we do a lot of hemimandibulectomies...never encountered such entity..although I hv found cases where parotid gland is not overrun after neck dissection...the appearance is pus like and not serous...get imaging done...rule out quack treatment ( incision and drainage) for parotid abscess..rule out diabetes and immunosuppression...probably MRI has the ability to find out ductal integrity and status

Thank you @Dr. Suvendu Maji

Pus in region of pinna Sinus parotid Mri rt mandible Xray r/0 osteomyelitis Pus for culture and sensitivity R/0 dm

Parotid injury during surgery and improper closure of parotidomasseteric fascia can lead to this complication. Compression dressings, hypertonic saline solution local injections with antisialogogues cures in most of the cases. Other wise superficial parotidectomy is the last resort. Thanks for sharing.

compression dressings after saline injection is already being tried.... no fruitful result till now.. parotidectomy should be the next line of treatment... I guess

I think it could be parotid fistula??

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