RESUMO
BACKGROUND: Salivary fistulas are common complications after reconstructive head and neck surgery with significant morbidity. Yet, there are no established guidelines for their management. METHOD: A comprehensive search of PubMed was performed from 01/01/2000 to 06/31/2019 to evaluate all treatment options in postreconstructive head and neck fistulas. RESULTS: Nineteen articles with 132 patients were included. Thirty-nine of 132(30%) patients were treated with conventional wound care. All fistulas closed after 51.6±54.0 days with no refistulations. Thirty-eight of 132(29%) patients were treated with negative pressure wound therapy (NPWT). Thirty-eight of 40(95%) fistula closed after 14.7±12.0 days with no refistulations. The reduced healing time was statistically significant as compared to patients on conventional wound care (pâ¯<â¯0.001). Fifty-three of 132(40%) patients received surgical management. Forty-four of 53(83%) patients had complete fistula closure without postoperative complications. A pedicled flap was used in 60% of cases (nâ¯=â¯32). CONCLUSION: Most salivary fistulas close with conservative management. NPWT potentially shortens fistula healing time while it achieves similar closure rates as conventional wound care. In the absence of contraindications, NPWT should be trialed on all salivary fistulas. Surgical management should be reserved for large, chronic, high-risk fistulas or those not responding to a trial of conservative treatment. Secondary reconstruction should be kept as simple as possible.
Assuntos
Fístula Cutânea/etiologia , Fístula Cutânea/terapia , Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos de Cirurgia Plástica/efeitos adversos , Fístula das Glândulas Salivares/etiologia , Fístula das Glândulas Salivares/terapia , Retalhos Cirúrgicos/efeitos adversos , Tratamento Conservador , Fístula Cutânea/cirurgia , Humanos , Tratamento de Ferimentos com Pressão Negativa , Complicações Pós-Operatórias/terapia , Fístula das Glândulas Salivares/cirurgia , Fatores de Tempo , CicatrizaçãoRESUMO
RATIONALE: Gustatory otorrhea can lead to cutaneous changes, recurrent infection, and social disruption. We present a case of a late, evolving sialocutaneous fistula to the external auditory canal, managed surgically after failing conservative therapies. This case is unique by late evolution, whereby the symptoms presented with significance 27 years after her operation and 19 years after mild symptoms initially arose. PATIENT CONCERNS: Gustatory, left-sided clear otorrhea with acutely increased volume over 8 months causing social disruption. DIAGNOSES: Sialocutaneous fistula to the external auditory canal. INTERVENTIONS: Superficial parotidectomy and temporoparietal flap for closure of fistula. OUTCOMES: No postoperative complications and resolution of gustatory otorrhea at one-year follow-up. LESSONS: This rare, but important, postoperative complication can present late with evolving symptoms, causing significant social disruption. It can be treated with conservative medical management and several surgical approaches.
Assuntos
Fístula Cutânea/cirurgia , Meato Acústico Externo , Glândula Parótida/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Fístula das Glândulas Salivares/cirurgia , Retalhos Cirúrgicos , Adulto , Fístula Cutânea/etiologia , Fáscia/transplante , Fasciotomia/métodos , Feminino , Humanos , Transtornos de Início Tardio/etiologia , Transtornos de Início Tardio/cirurgia , Fístula das Glândulas Salivares/etiologia , Sudorese Gustativa/complicações , Músculo Temporal/cirurgiaRESUMO
Congenital parotid fistulas are extremely rare diseases. Herein, the authors report a patient with congenital salivary fistula from parotid main gland in a 15-year-old boy. Therefore, clinicians should consider the possibility of congenital parotid fistula form parotid main gland. Surgical excision of the fistula and parotid gland can be effective treatment option of congenital parotid fistula.
Assuntos
Fístula Cutânea/congênito , Glândula Parótida/cirurgia , Fístula das Glândulas Salivares/congênito , Adolescente , Fístula Cutânea/cirurgia , Humanos , Masculino , Fístula das Glândulas Salivares/cirurgiaRESUMO
BACKGROUND: Does the extent of parotidectomy or other patient or tumor characteristics influence the rate of sialocele/salivary fistula formation? METHODS: All patients who underwent parotidectomy at the University of Wisconsin from 1994 to 2013 were considered. Patients who developed a sialocele/salivary fistula were identified. Extent of dissection, age, sex, body mass index (BMI), volume of specimen, and rate of malignancy were examined. RESULTS: Seventy of 771 patients (9.1%) developed a sialocele/salivary fistula. Sixty-seven fistulae (96%) developed within 1 month and all resolved by 6 months. Age, sex, pathology, and BMI were not increased in the sialocele group. Inferior and middle superficial parotidectomy had a significantly higher rate of sialocele than other extents of dissection. Volume of tissue removed was not significantly different between dissection groups. CONCLUSION: Sialocele/salivary fistula is common postparotidectomy and is more likely with inferior and middle superficial parotidectomy. © 2016 Wiley Periodicals, Inc. Head Neck 39: 387-391, 2017.
Assuntos
Glândula Parótida/cirurgia , Neoplasias Parotídeas/patologia , Neoplasias Parotídeas/cirurgia , Fístula das Glândulas Salivares/etiologia , Fístula das Glândulas Salivares/cirurgia , Adulto , Idoso , Estudos de Coortes , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Reoperação/métodos , Estudos Retrospectivos , Fatores de Risco , Fístula das Glândulas Salivares/epidemiologia , Resultado do Tratamento , Estados UnidosRESUMO
Spontaneous salivary otorrhoea is an extremely rare clinical entity. Most of the times, salivary otorrhoea results from various forms of trauma. It has also been attributed to the patent foramen of Huschke, and fissures of Santorini. Here, we present a rare case of an 8 year old child presenting with salivary discharge from both the ears. The diagnosis was established on the basis of biochemical and radiological investigations. The patient was managed by surgical exploration and ligation of the fistulous tract.
Assuntos
Otopatias/diagnóstico , Otopatias/etiologia , Fístula/diagnóstico , Doenças Parotídeas/diagnóstico , Fístula das Glândulas Salivares/diagnóstico , Criança , Otopatias/cirurgia , Fístula/cirurgia , Humanos , Masculino , Doenças Parotídeas/cirurgia , Doenças Raras/diagnóstico , Doenças Raras/cirurgia , Saliva , Fístula das Glândulas Salivares/cirurgiaRESUMO
IMPORTANCE: Submandibular fistula is a rare condition that presents diagnostic and treatment challenges. Accurate diagnosis may be achieved by means of thorough physical examination, proper imaging, and usually surgical exploration. We describe the clinical significance of aberrant submandibular ductal fistula or ostium and discuss our dilemmas during sialendoscopy in 2 patients with repeated submandibular glandular swelling. OBSERVATIONS: Two patients had submandibular ductal abnormalities. The first patient was found to have the ostium of the submandibular duct in an unusual anatomical location at the posterior floor of the mouth, which was identified during surgical exploration of the floor of the mouth. The second patient was found to have a submandibular ductal fistula into the floor of the mouth proximal to a calculus in the main duct (which was severely atrophic and could not be cannulated). CONCLUSIONS AND RELEVANCE: The precise etiology and pathogenesis of sialo-oral fistula formation are currently unknown but could be extrapolated from previously described syndromes involving ductal obstruction and inciting damage in other regions of the body. Consideration of submandibular fistula in the differential diagnosis may spare the patient morbidity of redundant invasive procedures.
Assuntos
Endoscopia , Cálculos Salivares/diagnóstico , Cálculos Salivares/cirurgia , Fístula das Glândulas Salivares/diagnóstico , Fístula das Glândulas Salivares/cirurgia , Glândula Submandibular , Adulto , Humanos , Masculino , Cálculos Salivares/complicações , Fístula das Glândulas Salivares/complicaçõesRESUMO
BACKGROUND: The salvage-laryngectomy (SLE) has compared to the laryngectomy a high risk for complications. The salivary fistula is the most frequent complication with an incidence range from 3% to 65% according to the literature. MATERIAL AND METHODS: From 2004-2011 we included in this study 16 patients with a recurrent or secondary T4a-squamous cell carcinoma (HNSCC) of the larynx or pyriform sinus undergoing a SLE. 6 HNSCC were located at the pyriform sinus (44%) and 9 at the larynx (56%). The aim of this retrospective study was to analyze the risk of developing a postoperative fistula after SLE as well as to present our surgical concept of persisting fistula treatment. RESULTS: 6 out of these 16 patients (38%) had a persisting fistula which needed a secondary surgical closure. In all of these cases we used a "sandwich"-concept which included a reconstruction of the pharynx by the pectoralis myofascial flap and another regional rotation flap as the deltopectoral flap or the latissimus dorsi flap for skin reconstruction of the neck. With this concept we were able to successfully close the fistula after the SLE in all 6 cases. CONCLUSION: By using our "sandwich"-concept we provide a multi-layered fistula closure with insertion of vital muscle tissue and a double epithelium. This guarantees a secure barrier to the saliva and prevents effectively a further fistula.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Recidiva Local de Neoplasia/cirurgia , Complicações Pós-Operatórias/cirurgia , Fístula das Glândulas Salivares/cirurgia , Terapia de Salvação/métodos , Idoso , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/secundário , Feminino , Humanos , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/secundário , Terapia a Laser , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Neoplasias Faríngeas/patologia , Neoplasias Faríngeas/secundário , Neoplasias Faríngeas/cirurgia , Seio Piriforme/patologia , Seio Piriforme/cirurgia , Reoperação , Estudos Retrospectivos , Retalhos Cirúrgicos/cirurgiaRESUMO
Parotid fistulas are very rare and arise from various causes such as trauma, operative complications, infection, malignancy and stone. They may also be congenital. A rare case of cutaneous salivary fistula is presented. A 59-year-old man had a recurrent inflammatory parotid disease which disappeared after the expulsion of the calculus.
Assuntos
Doenças Parotídeas/diagnóstico , Cálculos das Glândulas Salivares/diagnóstico , Fístula das Glândulas Salivares/diagnóstico , Fístula Cutânea/diagnóstico , Fístula Cutânea/etiologia , Fístula Cutânea/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Parotídeas/complicações , Doenças Parotídeas/cirurgia , Glândula Parótida/patologia , Glândula Parótida/cirurgia , Cálculos das Glândulas Salivares/complicações , Cálculos das Glândulas Salivares/patologia , Cálculos das Glândulas Salivares/cirurgia , Fístula das Glândulas Salivares/etiologia , Fístula das Glândulas Salivares/cirurgia , Resultado do TratamentoRESUMO
Cyst and fistulas of the gills grooves and thyro-glossal tracts are well documented. On the contrary, congenital neck salivary fistulas are uncommon.
Assuntos
Fístula Cutânea/diagnóstico , Pescoço/anormalidades , Fístula das Glândulas Salivares/diagnóstico , Adulto , Fístula Cutânea/congênito , Fístula Cutânea/cirurgia , Humanos , Masculino , Pescoço/cirurgia , Fístula das Glândulas Salivares/congênito , Fístula das Glândulas Salivares/cirurgia , Doenças da Glândula Submandibular/congênito , Doenças da Glândula Submandibular/diagnóstico , Doenças da Glândula Submandibular/cirurgiaRESUMO
The author reports a case of congenital fistula from an accessory parotid gland and describes its diagnosis and treatment. The patient was referred to the author's clinic for evaluation of a continuous serous discharge from a small orifice in the left cheek near the angle of the mouth. A left preauricular appendix was also noted. Fistulography detected an aberrant duct leading to an accessory parotid gland. The main parotid gland and its duct were normal. The anomalous duct was dissected in continuity with a small ellipse of skin and sutured to the buccal mucosa. The patient's recovery was uneventful. The author also discusses the embryologic origin of this rare anomaly.
Assuntos
Fístula Cutânea/diagnóstico , Glândula Parótida/anormalidades , Fístula das Glândulas Salivares/diagnóstico , Adolescente , Fístula Cutânea/congênito , Fístula Cutânea/cirurgia , Humanos , Masculino , Fístula das Glândulas Salivares/congênito , Fístula das Glândulas Salivares/cirurgiaRESUMO
OBJECTIVES: We report two cases of congenital salivary fistula of an accessory parotid gland, and we discuss its occurrence in Goldenhar syndrome. METHODS: Two teenagers complained of a congenital cheek fistula with constant salivary discharge. Computed tomography fistulography and sialography were performed. The diagnosis of Goldenhar syndrome was established based on clinical and imaging findings. Previously reported cases are reviewed and the clinical and radiological features summarised. RESULTS: In these two patients, a salivary fistula of an accessory parotid gland was demonstrated on computed tomography fistulography, and did not communicate with Stensen's duct. Deformity of Stensen's duct and hypoplasia of the ipsilateral mandibular ramus were present. Tragal appendices have frequently been reported in such cases. CONCLUSION: A congenital cheek salivary fistula of an accessory parotid gland should be considered indicative of Goldenhar syndrome.
Assuntos
Coristoma/diagnóstico por imagem , Fístula Cutânea/diagnóstico por imagem , Síndrome de Goldenhar/diagnóstico por imagem , Doenças Parotídeas/diagnóstico por imagem , Glândula Parótida/patologia , Fístula das Glândulas Salivares/diagnóstico por imagem , Adolescente , Bochecha , Criança , Coristoma/cirurgia , Fístula Cutânea/congênito , Fístula Cutânea/cirurgia , Assimetria Facial/congênito , Feminino , Humanos , Masculino , Doenças Parotídeas/congênito , Doenças Parotídeas/cirurgia , Saliva , Ductos Salivares/anormalidades , Fístula das Glândulas Salivares/congênito , Fístula das Glândulas Salivares/cirurgia , Sialografia , Tomografia Computadorizada por Raios X/métodosRESUMO
A rare case of congenital salivary gland fistula is reported. A 3-year-old girl presented with clear discharge from a dimple on the left cheek. An ectopic salivary gland fistula was unexpectedly diagnosed during operation. This is the first case of congenital salivary fistula draining from a minor salivary gland to a cutaneous pit. We completely excised the lesion, and the patient remains complication free.
Assuntos
Fístula Cutânea/congênito , Fístula das Glândulas Salivares/congênito , Glândulas Salivares Menores/cirurgia , Bochecha , Pré-Escolar , Fístula Cutânea/diagnóstico por imagem , Fístula Cutânea/patologia , Fístula Cutânea/cirurgia , Feminino , Humanos , Fístula das Glândulas Salivares/diagnóstico por imagem , Fístula das Glândulas Salivares/patologia , Fístula das Glândulas Salivares/cirurgia , Glândulas Salivares Menores/diagnóstico por imagem , Glândulas Salivares Menores/patologia , UltrassonografiaRESUMO
A salivary fistula is one of possible postoperative complications in the surgery of parotid gland tumors. We present three cases of postparotidectomy salivary fistulas, successfully treated by surgical access using 2-octyl-cyanoacrylate while closing the skin layer. The previous treatment of these cases by other therapeutic options did not give satisfactory results. In a 5-year follow-up period there were no signs of fistulas relapses. The surgical access with use of 2-octyl cyanoacrylate can be one of therapeutic options for the closing of postparotidectomy salivary fistulas, especially in cases where other therapeutic accesses are not successful.
Assuntos
Cianoacrilatos/administração & dosagem , Procedimentos Cirúrgicos Otorrinolaringológicos/efeitos adversos , Fístula das Glândulas Salivares/cirurgia , Técnicas de Sutura , Adesivos Teciduais/administração & dosagem , Administração Tópica , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Parotídeas/cirurgia , Complicações Pós-Operatórias , Fístula das Glândulas Salivares/etiologiaRESUMO
Accessory parotid glands are a common clinical occurrence and usually drain into the main Stenson's duct by small ductules and thereby, into the buccal cavity. Presence of an accessory parotid gland with an ectopic fistulous duct is a rare occurrence. We present the imaging findings in a case of right accessory parotid gland with ectopic fistulous duct associated with bilateral pre-aural appendages. Diagnostic workup was done by ultrasonography, sono-fistulography, contrast digital fistulography, contrast digital sialography and computed tomography fistulography. Imaging showed a right accessory parotid gland lying anterior to and separate from the main parotid gland draining via an ectopic fistulous duct opening over the right cheek. The child was managed surgically by internalisation of the duct to open into the buccal mucosa and excision of pre-aural appendages.
Assuntos
Glândula Parótida/diagnóstico por imagem , Fístula das Glândulas Salivares/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Criança , Humanos , Masculino , Glândula Parótida/cirurgia , Fístula das Glândulas Salivares/diagnóstico por imagem , Fístula das Glândulas Salivares/cirurgia , UltrassonografiaRESUMO
As lesões iatrogênicas da glândula parótida pós-ritidectomia são incomuns e têm incidência aproximada de 2%. No presente artigo, é relatado um caso com a solução encontrada pelos autores para a resolução da fístula.
The iatrogenic injuries of the parotid gland after ritidectomia are uncommon and have incidence around 2%. In the present article, a case is reported, followed by the solution found by the authors for the resolution of fistula.
Assuntos
Humanos , Feminino , Adulto , Fístula das Glândulas Salivares/cirurgia , Glândula Parótida/cirurgia , Complicações Intraoperatórias , Ritidoplastia/efeitos adversos , Doenças das Glândulas Salivares , Procedimentos Cirúrgicos Operatórios , Técnicas e Procedimentos Diagnósticos , Drenagem , Métodos , PacientesRESUMO
Oncological Dispensary of Leningrad Region, St.Petersburg Our paper deals with evaluation of the results of using distal pectoralis major myocutaneous flap (38) in 37 patients; bilateral dissection of tissue--1. Plastic reconstruction of surgical effects of the oral cavity and pharynx was performed in 27 (skin cancer--8, parotid salivary gland tumor--1). Flap was used to both shield the parotid artery and prevent erosive bleeding following radical cervical dissection, urgent plastic surgery--30, postponed--8. Complication, chiefly slight was reported in 60.5% and treated conservatively. Total necrosis was identified in 2 (5.3%), partial--4 (10.8%), salivary fistula--10 out of 27 reconstructions of the upper intestinal tract (18.4%), cervical suture failure--7 (18.4%), flap avulsion from wound edges--6 (15.8%), wound edge avulsion--2 (5.3%). Nasogastric probe for feeding was used for approx. 23.7 days. Feeding per os after the first operation was restored in 23 (85.2%). Repeat reconstruction using pectoralis major myocutaneous flap has proved effective in patients with surgical effects of head and neck.
Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Esvaziamento Cervical/efeitos adversos , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Perda Sanguínea Cirúrgica/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/cirurgia , Necrose , Observação , Músculos Peitorais/cirurgia , Neoplasias Faríngeas/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Fístula das Glândulas Salivares/etiologia , Fístula das Glândulas Salivares/cirurgia , Resultado do TratamentoAssuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Esvaziamento Cervical/efeitos adversos , Músculos Peitorais/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Idoso , Perda Sanguínea Cirúrgica/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/cirurgia , Necrose , Observação , Neoplasias Faríngeas/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Fístula das Glândulas Salivares/etiologia , Fístula das Glândulas Salivares/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: We present an extremely rare case of a 44-year-old woman with right gustatory otorrhoea and otalgia. CASE REPORT: The patient had been initially treated for otitis externa after Pseudomonas aeruginosa was grown from a microbiological swab. The otorrhoea fluid was collected and tested positive for amylase. Sialography and computed tomography imaging of the temporal bone confirmed a sialo-aural fistula from the right parotid gland to the bony external acoustic meatus. The defect was consistent with a patent foramen of Huschke. The fistula was identified surgically via a superficial parotidectomy approach, after contrast injection of Bonney's blue dye into the parotid duct, and then ligated and divided. The patient had immediate and sustained resolution of her otorrhoea. CONCLUSIONS: Sialo-aural fistulae are extremely rare, and usually arise as a complication of surgery or as an acquired disease process. To date, only four cases have been reported. This case demonstrates the use of sensitive investigation involving sialography and computed tomography, as well as successful surgical management, with complete resolution of symptoms.
Assuntos
Fístula Cutânea/congênito , Glândula Parótida/anormalidades , Ductos Salivares/anormalidades , Fístula das Glândulas Salivares/congênito , Adulto , Fístula Cutânea/cirurgia , Feminino , Humanos , Fístula das Glândulas Salivares/cirurgia , Sialografia/métodos , Resultado do TratamentoRESUMO
As fístulas salivares de origem congênita são má formações de incidência rara. Devem ser diferenciadas de fístulas de 2° arco branquial, pelas características clínicas distintas, como a ausência de episódios de infecção e drenagem abrupta, que aumenta durante a alimentação. Dúvidas ainda existem com relação à sua etiologia. As hipóteses existentes cogitam a migração anormal de tecidos embrionários e a heteroplasia de células ectodérmicas, que regridiriam no processo de diferenciação celular. A fistulografia da lesão mostra fundo de saco arboriforme e ajuda no diagnóstico diferencial da lesão. O tratamento é cirúrgico, com ressecção do trajeto da lesão e da glândula que a originou. Apresentamos três casos de fístulas salivares congênitas.
Salivary gland fistulas are rare malformations and should be differentiate from others draining sinuses pathologies, especially from the second branchial cleft sinuses. Precise pathogenesis is not fully understood. Clinically, the episodes of drainage are usually associated with a sense of fullness in the affected area and the amount of drainage usually increases during eating or mastication. A preoperative sinugram is helpful. The treatment is its excision. We present three cases of unusual salivary gland fistula.
Assuntos
Humanos , Masculino , Criança , Adolescente , Fístula das Glândulas Salivares/congênito , Fístula das Glândulas Salivares/cirurgia , Fístula das Glândulas Salivares/diagnósticoRESUMO
UNLABELLED: We report the imaging findings in a rare case of an accessory parotid gland fistula. MATERIAL AND METHODS: An eight-year-old boy was presented with complaints of serous discharge from his left cheek since birth. As part of the radiological investigation, magnetic resonance imaging, computed tomography sialography with fistulography, and digital sialography with fistulography were performed. RESULTS: Magnetic resonance imaging demonstrated the exact location of an accessory parotid gland but failed to demonstrate the accessory duct. The presence of an accessory gland was well delineated on computed tomography fistulography and computed tomography sialography. Fistulography revealed a small accessory parotid duct and gland. No communication between the ductal systems of both glands was demonstrated. CONCLUSIONS: In such cases, pre-operative imaging (with sialography, magnetic resonance sialography and computed tomography sialography with fistulography) is helpful for exact delineation of the ductal anatomy. To the best of our knowledge, only four previous cases of congenital accessory parotid gland fistula have been reported in the English literature.