Anatomic Danger Zones of the Head and Neck.

BACKGROUND: Dermatologic procedures require a detailed understanding of surface anatomy to avoid complications. The head and neck region has prominent danger zones including nerves and vasculature that may be at risk during cutaneous surgery. A thorough understanding of these danger zones can help avoid complications that may lead to functional or cosmetic impairment. METHODS: The anatomic literature regarding the course of high-risk structures of the head and neck was reviewed. Structures deemed at risk during dermatologic procedures were included in the analysis. The final analysis focused on branches of the facial nerve, parotid duct, spinal accessory nerve, trigeminal nerve, and the lacrimal system. Anatomical information was compiled regarding each high-risk structure to develop a "danger zone" at which each respective structure is at risk. RESULTS: The danger zone for each structure was compiled based on the review of the literature and depicted in the figures. CONCLUSION: With careful attention to anatomy and the meticulous surgical technique, there is great potential for reduction in surgical injury to danger zones of the head and neck.

Application of Delayed Surgical Managements in Patients with Stensen's Duct Injury.

The study aimed to retrospectively evaluate surgical treatment outcomes after delayed parotid gland and duct injuries. Nine patients subjected to parotid gland and duct injuries with 1- to 3-month treatment delay were retrospectively evaluated with special reference of etiology, past medical history, and injury location. Conservative treatment, microsurgical anastomosis, and diversion of salivary flow or ligation were chosen for delayed parotid gland and duct injuries concerning to their site of injury, time of repair and procedures. Assistant treatment as pressure dressing was adopted thereafter. All patients experienced an uneventful recovery at the time of finalizing the study. Two patients received Stensen's duct ligation, 5 received microsurgical anastomosis and 2 accepted salivary flow diversion for 5 patients with sialoceles and 4 patients with fistulas, and no re-occurrence was found. Facial paralysis occurred after surgery in 4 patients, and 3 of them recovered after the nerve nutrition treatment. Our study suggested that appropriate surgical treatment is efficient for the re-establishment of the tissue function and facial aesthetic for delayed injury of the parotid and its duct.

Device failure in sialoendoscopy: Intraoperative practical decision-making.

Sialoendoscopy has recently emerged as an alternative to gland excision in management of recurrent sialoadenitis and sialolithiasis. This technique has both diagnostic and therapeutic purposes. We report a case of unusual device failure during removal of a submandibular stone from Wharton's duct, which ultimately led to ductal avulsion. Sialoendoscopy is safe and effective in management of non-neoplastic major salivary gland disorders. Ductal avulsion can happen during mechanical procedures like stone removal or dilation of strictures. Failing to release the stone from the basket is very rare but can be problematic and lead to major complications.

Treatment of Parotid Sialocele after Sustaining a Facial Injury. Case Report and Literature Review.

We are presenting the case of a patient who developed a parotid sialocele after sustaining a facial injury. The patient was treated by creating a controlled intraoral fistula that drained saliva into the oral cavity and led to resolution of the sialocele. Articles were reviewed for discussion of current treatment methods in managing parotid sialocele and fistula. The articles reported successful management of parotid sialocele and fistula using both nonsurgical and surgical methods. Treatment depends upon the location of the injury (ductal injury vs. parenchymal injury) and the time of treatment (delayed vs. immediate).

Penetrating Trauma to the Parotid Gland.

Penetrating trauma to the parotid gland may present unique challenges especially when Stensen duct, neurovascular structures, and/or collateral organs are involved. Especially ballistic injuries caused by high-velocity projectiles or fragments of grenades and improvised explosive devices are often associated with massive tissue damage and a high risk of infections and other posttraumatic complications. Because penetrating parotid trauma is not very common, only limited information on the primary treatment of such injuries is available. This article gives a short overview about actual aspects on diagnosis and treatment strategies especially focusing on ballistic parotid injuries.

Foreign body induced sialolithiasis treated by sialoendoscopic intervention.

OBJECTIVE: The study aims to identify the impact of sialolith formation by reviewing the foreign body induced sialolithiasis treated by sialoendoscopic intervention. METHODS: The study group included 13 patients whose sialolithiasis was induced by foreign body. After the routine radiographic examination, sialoendoscopic procedures were performed. Then, the treatment protocol was designed. RESULTS: The occupations of the 13 patients included 5 fishermen, 3 office workers, 2 workers, 1 teacher, 1 farmer, and 1 retired police officer. All patients had a unique diet habit-seafood. Eleven patients had a remembered incident of implanted fish bone and the following symptoms, with either obstructions or infections. Only 2 of the 13 had no memory of such an injury. All the stones were in the ducts of submandibular glands. In 10 procedures, there was 1 solitary stone, whereas 2 stones were encountered in 3 procedures. After being removed, 16 stones were crushed to expose the fish bone nidus of the stone. There was relief of symptoms after the procedures. CONCLUSIONS: This study supported the possibility that some sialoliths resulted from a retrograde migration within the salivary ducts. In our study, the occupations (fisherman), the diet habit (seafood), and the injury history (a remembered incident of implanted fish bone and the following symptoms) were obviously related to the stone formation that was induced by the fish bone.

Sialendoscopy-assisted microsurgical repair of traumatic transection of Stensen's duct.

Sialendoscopy is established in the diagnostics and treatment of obstructive salivary gland diseases, but has not previously been reported in patients with injuries to Stensen's duct. Sialendoscopy assisted repair of a transected Stensen's duct in zone B is reported. The duct injury itself, its location, and its severity could be visualized and precisely assessed and allowed intraductal assessment of the ductal tissue. Rapid atraumatic dissection and also postoperative endoscopic follow-up examination with assessment of the anastomosis was provided by using the sialendoscope, which appears to be valuable for several reasons in the management of Stensen's duct trauma.

Stent reconstruction of an injured parotid duct in a thoroughbred colt.

OBJECTIVE: To report successful use of stent repair for a chronically injured parotid duct in a thoroughbred colt. STUDY DESIGN: Clinical report. ANIMAL: A 2-year-old thoroughbred colt. METHODS: Chronic injury to the parotid duct was identified 4-cm caudal to the facial vessel notch on the ventral border of the right mandible. After careful surgical dissection of the surrounding firm fibrous tissue, the defect was temporarily stented using an 8-Fr human ureteral catheter (223600 ERU(®) SOFT URETERAL(®) , Laboratoires pharmaceutique, Betschdorf, France) to bridge the tissue loss. The rostral end of the catheter exited the oral cavity through a buccotomy stab incision at the level of the second premolar tooth of the maxilla. RESULTS: Primary wound healing occurred and the stent was maintained for 5 weeks with saliva drainage visible when the colt was fed. After stent removal, function was restored with good cosmesis. CONCLUSIONS: A tissue defect in the parotid duct can be repaired successfully by temporary use of a stent until wound healing occurs.

Parotid duct repair using an epidural catheter.

The anatomy of the buccal region of the face is complex and injuries in this region can lead to significant complications. Trauma in this region can easily injure the parotid duct and facial nerve. The management of parotid duct injuries is usually by microsurgical anastomosis, diversion of salivary flow by creating an oral fistula, or suppression of salivary gland function. The authors present a case of parotid duct injury treated by using an epidural catheter.

[Reconstruction of dissected Stensen's duct after facelift surgery]. / Rekonstrukcja uszkodzonego przewodu wyprowadzajacego slinianki przyusznej po zabiegu odmladzajacym twarzy.

Rejuvenation procedures, especially facelift are nowadays common type of cosmetic surgery. According to the statistical data, facelifts were the seventh most popular aesthetic surgery performed after liposuction, breast augmentation, blepharoplasty (eyelid surgery), abdominoplasty (tummy tuck), breast reduction and rhinoplasty. The most common complication after surgery is bleeding. Less common, but potentially serious, complications may include damage to the facial nerves and necrosis of the skin flaps, infection and damage of parotid duct. We present a case of 50 years old woman, who has undergone facelift surgery with damage of parotid duct and consequently formation of sialocele. Localisation of damage and repair of dissected Stensen's duct was performed using external approach. The duct was sutured end to end using intraductal stent. After 3 weeks stent was removed. We observed normal saliva flow from natural orifice of parotid gland.

Iatrogenic transposition of the parotid duct into the maxillary sinus after tooth extraction and closure of an oroantral fistula. A case report.

CASE REPORT: We report the clinical course of a patient with a rare iatrogenic surgical complication of transposition of the Parotid duct into the maxillary sinus after tooth extraction. DISCUSSION: Oroantral fistula occurs most frequently following maxillary molar or premolar extraction. Closure of an oroantral fistula is frequently closed using the buccal mucoperiosteal flap first described by Rehrmann in 1936. Transposition of the Parotid duct is a rare surgical complication of this technique. CONCLUSION: Differential diagnosis of nonspecific discharge from the nose should take this rare cause into account as it is a common symptom of this complication. A careful and full patient history and the correlation of nasal secretion with food intake can lead to the diagnosis.

Spontaneous tissue regeneration of the Stensen duct in dogs.

OBJECTIVE: There is a high incidence of wounds in the excretion duct of the salivary parotid gland owing to facial trauma that causes a loss of duct tissue. The aim of this study is to evaluate the ability of the salivary tissue to spontaneously self-regenerate, which is here widely demonstrated. STUDY DESIGN: This work was carried out on 20 adult dogs. A biomaterial catheter was inserted using microsurgical procedures to regenerate the lost duct tissue. This catheter served as an indicator for regenerating tissue growth. The results were assessed through clinical and radiographic exams by means of salivary charts and a histologic study. RESULTS: The results obtained demonstrate the complete regeneration of the Stensen duct in all cases. The self-expulsion of the intraductal guide was satisfactory, albeit unexpected, such that subsequent management of the patient was unnecessary. CONCLUSION: Spontaneous tissue regeneration of salivary ducts is possible using a biomaterial guide.

Management of parotid gland and duct injuries.

Surgical repair of injuries to the parotid gland and its duct have been described in the literature for more than 100 years. Injury to the glandular structures are usually associated with penetrating wounds of the face and often involve concomitant damage to adjacent structures, including the facial nerve, the ear, and the nearby bony structures. Most investigators agree that management of these injuries depends on the location of the damage. However, there are differences of opinion as to the proper management of the repair when the injury to the glandular system is discovered early or late.

Salivary gland injury subsequent to implant surgery.

Implant-based prosthetic restoration and oral rehabilitation is a very popular modality of treatment, with excellent success rates. Although a relatively safe procedure, implant insertion has its risks, which have been described in the literature. This article describes an as-yet unreported complication following implant insertion-salivary gland injury. The characteristics of salivary gland injury are examined, and 4 cases in which the salivary apparatus was injured or obstructed during 1 of the phases of implant therapy are presented.

[Non-surgical management of parotid gland and duct injuries: interest of botulinum toxin]. / Prise en charge non chirurgicale des plaies de la glande parotide et du canal de Stenon: intérêt de la toxine botulinique.

Salivary fistulas and sialoceles are rare complications of post-traumatic or postoperative parotid gland and duct injuries. Local injections of type A botulinum toxin represent a new and effective treatment for complications of these injuries, which is less invasive, stressful and lengthy than conventional methods. The authors report five cases in which three salivary fistulas and two sialoceles were successfully treated by botulinum toxin injections. The therapeutic protocol is described; it allows simple management of these complications and use of smaller doses than those described in the literature for treatment of sialoceles. The authors recommend use of botulinum toxin injections in first intention for management of salivary fistulas and sialoceles.