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.

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.

Surgical management of Stenson's duct injury using epidural catheter: a novel technique.

Stenson's duct of parotid gland is a major duct which drains saliva into the oral cavity. Deep penetrating wound in the form of cut or crush injury to the buccal area carries the risk of parotid duct injury. It is in the form of ductal exposure, laceration, total severing, or crushing of the duct. These conditions are difficult to diagnose because of complex anatomy and variable nature of injury. Successful management of parotid duct injury depends on early diagnosis and appropriate intervention, failing of which may lead to complications like sialocele or salivary fistula. Many techniques have been proposed for diagnosis and management of parotid duct injuries. This article presents an easy and novel technique to diagnose and manage the parotid duct injuries using an "epidural catheter" which is often used for inducing spinal anesthesia. The technique of epidural catheter usage, its advantages, and limitation over other techniques proposed for the management of parotid duct injury are discussed.

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.

Orthodontic parotitis: a rare complication from an orthodontic appliance.

A case is presented of a 14-year-old female undergoing orthodontic fixed appliance treatment who presented with right facial swelling in the parotid region. An initial diagnosis of acute infective parotitis was made by her primary care clinician. However, after clinical examination and ultrasonographic imaging, a diagnosis of salivary stasis secondary to inflammatory occlusion of Stensen's ductal orifice was made. The ductal orifice had been traumatized by the adjacent orthodontic appliance. This has not been described before in the literature. The differential diagnosis of parotid enlargement in children is discussed.

Induction of Sca-1 in the duct cells of the mouse submandibular gland by obstruction of the main excretory duct.

The effect of ligation of the main excretory duct (MED) of the mouse submandibular gland (SMG) on the expression of Sca-1, a stem cell antigen, was examined by Western blotting and immunohistochemistry. By Western blotting, the expression of Sca-1 with a molecular weight of 18 kDa was identified in the normal gland. At 1 day post-ligation, the expression level of Sca-1 was strongly increased in the experimental gland and weakly in the contralateral gland, and such expression in both glands decreased at 6 days. By immunohistochemistry, Sca-1 was detected weakly in the apical membrane of excretory duct (ED) cells of the SMG under the normal condition. By duct ligation, Sca-1 became expressed strongly in most cells of the two major duct systems, i.e., the striated duct (SD) and granular convoluted tubules (GCT), but was not detected in the acinar (Ac) cells. By fluorescence-activated cell sorter (FACS) analysis, the number of side population (SP) cells in this gland was found to be increased by ligation. These results imply that Sca-1-positive cells may have a role in the duct cell proliferation in the regeneration step elicited by MED ligation-induced injury.

Trauma evaluation of the parotid duct in an austere military environment.

Evaluation of the parotid duct from trauma in an austere military environment can be challenging. Appropriate radiologic evaluation of a potential isolated parotid duct injury in this environment has not been reported. The use of a plain X-ray sialogram at the forward surgical team is demonstrated and may be beneficial in this setting.

[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.

Reconstruction of traumatically avulsed parotid duct using buccal mucosa flap: report of a new technique.

Injury to parotid duct is frequently overlooked especially in multiple injuries settings. Consequently they are rarely reported in the literature. Treatment of these injuries is highly controversial. Short series and anecdotal case studies claim success with various approaches such as nonsurgical management, simple ligation of the proximal duct with or without antisialagogues, microsurgical primary repair, creation of sialodocho-oral fistula, and vein-graft replacement. A novel technique of sialodochoplasty using buccal-mucosa pedicle flap is described in this report. Short-term result of this method in a 4-year-old boy with traumatic loss of right parotid duct was encouraging. Hypothetical advantages of this new operation are reviewed in the background of alternative procedures. It is concluded that buccal-mucosa flap technique appears to be a promising alternative in the management of parotid duct injuries.

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.

Detection of a metallic foreign body in the Wharton duct: A case report.

RATIONALE: Foreign bodies are rarely found in the submandibular gland and the Wharton duct, due to their physiological and anatomical features. PATIENT CONCERNS: A 23-year-old man was referred to Foshan Stomatology Hospital in July 2016, with pain and intermittent swelling in the right submandibular area. DIAGNOSES: Physical examination revealed enlarged, indurated, and painful swelling in the right submandibular area, with a normal oral cavity. No abscess or fistula was detected. Radiography and computed tomography (CT) indicated a 1.7 cm radiopaque mass in the Wharton duct, close to the submandibular gland. INTERVENTIONS: Submandibular sialadenectomy was performed under general anesthesia. Upon exploration of the fully dissected submandibular gland, a 2.0 cm long barb-like metallic body was found in the Wharton duct. OUTCOMES: The patient had an uneventful recovery during a 6-months follow-up. LESSONS: Foreign bodies in the Wharton's duct can be detected by imaging techniques, such as radiography and CT, and successfully treated by submandibular sialadenectomy.

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.

A treatment algorithm for the management of intraoral burns: A narrative review.

Oral mucosa follows a distinctly different trajectory of wound healing than skin. Although there are contemporary guidelines regarding treatment of burns to the skin, there is no standard of care specific to intraoral burns. This narrative review proposes an evidence-based treatment algorithm for the management of intraoral burns. Data was collated through a comprehensive review of the literature and only included studies that have reported particular success with favorable short- and long-term prognoses. In order to critically appraise the strength of the treatment recommendations, the GRADE criteria was applied to each arm of the algorithm. The algorithm was initially subdivided into the four primary etiologies of intraoral burns - thermogenic, cryogenic, chemical, electrical. Our findings emphasize the importance of conservative modalities of intra-oral burn treatment.

Surgical management of parotid salivary duct rupture secondary to non-iatrogenic trauma in a dog.

A 3-year-old French bulldog presented for evaluation of recurrent swelling and a fistula on the right cheek after a dog fight. A large volume of serous fluids was identified on the wound immediately after atropine drops. A diagnosis of parotid salivary duct rupture secondary to trauma was made. On surgical exploration, the thickened proximal segment of the severed duct was identified and circumferentially double ligated with 3-0 silk. No evidence of swelling and normal appearance of the parotid salivary gland were identified 4 months postoperative recheck. No further problems were noted 10 months postoperatively phone-call. To the author's knowledge, this is the first reported case of successful proximal parotid duct ligation of parotid salivary duct rupture secondary to non-iatrogenic trauma.

Soft tissue pediatric facial trauma: a review.

Facial soft tissue injuries are common in pediatric trauma patients. Early diagnosis and definitive treatment as well as good postoperative wound care are important when dealing with soft tissue injuries, such as facial nerve and parotid injuries, animal bites, avulsive skin wounds and eyelid and ear lacerations. Children heal quickly, but they also tend to develop hypertrophic scars. Proper wound management during the healing period can help to minimize the risk of adverse scar formation. Dentists may be involved in the initial assessment of these patients. Knowledge of the diagnosis and management of soft tissue trauma is useful when dealing with pediatric patients and their parents postoperatively.