The ectopic accessory parotid system: A new patient, studied through magnetic resonance imaging.

The ectopic accessory parotid system (EAPS) connotes an extra parotid tissue with its ductal outlet that is morphologically distinct from the main parotid gland and its drainage system. Clinically presenting as a saliva-draining cheek fistula near the oral commissure, this rare congenital anomaly is almost always associated with ipsilateral preauricular appendages and occasional mandibular hypoplasia, and is considered a variant of the oculo-auriculo-vertebral spectrum. This report discusses the embryology, clinical details, and management aspects in a new patient, highlighting the role of magnetic resonance imaging in, for the first time, tracking the ectopic salivary system, and establishing its independent existence.

Congenital salivary fistula of an accessory parotid gland in Goldenhar syndrome.

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.

Congenital ectopic fistula of a minor salivary gland.

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.

Accessory parotid gland with ectopic fistulous duct--diagnosis by ultrasonography, digital fistulography, digital sialography and CT fistulography. A case report and review of current literature.

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.

[Radiotherapy : an option for refractory salivary fistulas]. / Radiatio : Therapieoption bei therapierefraktärer Speichelfistel.

A 45-year-old patient presented with refractory salivary fistula, attributed to multiple surgery and Botulinum toxin, following lateral parotidectomy. He underwent fractionated radiotherapy of the remaining parotid gland including the fistula opening (total dose of 30 Gy) at our clinic. In time, fistula secretion could be inhibited completely. Although the indication for radiotherapy for such fistulas is rare since Botulinum toxin has been in use, it should still be considered in refractory disease courses.

Submandibular sialogram performed through a Wharton's duct fistula: technical adaptation of conventional technique.

We report a case of submandibular duct fistula in which a sialogram was performed through the fistulous opening after attempt of sialography through the Wharton's duct had failed. To our knowledge, this technical modification in obtaining a sialogram has not been described previously in scientific literature. Blunt-tipped needles and polythene catheters are commonly used for cannulation of the submandibular duct orifice for obtaining a sialogram. However, in this case, a larger gauge metallic cannula was employed to opacify the ductal system through the fistula.

Salivary otorrhoea: a case report and a review of the literature.

This report presents an unusual case of spontaneous salivary otorrhoea in which advanced imaging was used to identify a developmental defect in the anterior wall of the bony external auditory meatus. This defect, the so-called foramen of Huschke, was subsequently found to be the source of the fistula. A review of the literature highlights the diagnostic dilemmas that such cases pose for the clinician.

The value of magnetic resonance imaging in a fistula of Wharton's duct.

A 30-year-old woman developed a fistula of the Wharton's duct following excision of the submandibular gland. The contribution of conventional fistulography, MRI and MRI fistulography in detecting the exact extent of the fistula is discussed.

Congenital fistula from ectopic accessory parotid gland: diagnosis with CT sialography and CT fistulography.

We report a case of congenital fistula from ectopic accessory parotid gland to the cheek demonstrated by CT sialography and CT fistulography. The right parotid gland was abnormally located lateral to masseter muscle. The fistula was arising from an ectopic accessory parotid gland with ectopic duct positioned anterior to masseter muscle. CT sialography and CT fistulography were very helpful in the diagnosis and surgical planning.

Case report: congenital fistula between the submandibular gland and the oropharynx.

Congenital salivary fistulae are rare and may be associated with abnormalities of the branchial apparatus or arise from aberrant or accessory salivary tissue. Previous case reports have documented cutaneous fistulae. We report a case of a salivary fistula between the submandibular gland and the oropharynx and discuss a possible embryological basis for the abnormality.

Barium swallow is a predictor of salivary fistula following laryngectomy.

Pharyngocutaneous salivary fistula after laryngectomy is a serious complication that can lead to prolonged hospitalization and increased patient morbidity. A postoperative barium swallow provides the surgeon with information regarding the integrity of the pharyngeal suture line. In an attempt to determine whether this information can be used to predict or prevent salivary fistula, we reviewed the records of 109 patients who underwent total laryngectomy, including 51 who had a barium swallow before they began oral intake. Ten patients (20%) demonstrated a sinus tract originating from the pharyngeal suture line. A clinical salivary fistula developed in all four patients with a sinus tract 2 cm or longer, but in only one of six patients with a tract shorter than 2 cm. Other factors predictive of salivary fistula included tumor stage, previous radiation therapy, and the presence of concurrent postoperative complications. A single fistula developed in the 58 patients not studied with barium. Information provided by postlaryngectomy barium swallow appeared to predict, but not prevent salivary fistula formation.

Giant salivary calculi: an orocervical fistula caused by a submandibular gland calculus.

Large calculi of the salivary glands are rare. They may go undetected for many years. The authors report three cases of giant submandibular gland calculi. In one patient, the calculus was an incidental finding. In all patients, the mass was in the substance of the gland; in one, the configuration of the mass was unusual and it had eroded through the floor of the buccal cavity forming an orocervical fistula (the first such report) and in another the mass occupied a small portion of Wharton's duct. The histopathologic findings in all three cases were of nonspecific chronic inflammation. All the patients made a smooth recovery and had no complaints at follow-up.

Absolute indications for salivary gland scintigraphy with 99mTc-pertechnetate.

In recent years salivary gland scintigraphy has gained widespread acceptance as a useful means for evaluating salivary gland disorders. An absolute indication for this procedure exists when the ductal orifice of one or several major salivary glands cannot be found or cannot be cannulated. Clinical conditions in which this problem occurs include technical failure to probe and cannulate the duct, developmental anomalies, obstructive disorders, traumatic lesions and fistulae and the need of postsurgical information after glandular excision or after ligation or repositioning of a major excretory duct. The clinical value of scintigraphy in these conditions is demonstrated by means of case presentations.

Salivary scan after major ablative head and neck surgery with prediction of postoperative fistulization.

Patients with carcinoma of the head and neck undergoing major ablative and reconstructive procedures following periods of prolonged debilitation, chemotherapy, and/or radiation therapy have been identified as having a high risk for postoperative wound complication, most often infection. Does postoperative wound infection arise de novo, does infection result from failure of prophylactic antibiotic coverage, or is it the result of anastomatic salivary leak? To investigate the incidence of unrecognized salivary leak into the neck, 24 patients underwent salivary radioisotope studies using technetium 99m sodium pertechnetate from three to six days postoperatively. The isotope was administered early in the morning with drainage bags empty. Patients and the collection system were scanned for activity between four and six hours later. Nine patients had postoperative evidence of salivary secretion radioactivity in their drainage system. All of these patients developed transient wound infections or fistulas. The remaining 15 had no uptake in their collection systems and no wound complications. We suggest that the preliminary results from this noninvasive, simply administered study indicate that the infected surgical neck wound may be secondary to unrecognized postoperative salivary contamination. This technique can be used to provide early identification of potential wound infection. Alternatively, information generated by this kind of study may be valuable in predicting patients with the highest risk for postoperative infection, thereby offering guidelines for the use of perioperative antibiotic prophylaxis.