SALIVARY GLANDS - SIALOCELE FEBRUARY 1999 A parotid sialocele is a periductal accumulation of saliva resulting from a complete or partial disruption of the parotid duct. It usually becomes apparent 8-14 days after an injury. Facial lacerations or an operative procedure such as a mandibular osteotomy are frequent initiating factors. Diagnosis of a sialocele is based on a history of trauma. Clinically, a soft mobile painless swelling is evident extraorally involving the buccal soft tissues. A CT scan will reveal a single or multiloculated cyst-like mass with less density than the surrounding tissues and whose margins are smooth. Extraoral fistula formation is a possiblility as is secondary infection. Sialography can play a significatnt role in diagnosis by indicating the extent of parotid duct injury, thus dictating the surgical approach. In the past, radiation, gland removal and tympanic neurectomy have been advocated for treatment. Present-day approaches are more conservative and take many forms. Immediate treatment of a parotid duct laceration can avoid sialocele formation, but treatment is dependent upon the location of duct involvement. If ductal injury involves ducts within the parotid gland, capsular suturing and a pressure dressing are usually successful. However, injury to the duct as it crosses the masseter muscle is best treated by duct suturing over a previously placed catheter which is subsequently removed. The severity of duct injury may preclude this approach. In such a cases, ligation of the proximal duct segment is acceptable, but will lead to gland atrophy. Injury to the duct anterior to the masseter muscle can be managed by re-establishing the duct's oral continuity or surgically creating an intraoral fistula. If a sialocele develops following the initial injury and/or its treatment, a conservative approach can be tried. Repeated aspirations, pressure dressings and antisialogogic agents are often successful. If the sialocele proves to be resistant, a catheter or drain can be temporarily introduced surgically extending from the sialocele to the oral cavity, whereupon it is sutured to the buccal mucosa. Fistula formation can also occur following duct injury. Pressure dressings, antisialogoues, time and prayer are often sufficient to solve the problem. If failure occurs, surgery can be performed. Surgically, an intraoral opening for salivary escape is required. The surgical opening is provisionally maintained with a catheter, seton, or Penrose-like drain until such time as saliva is seen exiting intraorally. Pressure dressings and xerostomic agents are used as supplements. The Salivary Gland Center (SGC) was developed because a void existed in the diagnostic and comprehensive care of patients with salivary gland problems and/or secretory dysfunction. Since the diversity of these salivary conditions presents challenges to the clinician, the SGC is available for referrals. Louis Mandel, DDS Director, Salivary Gland Center (212) 305-9982