Head Misc

Question 1

What is the diagnosis?

List possible treatment options

Answer 1

Sialolith within the parotid salivary duct

Can be excised standing via a transcutaneous approach (Poore et al EVE CR 2019) or intra-oral approach

Complications of transcutaneous excision incl. fistula formation if closure of the parotid salivary duct fails, and damage to the dorsal branch of the facial nerve

Complications of intra-oral excision incl. difficulty in accessing the sialolith, infection at the unsutured surgical site, fistula formation at the surgical site and granulation tissue causing an obstruction at the buccal ostium

Question 2

Describe the path of the parotid salivary duct

Answer 2

Accompanies the facial 9 artery and vein, and with them winds around the ventral border of the mandible to enter the lateral surface of the face. The duct opens into the oral vestibule opposite the 2nd or 3rd upper cheek tooth (PM 3 or 4 - triadan 7 or 8) - ie typically rostral to the facial crest