Analysis of Sialocele and Salivary Fistula in Post-Parotidectomy Patients

Objective: The objective of this study is to determine the incidence, risk factors, and management of sialoceles and salivary fistula after parotidectomy. Methods: Single institution, multiple surgeon retrospective review of patients undergoing parotid surgery r over a three year period (2006-2009). Results: The incidence of sialocele and/or fistula in 65 patients was 21.4%. A salivary fistula was seen in 28% of patients that had a complete superficial parotidectomy, and 5% of patients that had a partial parotidectomy (p 1week) and/or is amylase positive. Factors that were examined included tumor pathology, type of parotidectomy performed (partial lobectomy, complete superficial parotidectomy, total parotidectomy, and radical parotidectomy), the type of drain placed, the duration of drain placement, the volume of the specimen, and the duration of the sialocele or fistula. Patients that required neck dissection, skin resection, regional or microvascular flap reconstruction, or temporal bone resection were excluded. Surgeries were classified as a partial lobectomy (dissection and removal of tissue over either the upper or lower division of the facial nerve), complete lateral lobectomy (dissection and removal of tissue over both the upper and lower division), deep lobe parotidectomy, radical parotidectomy. A students t-test and Fisher exact test were used to determine significance. The incidence of sialocele in this study was found to be 21%, which is consistent with what is reported in other studies. A myriad of factors were examined to determine if a correlation existed with sialocele formation, but the only factor that achieved statistical significance was the type of parotid surgery performed. Patients undergoing a complete dissection of the superficial lobe of the parotid had a significantly higher rate if salivary fistula formation. This finding is contrary to what has been reported in previous studies which showed a higher rate of sialocele with a partial lobectomy.4 Though the reason for the association with extent surgery is unclear, it is possible that as a larger surface area of the gland is exposed, there is a greater accumulation of saliva, leading to a higher propensity of sialocele formation. The higher rate of of sialocele formation in patients undergoing a deep lobe parotidectomy is also suggestive of this reasoning, but this did not approach statistical significance given the low number of patients undergoing this procedure. The type of treatment did not seem to hasten resolution of the sialocele, though the power of this portion of the study was low. A prosepctive study or larger sample size would be necessary to answer this question. Other limitations of this study are primarily due to its retrospective nature. In conclusion, sialoceles and salivary fistulas are a relatively common occurrence after parotid surgery. They appear to occur more frequently with removal of the entire superficial lobe of the parotid compared . Resolution tends occur in approximately one month. At present, no therapy has been shown to prevent their occurrence. Introduction Material and Methods Results Discussion/Conclusion Type of Surgery Sialocele Partial Lobectomy 5% Complete Lateral Lobectomy* 28% Deep Lobe Parotidectomy 50% Treatment Frequency Used Average Days to Resolution Aspiration 64% 26.3 Packing 7.1% 26 Pressure Dressing 35% 26.4 Scopolamine 42% 29.5 Drain 14% 27 TABLE 1 Incidence of Sialocele/Salivary Fistula Based on the type of Surgery Performed