CONGENITAL PAROTID SALIVARY FISTULA FROM

STENSONS DUCT
*Mayashankar B. Vishwakarmam, **Hemantkumar O. Nemade ,
***Subhalakshmi A. Jaiswal, ****Shankar Kothule
ABSTRACT
Congenital parotid gland fistulas are extremely rare and they can be arising from the ectopic parotid tissue and
are more infrequently from the normal salivary gland forming sialo-cutaneous fistula. Here we present a unique
case in which 15 years old female patient presented with small pit near left oral commissure draining the salivary
flow which was communicating with the normal ductal system of the parotid gland and with intact Stensens
duct opening in the oral cavity.
The patient was investigated to confirm the origin of the fistula by fistulogram which revealed the fistula
communicating the normal ductal system of the parotid gland. Patient was operated with prior cannulation of
the fistula with the 26 G needle one and half inch needle and dissected around it till the parotid gland is excised
completely along with small amount of parotid gland after ligating it with non absorbable suture material.
This is an extremely rare condition posing diagnostic and therapeutic challenges to the treating physician.
Keywords: salivary gland, sialo-cutaneous fistula, congenital anomalies.

Vol.-9, Issue-II, July-Dec. - 2015

INTRODUCTION
Parotid fistulas are most commonly acquired and
are secondary to the trauma, surgery, malignancies and
inflammation. Congenital parotid fistulas are extremely
rare. They can arise from the ectopic parotid gland and
less frequently from the normal salivary gland
communicating with its ductal system.
CASE REPORT:
15 year old female patient presented to our OPD
with small pit near left angle of mouth complaining
serous discharge from the pit since birth. There was no
history of trauma or previous surgery. There was no
history of increase in the discharge with food intake.
There was no history of local swelling in past. On
inspection pinpoint opening seen 2 cm lateral to left
oral commissure(figure 1). Drops of clear fluids were
expressed from the opening when digital pressure on
the ipsilateral parotid region is given(figure 2). On intraoral
examination both Stensens duct opening seen. No other
anomalies were found. Fistulogram was done which
revealed dye reaching to the normal ductal system of
the parotid gland. The contrast dye injected through
the fistula enhanced the parotid gland(figure 3). Patient was
posted under general anesthesia for excision of fistula.
40

The fistula was canulated with the 26 G one and half

inch needle. 2 ml methylene blue dye was injected
through the fistula to identify the branches if any. Small
elliptical incision taken with long axis along the
nasolabial furrow around the opening of the fistula.
The dissection of the complete fistula tract was aided
by the needle inside the fistula(figure 4). Dissection done
till the normal parotid gland was exposed and the
complete fistula tract along with the small amount of
parotid tissue ligated with non absorbable suture (silk
3-0) and excised. The wound was closed in layers.
Postoperative course was uneventful. Patient was
followed up for six months without any complaints.
DISCUSSION:
All of the major salivary glands are derived from
oral cavity epithelium, which proliferates and burrows
Affiliations:
*Assistant professor ,**Assistant professor,***Professor & Head ,****PG
resident P.G.Dept of ENT & Head & Neck Surgery Dr.Vaishayampayan
Memorial Government Medical College, Solapur, Maharashtra, India.
Address of Correspondence:
Dr. Shankar Kothule, MD,
PG Resident, ENT dept, 2nd floor, B block, Civil hospital,
Solapur-413003
Email id: - shankarkothule@gmail.com
Contact no: - +91 9552609914

Fig 1 :-Discharging fistula lateral to left ant. Commissar.

Fig.5 :-Intraoperative photo of excision of fistula.

Fig. 3:- Contrast dye injected through the fistula enhanced the
parotid gland.

The exact aetiology of the congenital salivary

fistula is not known. Yamasaki et. al.1 proposed that
excess parotid anlage may have proliferated from the
original epithelium of the oral fossa and grown
posteriorly and superiorly apart from the original
parotid gland to form accessory parotid gland. Gilbert
et. al.2 considered that it was possible that the primitive
parotid bud developed from the edge of the maxillary
processes in such a way that subsequent fusion of the
processes leaves the parotid opening external rather than
internal.
Sun Z et. al.3 described two cases of parotid fistula
in cheek in cases of Goldenher syndrome and suggested,
a congenital cheek salivary fistula of an accessory parotid
gland should be considered indicative of Goldenhar
syndrome.

Fig. 4:- Contrast dye injected through the fistula enhanced the
parotid gland.

The diagnosis of the parotid fistula in our case

was done by fistulogram. Gadodia et. al.4 put forth the
importance of the sialography, magnetic resonance

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Vol.-9, Issue-II, July-Dec. - 2015

Fig. 2 :- Drop of clear fluid on digital pressure.

into the surrounding mesenchyme to form a solid cord.

Extensive branching occurs during embryogenesis to
form the acini of the glands, and a lumen develops
within the main trunk to form the excretory duct. After
fusion of the maxillary and mandibular processes, which
are both derived from the first branchial arch, the
parotid duct takes its normal position inside the mouth
at the level of the superior second molar. Congenital
salivary fistulas from the parotid gland and from the
accessory parotid gland are rare; when they do occur,
they usually open at the facial skin near the angle of
the mouth.

sialography and computed tomography sialography

with fistulography in delineating the ductal anatomy.
But these investigations are expensive and not required
in all cases for diagnosis.As this condition is rare, there
is no standardization of the treatment. Most of the cases
in the literature are from the accessory parotid duct
fistula which were treated by dissection and reposition
of the parotid fistula into oral cavity by Delores
method1. Woo Kyung Moon in their case report treated
the accessory parotid fistula by fistulectomy with
excision of accessory parotid gland5. J. Hun Hah treated
the accessory parotid fistula by chemocauterization by
40% trichloroacetic acid6. In our case dissection of the
tract was carried out by placing a needle in the tract,
excessive dissection was avoided to damage to terminal
branch of facial nerve.

REFERENCES:
1.

Yamasaki H, Tashiro H, Watanabe T. Congenital

parotid gland fistula. Int J Oral Maxillofac Surg
1986;15(4):492-4.

2.

Gilbert PM. Congenital external fistulae of the

parotid duct. Br J Plast Surg 1987;40(1):99-101.

3.

Sun Z, Sun L, Zhang Z, Ma X. Congenital

salivary fistula of an accessory parotid gland in
Goldenhar syndrome. J Laryngol Otol 2011;Oct
28:1-5.

4.

Gadodia A, Seith A, Sharma R, Thakar A.

Congenital salivary fistula of accessory parotid
gland: Imaging findings. J Laryngol Otol
2008;122(3):e11.

5.

W.K. Moon, M.H. Han, I.O. Kim, et al.,

Congenital fistula from ectopic accessory
parotid gland: diagnosis with CT sialography
and CT fistulography, Am. J. Neuroradiol. 16
(1995) 997999.

6.

J. Hun Hah et al., clinical and experimental

otorhinolaryngology Vol 1, No. 2: 113-115, june
2008.

CONCLUSION:
Congenital parotid fistula is rare and that from
stensons duct is further rare entity which usually
follows trauma.
DISCLOSURES

Vol.-9, Issue-II, July-Dec. - 2015

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