Gordin Eli A, Daniero James J, Krein Howard, Boon Maurits S
Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Jefferson Medical College, Philadelphia, PA, USA.
Facial Plast Surg. 2010 Dec;26(6):504-10. doi: 10.1055/s-0030-1267725. Epub 2010 Nov 17.
Parotid trauma can lead to both short and long-term complications such as bleeding, infection, facial nerve injury, sialocele, and salivary fistula, resulting in pain and disfigurement. Facial injuries inferior to a line extended from the tragus to the upper lip should raise concern for parotid injury. These injuries can be stratified into three regions as they relate to the masseter muscle. Injuries posing the greatest risk of damage to Stensen's duct include those anterior to the posterior border of the masseter and necessitate exploration. When the duct is disrupted, emphasis should be placed on primary repair or re-creation of the papilla; however, proximal ductal lacerations can be treated by ligation of the proximal segment. Isolated parenchymal injury can be treated with more conservative means. Sialocele and salivary fistula can frequently be managed nonoperatively with antibiotics, pressure dressings, and serial aspiration. Anticholinergic medications and the injection of botulinum toxin represent additional measures before resorting to surgical therapies such as tympanic neurectomy or parotidectomy.
腮腺创伤可导致短期和长期并发症，如出血、感染、面神经损伤、涎囊肿和涎瘘，从而引起疼痛和毁容。从耳屏至下唇延长线以下的面部损伤应引起对腮腺损伤的关注。根据与咬肌的关系，这些损伤可分为三个区域。对腮腺导管造成最大损伤风险的损伤包括位于咬肌后缘前方的损伤，需要进行探查。当导管断裂时，应着重于乳头的一期修复或重建；然而，近端导管撕裂伤可通过结扎近端段进行治疗。孤立的实质损伤可用更保守的方法治疗。涎囊肿和涎瘘通常可通过使用抗生素、加压包扎和连续抽吸进行非手术处理。在采取诸如鼓室神经切除术或腮腺切除术等手术治疗之前，抗胆碱能药物和注射肉毒杆菌毒素是另外的治疗措施。
