Palomino Ludivine, Mouchon Emmanuelle, Nieto Pauline, Gallois Yohan
Otorhinolaryngology, Neurotology and Paediatric ENT Department, Pierre-Paul Riquet Hospital, Toulouse University Hospital, Toulouse, France.
Otolaryngology and Head and Neck Surgery Department, Larrey Hospital, Toulouse University Hospital, Toulouse, France.
Eur Arch Otorhinolaryngol. 2025 Jan;282(1):543-547. doi: 10.1007/s00405-024-08914-4. Epub 2024 Sep 6.
Cheek fistulas of salivary origin in children are very rare, predominantly of congenital or traumatic origin but rarely caused by parotid sialolithiasis given its low prevalence in paediatric populations.
A 3-year-old child with no history other than substantial left-cheek swelling for 2 months was referred. We identified a cutaneous fistula with seropurulent discharge. At this time, we only observed mild inflammation of the left parotid duct papilla with no visible calculi. A first ultrasound scan only detected acute inflammation of the parotid duct that was treated with antibiotics. The discharge subsided but the fistula persisted. Two more episodes of infection occurred at 6-month intervals that were both treated by antibiotics. After this second treatment, a second ultrasound scan showed dilatation of the left parotid duct upstream of the cheek fistula with the presence of a calcification. We performed sialoendoscopy under general anaesthesia 10 days later. Before introduction of the sialoendoscope, we noticed a whitish calculus within the papilla that was removed by intraoral incision and digital pressure alone. Sialoendoscopy went on to detect a dilated parotid duct that was highly inflamed and bled upon contact at the site of the cheek fistula. No other sialoliths were detected. The fistula had healed four months later without any recurrence of parotitis or discharge.
Sialolithiasis should be considered for spontaneous cheek fistulas in children. Sialoendoscopic-assisted diagnosis and treatment can result in complete resolution of cutaneous-parotid fistulas without the need for more aggressive surgery.
儿童唾液腺源性颊瘘非常罕见，主要为先天性或创伤性起源，但由于其在儿科人群中的患病率较低，很少由腮腺涎石病引起。
一名3岁儿童因左侧脸颊肿胀2个月前来就诊，无其他病史。我们发现一个有浆液脓性分泌物的皮肤瘘管。此时，我们仅观察到左侧腮腺导管乳头轻度炎症，未见结石。首次超声扫描仅检测到腮腺导管急性炎症，给予抗生素治疗。分泌物消退，但瘘管持续存在。此后每隔6个月又发生两次感染，均用抗生素治疗。第二次治疗后，第二次超声扫描显示颊瘘上游的左侧腮腺导管扩张，并有钙化。10天后，我们在全身麻醉下进行了唾液腺内镜检查。在插入唾液腺内镜之前，我们注意到乳头内有一个白色结石，仅通过口腔内切口和指压将其取出。唾液腺内镜检查发现腮腺导管扩张，高度发炎，在颊瘘部位接触时出血。未检测到其他涎石。四个月后瘘管愈合，腮腺炎或分泌物未再复发。
对于儿童自发性颊瘘应考虑涎石病。唾液腺内镜辅助诊断和治疗可使皮肤-腮腺瘘完全愈合，无需进行更激进的手术。
