Parotid fistulas: a review.

A series of 17 cases of parotid fistulas seen at one hospital over a 10-year period is presented with detailed analysis of aetiological factors, clinical presentation and therapy. Distinctions between glandular and ductal fistulas have been enumerated and the poorer prognosis of the ductal fistulas, especially of the proximal part, is emphasized. Two-thirds of the fistulas were iatrogenic. Malignancy and oral leucoplakia were unusual causes. Direct duct suture is rarely successful. Ablative surgery carries a significant risk of facial nerve injury. A wide choice of treatment exists for glandular and distal duct fistulas, while for the proximal duct injuries excision is usually necessary. A new alternative operation of vein grafting for such cases is described. Successful closure is obtained in only 50 per cent of patients with long standing fistulas with any method of treatment.