Salivary Duct Trauma

Abstract

Salivary duct trauma is an under-recognized complication of salivary gland and duct surgery. As more practitioners continue embrace and perform sialendoscopy, and the technique moves from the academic to community setting, it is imperative practitioners maintain vigilance of appropriate operative technique and awareness of the potential for duct trauma. Wharton’s duct and Stensen’s duct have uniquely different anatomy, and therefore unique risk factors for trauma. The degree of trauma can vary from mild transient duct inflammation to complete strictures or avulsion (Nahlieli, J Oral Maxillofac Surg 73(1):75–80, 2015). Thoughtful preoperative planning, attention to detail during salivary duct surgery, and prudent duct manipulation can prevent most severe duct trauma. Minor trauma may be inherent and necessary in certain procedures, such as mild ductal excoriation or planned ductotomy for salivary stones. However, these minor traumas may lead to significant long-term consequences, such as obstructive sialadenitis secondary to salivary stricture, and need for salvage surgery, including gland excision. Therefore practitioners need to appropriately counsel patients preoperatively and provide adequate postoperative follow-up. This chapter reviews the etiology and types of ductal trauma seen with surgery of Wharton’s and Stensen’s duct. In addition, methods to avoid, recognize, and manage ductal trauma are outlined.