Management of Traumatic Soft Tissue Injuries of the Face

Facial soft tissue injuries encompass a broad spectrum of presentations and often present significant challenges to the craniofacial surgeon. A thorough and systematic approach to these patients is critical to ensure that the patient is stabilized, other injuries identified, and the full extent of the injuries are assessed. Initial management focuses on wound cleaning with irrigation, hemostasis, and debridement of nonviable tissue. Definitive management is dependent on the region of the face involved with special considerations for critical structures such as the globe, lacrimal apparatus, facial nerve, and parotid duct. Following sound surgical principles, these injuries can be managed to maximize both functional and aesthetic outcomes while minimizing complications.

Feline sialocoele: clinical presentation, treatment and outcome in 19 cases

Objectives The aim of this retrospective observational study was to describe the clinical presentation, treatment and outcome of cats with sialocoele. Methods Clinical records from seven referral hospitals were retrospectively searched to identify cats with sialocoele between 2007 and 2021. Results Nineteen cats were identified. The most common clinical signs were ptyalism, dysphagia and anorexia. Localisation of the sialocoele was cervical (n = 6), sublingual (n = 6), cervical/sublingual (n = 3), facial (n = 2), cervical/pharyngeal (n = 1) and zygomatic (n = 1). The affected salivary glands were mandibular–sublingual (n = 15), mandibular–sublingual/parotid (n = 1), zygomatic/parotid (n = 1) and parotid (n = 2). The aetiology of the sialocoele was traumatic in two cases, neoplastic in one cat and unknown in 16 cats. Sialoadenectomy was performed in 11 cats. Other treatments included ranula marsupialisation (n = 3), needle drainage (n = 2), single stab incision (n = 2) and parotid duct ligation (n = 1). The median follow-up time was 399 days (range 15–1460). Postoperative seroma was the only complication observed in one cat. No recurrence was reported. Conclusions and relevance Feline salivary sialocoele are relatively rare and have a good prognosis. They can be managed successfully with sialoadenectomy; however, a more conservative approach can be used with appropriate case selection.

1341 Outcomes of Sialendoscopic Stone Retrieval Under Local Anaesthesia in The Outpatient Setting- A Single Surgeon’s Experience

Aim The aim of this retrospective case series was to investigate the success rate of sialendoscopic stone retrieval under local anaesthetic. Method The records of 52 patients who underwent salivary endoscopy between September 2018 and February 2020 were reviewed. Included cases presented with at least one symptomatic major salivary gland, and sonographic or radiographic evidence of stone disease. Results A total of 25 patients (48%) and 27 stones were identified. Most cases (19/25) involved the submandibular gland, with a virtually even division between left and right sides. 19/25 patients underwent stone retrieval under local anaesthetic (LA) in the first instance (two of these patients had two stones). 6/25 patients underwent stone retrieval under general anaesthetic (GA) in the first instance, and this was successful in 5/6 cases. The overall success rate of LA sialendoscopic stone retrieval was 18/21 (86%), with 14/21 stones (66%) being successfully removed at the first treatment session and a further four at the subsequent treatment session. Under LA, 13/18 stones were removed intact, while the remaining 5 underwent fragmentation with an intraoral salivary pneumatic lithotripter (Cook Medical). Conclusions Sialendoscopic stone retrieval is a minimally invasive and effective treatment for both submandibular and parotid duct stones. It is possible to remove most stones under local anaesthetic at the first treatment session, using intraoral lithotripsy as an adjunct when indicated. This treatment modality provides therapeutic benefit with 86% success of stone retrieval under local anaesthetic with gland preservation in the vast majority of patients.

DICER1-Mutated Botryoid Fibroepithelial Polyp of the Parotid Duct: Report of the First Case

DICER1, a member of the ribonuclease III family, is involved in the biogenesis of microRNAs and, hence, it influences gene expression regulation. DICER1 germline (associated with the inherited DICER1 syndrome) or somatic mutations have been linked to tumorigenesis in histogenetically diverse benign and malignant neoplasms in different organs including pleuropulmonary blastoma, cystic nephroma, embryonal rhabdomyosarcoma, nasal chondromesenchymal hamartoma, poorly differentiated thyroid carcinoma, thyroblastoma, intracranial sarcoma and gonadal Sertoli-Leydig cell tumors in addition to others. Moreover, rare botryoid (giant) fibroepithelial polyps may harbor this mutation. Herein, we describe the first reported case of a DICER1-mutated botryoid fibroepithelial polyp occurring within the parotid duct of a 65-year-old female who has no other features or family history of the DICER1 syndrome. Based on its distinctive morphology, we tested this lesion specifically for DICER1 mutations and confirmed the presence of a pathogenic DICER1 variant with a low allele frequency, consistent with a somatic mutation.

Twin presentation of rhinocerebral mucormycosis and parotid abscess with facial nerve palsy in a case of unrevealed uncontrolled diabetes mellitus

<p class="abstract">Rhinocerebral mucormycosis is a saprophytic invasive fungal infection of the nose and paranasal sinuses. The angio-invasive nature of the disease and rapid spread to the surrounding vital structures makes this infection more fatal. Parotid abscess is a rare disease in both adults and children due to an ascending infection from the oral cavity via the parotid duct. Diabetes mellitus is an immuno-compromised state in which patients are more prone for several infections. Both these diseases can lead to fatal complications due to their spread and toxicity, but the one rare complication of both these diseases is Facial nerve palsy. We are presenting a case of Diabetes mellitus with Rhinocerebral mucormycosis and Parotid abscess. There have been very few documented cases of co-existing Rhinocerebral mucormycosis and Parotid abscess in a patient with facial nerve palsy as complication.</p>

Challenges encountered during the management of pediatric facial soft tissue injury from a mobile battery blast: A case report

The present case reports facial soft tissue injury involving the lateral aesthetic unit of the cheek on a 10-year-old boy from the disposed mobile battery blast on a roadside campfire. This case highlights one of the challenges encountered from injury to parotid duct and its conservative management.