We report the case of a 45-year-old male patient who complained of severe pain, suppuration and unilateral inflammation in the parotid region.
It smells bad and tastes bad, between salting and taste.
This condition usually occurs at the time of meals, with remission in a relatively short period of time, never exceeding two hours.
The patient reported the onset of symptoms in the last nine days, and none of them had fever or general symptoms.
In the intraoral examination, a bulging was visualized, which showed fibrotic not adhered to deep planes.
The diagnosis of suspected obstructive sialolithiasis was negative when performing an orthopantomography, but when performing a simple plate sialolith was visualized in the excretory duct, confirming the nature of the condition.
The radiological technique consists of placing a radiographic plate in the vestibule at the level of this bulging and the beam of rays perpendicular to the plate, so that any calcified structure will be seen on the beam.
The first measure we adopted was to treat the symptoms of the process.
Pain was treated with analgesics day to day with antibiotics (amoxicillin 875 mgr and clavulanic acid 125 mgr), 600 mg every 8 hours for 7 days.
The patient was recommended to follow a diet rich in proteins and liquids, including foods or acid drinks that suppress salivation.
Once the process was controlled, treatment planning was carried out.
Assessing stone location and size, medical techniques aimed at achieving spontaneous remission of sialolith were ruled out, and we chose to eliminate sialolith using a technique.
The first step of our surgical treatment, once the sialolith was located, was the immobilization of the sialolith by means of a suture, which prevented its mobility along the duct during the intervention.
Once immobilized, the incision was made over the indurated area, and a simple pressure on the cheek at this level made the sialolith emerge through the incision.
The sialolith size was found to be the expected and detected in the X-ray.
After removing the sialolith, the problem lies in healing and repairing the duct.
The two possible solutions were the anastomosis of the duct with microsurgery or the creation of a new communication of the duct with the oral cavity due to a salivary fistula.
We opted for this second technique because of its simplicity, effectiveness and the results obtained are totally satisfactory for the function of the gland.
Thus, we chose to separate the margins of the wound, helping us with dissection scissors.
This makes it difficult to heal the canal, preventing its obliteration and causing the formation of a salivary fistula, thus obtaining our new communication with the oral cavity.
In subsequent revisions we proved the complete disappearance of symptoms, the effectiveness of the new salivary drainage, as well as the normal functioning of the parotid gland.
