PMC4701807_01
A; six centimeter long, deep lacerated wound at the right buccal cheek. B; the buccal mucosa near the second maxillary molar was cannulated with 22G (blue color) cannula. The cannula was slightly modified by cutting the closed distal tip end of the needle. C; the proximal cut-end of the parotid duct was also cannulated and joined to the JJ stent that had extended from the distal cut-end. D; stent passing through both cut ends of the parotid duct.
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On examination he was conscious, with six centimeter long, deep lacerated wound at the right buccal cheek [Fig. 1A] with soft tissue bleeding. Normal saline was slowly flushed through the cannula and a clear leak in the wound was observed confirming the parotid duct injury [Fig. 1B]. This duct was cannulated and joined to the JJ stent that had extended from the distal cut-end [Fig. 1C].
A; Microsurgical anastomosis of the cut-ends of the parotid duct was performed with 6-0 Vicryl suture. B; and further wound closure was performed in layers. C; The JJ stent catheter was left in the duct and the excess length was cut (5 cm beyond the ductal orifice outside the oral cavity) and fixed by suturing to the buccal mucosa.
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Finally, microsurgical anastomosis of the cut-ends of the parotid duct was performed with 6-0 Vicryl suture [Fig. 2A] and further wound closure was performed in layers. We also put corrugated drain to prevent hematoma and saliva accumulation (edema) which may cause pressure and affect duct healing [Fig. 2B]. The JJ stent catheter was left in the duct and the excess length was cut (5 cm beyond the ductal orifice outside the oral cavity) and fixed by suturing to the buccal mucosa [Fig. 2C].