Surgery of the salivary ducts

Successful surgery of the salivary ducts relies on an understanding of the surrounding anatomy and the delicate dissection of tissues in order to reduce morbidity. Trauma to the ducts should be assessed when lacerations or wounds encroach on their paths. Early diagnosis and treatment will reduce the complications of stricture and fistula formation from these injuries. Sialoliths can be located in several places along the length of the salivary ducts. The correct diagnosis and positioning of the stone in the duct is important in establishing the appropriate surgical approach. Imaging using plain films, ultrasonography, and endoscopy can be very valuable, with sialography and CT scans helpful in cases of radiolucent stones, glandular atrophy, or suspected tumor. As the condition becomes more chronic, resulting in glandular atrophy, excision of the diseased gland is often indicated. Treatment of excessive salivary flow in patients with cerebral palsy can be managed by a combination of ductal repositioning and glandular excision. Redirection of both the parotid and submandibular glands can be accomplished, either to reroute excess salivary flow or salvage the duct in cases of lesion excision.