Parotid Massage Facilitated by Straightening Stensen's Duct

Obstructive sialadenitis may be associated with acute angulation at the masseteric bend of Stensen's duct previously reported to be associated with masseter enlargement. We report the case of a 44-year-old male who presented with intermittent left parotid pain and swelling without identifiable etiology on ultrasound and computed tomography imaging but with sialography notable for an acute masseteric bend in Stensen's duct. Fluoroscopic imaging on removal of the sialogram catheter demonstrated straightening of the masseteric bend, prompting patient education toward similar straightening of the duct with anterior traction to the cheek to facilitate parotid massage. Interval evaluations up to 4 months later identified a consistent response to this maneuver to prevent the previously experienced episodes of salivary gland swelling and pain. This maneuver, termed the "Molotkova Maneuver" offers an adjunct to standard parotid massage as a conservative management strategy to improve parotid drainage for select patients.