Risk factors for sialocele after parotidectomy

Parotidectomy, the surgical excision of the parotid gland to treat tumors, is frequently complicated by sialocele formation-a subcutaneous accumulation of saliva that presents clinically as a cystic mass. With reported incidences ranging from 0% to 44%, the specific etiology remains incompletely defined. This study aimed to identify independent predictors of postoperative sialocele formation to suggest targeted preventive strategies.

A retrospective cohort study analyzed patients undergoing parotidectomy at a single tertiary center from 2014 to 2020. Data including patient demographics, comorbidities, lifestyle habits, operative details, and postoperative care were collected. The primary clinical outcome was clinically diagnosed sialocele. Independent predictors were evaluated using multivariable logistic regression, calculating adjusted odds ratios (aORs) and 95% CIs.

Among 597 subjects (mean age 52.2 ± 14.4 years; 58.5% male), 54 (9.0%) developed a sialocele. Multivariable analysis revealed significant independent predictors: betel nut use (aOR = 2.37; 95% CI, 1.13-4.97; p = 0.023), history of cerebrovascular accident (aOR = 4.10; 95% CI, 1.30-14.86; p = 0.032), surgical drain removal in <3 days (aOR = 1.89; 95% CI, 1.04-3.44; p = 0.036), and a diagnosis of mucoepidermoid carcinoma (aOR = 4.18; 95% CI, 1.37-12.78; p = 0.012). Variables like age, sex, tumor size, and operative method showed no significant association.

Betel nut use, a history of stroke, early drain removal, and malignant pathology are significant independent risk factors for postoperative sialoceles. Adjusting perioperative management, particularly delaying drain removal, may lower this risk. Tumor size and operative method did not influence outcomes. Prospective studies are needed to confirm these single-center retrospective findings.