Ear-Nose and Throat Doctor (ENT) Questions Parotid Gland Disorders

Parotid seroma keeps coming back after draining

I had a parotidectomy 1 month ago for a benign pleomorphic adenoma which was about 3cm. About two weeks post op, I developed swelling under my ear around the incision. I waited till I was one month post op- swelling was still there and went back to the doctors and he said it was a seroma that is filled up with saliva due to my body adjusting to the the partial removal of the gland. I had it drained and within a couple of hours it came back. I am very frustrated and don't know what to do. Should I keep having it drained- and how many times could this keep happening? I have read some things about using botox to decrease salivary production is this true? Please help, I am very upset thinking I am going to be dealing with this cycle of draining forever.

11 Answers

I think I would go to another doctor and ask them what they think.
I strongly recommend you visit your doctor as soon as possible and analyze together the causes of this complication. Maybe you can consider the possibility of a salivary fístulae. Ask your doctor. Botox is a good option that could help in the case of a salivary fistulae.
This is not uncommon after a parotidectomy. The first thing is that it may need to be repeatedly drained and a pressure dressing placed to diminish the dead space under the skin. It will eventually scar down. Botox is really better for Frey's syndrome that also can occur after a parotidectomy.
You had an operation which is not too long ago. Indeed your body is still healing.
Give little time more listen to what your Surgeon is advising you. At this stage you need to drain the seroma in the care of your Surgeon's team.
There is no evidence that Botox will help.
To drain or not to drain? That is the question with seromas. I tend to leave them alone and let the body take care of it. If after three months it is still bothersome, that is when I tend to drain or excise them. Be patient. It should take care of itself.
Good day. Thank you for an interesting question.

You either have a seroma or a sialocele. The former is an accumulation of lymphatic and wound fluid in a cavity after surgery where a space was created between the skin and the underlying tissue. A sialocele is an accumulation of saliva type fluid originating from the Parotid gland which is essentially a saliva secreting gland. In both instances, one expects this to be self limiting and to resolve in time.

For a seroma, a suction drain will suffice if left in for 1 - 2 weeks. Alternatively, one can have needle aspirations every so often until it settles spontaneously. As far as a sialocele goes, the gland will produce more saliva when eating sour or acid type foods such as citrus, apples, vinegar etc. One has to stay away from such foods for a while and still have needle aspirations too every 2 weeks or so. It should settle over time.

One can differentiate between a seroma and a sialocele by doing a fluid amylase assessment. This is a salivary enzyme which will not be present in a true seroma, but in a sialocele. Botox injection into the gland or revision surgery have been tried in the past to manage a sialocele, but surgery carries further risks for nerve injury and should not be chosen as a firstline step. It should really clear up with sequential aspirations over a period of 3 months. It is possible that a salivary fistula may develop and again this will be managed the same way. It is uncommon to have to undergo further surgery for this.
What you describe is a sialocele, not a seroma. This is one of the known complications of parotid surgery occurring in a small percent of patients. It is best managed by ligation of the duct draining into the sialocele, often done at the time of the initial surgery, but not so much a month later. This can be treated with variable success by pressure dressings, oralantisialagogues, and botox. Additional surgery or radiation may become necessary. Continue to work with the surgeon to resolution.
You need to keep a drain in the surgical area for a few days and if it continues draining after a reasonable time you might need to have a complete surgical removal of your parotid gland,
I believe ultimately it should stop. A good experienced radiologist can place a small drain tube under ultrasonography.
Could re-aspirate it. Inject small amount of corticosteroid and apply pressure dressing. Course of clindamycin may be indicated.
Your problem sounds less like a seroma and more like a fluid collection of salivary fluid due to a leaking salivary duct. Seromas don’t recur within a couple of hours, but a salivary fistula can. I suggest you discuss this possibility with your surgeon, and ask him to test the fluid for amylase content. Salivary fluid will be very high in amylase, and a seroma will not. Your surgeon can then determine the best course of action depending on the results.

Joseph E. Ronaghan, MD, FACS, FICS