Endoscopic treatment of salivary gland injuries due to facial rejuvenation procedures

OBJECTIVE: The purpose of this article is to describe innovative surgical techniques for treatment of salivary gland injuries caused by facial rejuvenation procedures. METHODS: Between 2001 and 2007, a total of 14 patients, all females ages 46 to 70 who suffered from salivary gland injuries caused by facial rejuvenation procedures, were treated, primarily by an endoscopic-guided technique that involved location of the injury and endoscopic repair. RESULTS: There were four types of postsurgical injuries of the salivary glands that were caused by operations for facial rejuvenation: 1) compression of salivary ducts with temporary swelling (n = 1); 2) laceration of the capsule of the salivary gland (n = 3); 3) stretching and compression of the ducts with penetration of the capsule of the duct leading to sialocele and long-term swelling (types 1 and 2 combined) (n = 5); and 4) complete cut or penetration of the main salivary duct or of one of its main branches resulting in sialocele (n = 5). The endoscopic technique treatment was successful in all cases. CONCLUSION: The main reasons for salivary gland injuries due to facial rejuvenation procedures in our patients were: poor anatomical identification of the border between the superficial muscular aponeurotic system (SMAS) and the parotid capsule; penetration of the salivary gland capsule by blunt or sharp dissection; unnecessary use of sharp-tip scissors; and a tear of the salivary duct by hooks during a face-lift procedure. Plastic surgeons should be aware of these complications and try to improve their techniques accordingly. To avoid atrophy of the salivary gland, once the diagnosis it made, it is advisable to send the patient to a maxillofacial or ENT surgeon skilled in endoscopy.