HEAD AND NECK Status of the remaining parotid duct and gland following superficial parotidectomy Charbel Rameh Æ Roula Hourany-Rizk Æ Abdul Latif Hamdan Æ Mohammad Natout Æ Nabil Fuleihan Received: 17 May 2007 / Accepted: 12 August 2007 / Published online: 12 September 2007 Ó Springer-Verlag 2007 Abstract The changes in Stensen’s duct and remaining parotid tissue following superficial parotidectomy have not been studied previously. The aim of this clinical case control study is to describe these changes using sialography and CT-sialography techniques. Fourteen superficial pa- rotidectomy cases underwent parotid sialography bilaterally. CT sialography was also done. Stensen’s duct was patent in 11 cases (79%), and non-patent in three cases (21%). Its angle in relation to our reference line was 20° in operated cases versus 37° for the non-operated cases. Following superficial parotidectomy, the remaining parotid tissues usually remain functional and retain drainage through Stensen’s duct. Furthermore, superficial paroti- dectomy changes the direction of this duct. Parotid sialography and CT sialography can still be used to study the status of remaining parotid tissue following superficial parotidectomy. The post-surgical changes should be reviewed with care before interpreting these studies. Keywords Stensen’s duct Á Parotid gland Á Superficial parotidectomy Á Sialography Á Computed tomography Introduction Superficial parotidectomy is indicated for the excision of benign tumors of the superficial lobe of the parotid gland. Since these tumors are often well encapsulated, a total parotidectomy is not indicated. The changes in the remaining parotid tissue and its pattern of drainage fol- lowing interruption of the superficial ducts during superficial parotidectomy have not been studied before. Knowing the status of the function of the remaining parotid tissue and the anatomy of Stensen’s duct is essential to determine the possible future disease processes that may affect this region, as well as the clinical and surgical implications. Several diagnostic tools are currently used for the evaluation of parotid gland and duct diseases. Sialography and magnetic resonance imaging (MRI) are the most commonly used modalities to diagnose intraglandular and intraductal pathologies [1–6]. Magnetic resonance (MR) characteristics are helpful in categorizing parotid gland tumors according to histologic type. Carcinomas are characterized by infiltration into the muscles along the surface of the mandible and show contrast enhancement, whereas Warthin’s tumors and pleomorphic adenomas show areas of different signal intensity on T2-weighted images and do not infiltrate the muscles. With additional dynamic contrast-enhanced MRI, a more reliable differ- entiation between common parotid tumors is possible before surgery, allowing both functional and morphologi- cal evaluation of the salivary glands [7–9]. Furthermore, the combination of computed tomography scanning and sialography (CT-sialography) has also allowed better identification of parotid tumors, as well as their localization to the superficial versus deep lobes [10–15]. Most of the times, these radiological tests are C. Rameh Á A. L. Hamdan (&) Á M. Natout Á N. Fuleihan Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, P.O. Box: 11-0236, Beirut, Lebanon e-mail: alhamdan@svclb.com R. Hourany-Rizk Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon 123 Eur Arch Otorhinolaryngol (2008) 265:209–215 DOI 10.1007/s00405-007-0429-3