Diagnosis and management of salivary fistula after surgery for congenital aural atresia.
OBJECTIVE
Salivary fistula is an uncommon and unreported yet meaningful complication associated with the repair of congenital aural atresia. The capsule of the parotid gland may be violated during two steps of the operation: the initial dissection around the glenoid fossa or while aligning the auricle with the bony canal at the end of the procedure. We present the first described series of patients with salivary fistula after repair of congenital aural atresia.


METHODS
Retrospective case review from 1985 to 2004.


METHODS
Tertiary referral center.


METHODS
We included all patients who were diagnosed with a salivary fistula after congenital aural atresia repair.


METHODS
The diagnosis of a salivary fistula or salivary tissue in the external auditory canal after atresia repair was based on one of the following criteria: 1) identification of a fistula tract or salivary tissue in the external auditory canal, 2) otorrhea positive for amylase, or 3) intermittent otorrhea associated with eating.


RESULTS
Of 1,500 patients operated on for aural atresia, we identified 6 with salivary fistula after atresia repair. Salivary fistulas were diagnosed from 15 days to 10 years postoperatively, and the duration ranged from 6 months to 14 years. Treatment included observation, medical management, and surgical intervention.


CONCLUSIONS
Salivary fistulas in the external auditory canal may present with granulation tissue, persistent crusting, or persistent otorrhea; it is therefore necessary to consider salivary fistula when managing these findings in postoperative congenital aural atresia patients. Salivary fistula secondary to repair of congenital aural atresia may be managed conservatively or surgically.
Miller
Robert Sean
RS
Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA. linusnavypilot@hotmail.com
Jahrsdoerfer
Robert A
RA
Hashisaki
George T
GT
Kesser
Bradley W
BW
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004424:Ear Canal / Q000002:abnormalities / Q000601:surgery; D004431:Ear, External / Q000002:abnormalities* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012467:Salivary Gland Fistula / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D014433:Tympanoplasty