Parotid Gland Injury
Trauma to the salivary gland near the ear or its duct
Quick Facts
- Type: Facial / salivary gland injury
- Location: Cheek, in front of and below the ear
- Common causes: Cuts, blows, surgery, animal bites
- Key concern: Facial nerve and duct damage
Overview
The parotid glands are the largest salivary glands, sitting just in front of and below each ear. They make saliva that travels through a small tube called the parotid (Stensen's) duct, which empties into the mouth near the upper back teeth. A parotid gland injury is damage to this gland or its duct, usually from trauma to the side of the face.
Because the facial nerve, which controls the muscles of facial expression, runs directly through the parotid gland, injuries to this area can affect both saliva flow and facial movement. Prompt evaluation is important to protect the nerve and the duct and to prevent complications such as a saliva leak. Early, careful assessment of any deep wound to this area helps ensure that injuries to the nerve or duct are repaired before they cause lasting problems.
Symptoms
Symptoms depend on what part of the gland or duct is injured and how severe the trauma is.
- A cut, puncture, or wound over the cheek in front of or below the ear
- Swelling, bruising, or pain in the cheek
- Clear fluid (saliva) leaking from a wound, especially during eating
- Weakness or drooping on one side of the face, such as trouble closing the eye, raising the eyebrow, or smiling, if the facial nerve is affected
- Numbness near the ear or cheek
Saliva leaking from a wound or new facial weakness after an injury should be evaluated promptly.
Causes
Parotid injuries result from trauma to the side of the face or from procedures in that area.
- Penetrating wounds: Knife cuts, glass, gunshot wounds, or animal and human bites to the cheek.
- Blunt trauma: A strong blow to the side of the face, such as in a fall, assault, or vehicle crash.
- Surgical injury: Damage during operations on the face, ear, or jaw region.
Depending on the location, these can injure the gland itself, the parotid duct, the facial nerve, or a combination.
Risk Factors
- Facial trauma from accidents, falls, or violence
- Sports without facial protection
- Surgery in the parotid, ear, or jaw region
- Deep facial lacerations or animal bites
- Occupations or activities with a high risk of face injuries
Diagnosis
A clinician examines the wound and tests facial nerve function and saliva flow. Evaluation may include:
- Physical exam: Checking facial movement, the wound, and whether clear saliva drains from it.
- Duct testing: Examining the duct opening inside the mouth and, when needed, probing or injecting it to find a leak or cut.
- Imaging: CT scans to assess deeper injury and rule out fractures, and sometimes specialized studies of the duct.
Treatment
Treatment depends on whether the gland, duct, or nerve is damaged.
- Wound care: Cleaning, closing the wound, and preventing infection, including a tetanus update and antibiotics when appropriate.
- Duct repair: If the parotid duct is cut, a surgeon may repair it over a small stent or reroute it so saliva drains into the mouth.
- Facial nerve repair: If branches of the facial nerve are cut, microsurgical repair may be done to restore movement.
- Managing saliva collections: A pocket of leaked saliva (sialocele) or a persistent leak may be treated with drainage, pressure dressings, or other measures to reduce saliva flow temporarily.
With timely care, many injuries heal well, though nerve recovery can take time and sometimes requires ongoing therapy. The specific treatment plan depends on which structures are involved and how severe the wound is, so care is tailored to each person.
Prevention
- Wear seat belts and appropriate protective gear during sports and high-risk activities
- Use caution with sharp tools and follow workplace safety practices
- Seek prompt care for deep facial wounds and bites
- Keep tetanus vaccination up to date
When to See a Doctor
Seek medical care for any deep cut or significant blow to the cheek in front of or below the ear, especially if you notice clear fluid leaking from the wound or new facial weakness.
Seek emergency care for heavy bleeding, a wound that will not stop bleeding, signs of a deep facial injury, sudden inability to move part of the face, or a bite wound, which carries a high infection risk.
Frequently Asked Questions
How do I know if my facial nerve was injured?
Signs include weakness or drooping on one side of the face, such as trouble closing the eye, raising the eyebrow, or smiling evenly, after a cheek injury. Any new facial weakness following trauma should be evaluated promptly, since early repair gives the best chance of recovery.
What is a saliva leak from a wound?
If the gland or duct is cut, saliva can leak out through the wound, often increasing when you eat. This needs medical attention because untreated leaks can form a fluid pocket or a draining tract, but they can usually be managed with repair, drainage, or measures to reduce saliva flow.
Will the parotid gland heal on its own?
Minor injuries to the gland tissue often heal with wound care, but cuts to the duct or facial nerve usually need a surgeon's repair. Getting evaluated early helps prevent complications and improves the outcome.
Are facial bite wounds an emergency?
Bite wounds to the face carry a high risk of infection and may involve the gland, duct, or nerve, so they should be seen promptly. Seek emergency care for deep bites, heavy bleeding, or signs of nerve injury, and ensure tetanus protection is current.
Can a parotid injury affect saliva long term?
Sometimes. Damage to the duct can change how saliva drains, occasionally leading to swelling during meals or a fluid pocket. Many of these problems can be corrected with treatment, and your care team can advise on long-term follow-up.
References
- American Academy of Otolaryngology-Head and Neck Surgery. Salivary Glands.
- MedlinePlus, U.S. National Library of Medicine. Salivary gland disorders.
- Mayo Clinic. Salivary gland infections.
- National Institute of Dental and Craniofacial Research (NIDCR). Salivary gland disorders.