LAUSR

The parotid gland is the largest of all the major salivary glands and it is entirely serous in secretion. The parotid duct, also known as Stensen’s duct, exits from the anterior portion of the gland where it passes superficial to the masseter muscle. Approximately 1 cm beyond the anterior border of the masseter muscle, it turns medially to penetrate the buccal fat pad and buccinator muscle, to open into the oral cavity opposite the second maxillary molar. Its course is parallel to the zygomatic arch and the buccal branch of the facial nerve. Van Sickels divided the duct into three distinct zones to establish a treatment protocol. Zone A corresponds to the most proximal part of the duct where it exits from the substance of the gland to the posterior border of the masseter muscle. Zone B represents the part of the duct which is located superficial to the masseter muscle. Zone C corresponds to the portion of the duct which is located distal to the anterior border of the masseter muscle to the exit of the duct in the oral cavity. There is little controversy about the management of zone A and C injuries. It is widely agreed that zone A wounds are best treated by a parotid capsule suture, followed by external compression. Zone C cases are treated by reimplanting Stensen’s duct more posteriorly into the buccal cavity. In contrast, the treatment of zone B injuries arouses much controversy; however, good results have been reported after primary microsurgical repair and an intraluminal stent during the postoperative period. Oral cancer involving the buccal mucosa sometimes requires resection of the parotid (Stensen’s) duct orifice. Relocation of Stensen’s duct can be challenging if the resection extends beyond the point where the duct curves around the anterior margin of the masseter muscle, due to inadequate length. Reconstruction of Stensen’s duct in setting of malignancy is poorly reported in the literature. Surgical repair of the duct is the context of trauma is well established, where a silicone tube is placed to stent the reconstructed duct and prevent salivary leak. Autologous vein grafts have been successfully used to reconstruct the urethra, ureter and Stensen’s duct. In the present report, we describe a technique for reconstructing a long section of Stensen’s duct using excess autologous cephalic vein graft from a radial forearm free flap anastomosed to the residual duct using a venous coupler to prevent stenosis.