Parotid duct diversion, bilateral (Wilke type procedure); with ligation of both submandibular (Wharton's) ducts
CPT4 code
Name of the Procedure:
Parotid duct diversion, bilateral (Wilke type procedure); with ligation of both submandibular (Wharton's) ducts.
Summary
In layman's terms, this surgical procedure redirects the flow of saliva from the parotid glands (located near the jaw) to other ducts, and simultaneously ties off the ducts of the submandibular glands (located under the jaw). This is often done to relieve chronic issues with salivary flow.
Purpose
This procedure addresses chronic sialorrhea (excessive drooling) or recurrent issues with infection and blockage of saliva glands. The goal is to reduce the occurrence of saliva pooling and its uncomfortable symptoms by rerouting the saliva to facilitate better management.
Indications
- Chronic sialorrhea unresponsive to medical management.
- Recurrent parotid gland infections.
- Salivary gland disorders leading to discomfort and quality-of-life impairment.
- Patients who are poor candidates for less invasive measures.
Preparation
- Fasting for at least 8 hours prior to surgery.
- Discontinuation of specific medications as advised by the healthcare provider.
- Pre-procedure imaging studies like sialography or MRI to map the anatomy of the salivary ducts.
- Preoperative blood tests and physical examination.
Procedure Description
- The patient is placed under general anesthesia.
- Small incisions are made near the parotid glands.
- The surgeon disconnects the parotid ducts and re-routes them to a different location in the mouth.
- The submandibular (Wharton's) ducts are identified and ligated (tied off) to prevent saliva from entering the mouth.
- Incisions are closed with sutures.
Tools used include scalpels, dissecting instruments, and suturing materials. General anesthesia ensures the patient is unconscious and pain-free during the procedure.
Duration
The procedure typically takes 2 to 4 hours.
Setting
This surgery is performed in a hospital operating room or specialized surgical center.
Personnel
- Head and neck surgeon or otolaryngologist.
- Surgical nurses.
- Anesthesiologist.
- Surgical technician.
Risks and Complications
- Infection at the surgical site.
- Bleeding.
- Swelling or bruising in the face and neck.
- Damage to adjacent structures such as nerves.
- Salivary fistula formation.
- Dry mouth or xerostomia.
- Anesthesia-related risks.
Management includes antibiotics for infection, proper wound care, and additional procedures if complications arise.
Benefits
- Significant reduction or elimination of chronic sialorrhea.
- Decreased frequency of salivary gland infections.
- Improved quality of life. Benefits generally become noticeable within a few weeks post-surgery.
Recovery
- Post-procedure care includes wound care, pain management, and potentially a soft diet.
- Most patients can return to normal activities within 2 to 4 weeks.
- Follow-up appointments to monitor healing and address any concerns.
Alternatives
- Botulinum toxin injections to temporarily reduce saliva production.
- Oral medications that decrease saliva production.
- Radiation therapy in severe, refractory cases.
- Pros of alternatives: Less invasive, no surgical risks.
- Cons of alternatives: Temporary effects, not always effective, may need repeated treatments.
Patient Experience
- During the procedure: Patient experiences no sensation due to general anesthesia.
- After the procedure: Postoperative pain managed with prescribed analgesics; some swelling and discomfort expected.
- Pain management: Includes oral pain medications, ice packs, and soft food diets for comfort.
Patients should follow postoperative instructions closely to ensure a smooth recovery and attend all follow-up appointments for optimal outcomes.