Bilateral Parotid Sialocele After Facial Endolifting: A Case Report

Abstract

Subcutaneous laser-assisted procedures, such as Endolift®, are minimally invasive techniques widely used for facial rejuvenation. Although considered safe, they are not free of complications, particularly in the presence of unanticipated anatomical variations. The formation of an iatrogenic sialocele following a subcutaneous laser procedure is a rarely reported complication. A 36-year-old woman presented with a bilateral, fluctuant, painful swelling of the masseteric region that appeared one month after a subcutaneous laser aesthetic procedure, with no response to systemic corticosteroids, physical therapy, or self-performed aspiration puncture. Contrast-enhanced magnetic resonance imaging revealed two bilateral subcutaneous collections in the premasseteric subdermal plane, anterior to both parotid glands, consistent with sialoceles, along with distal dilation of both parotid ducts. The diagnosis of bilateral traumatic sialocele secondary to accessory parotid tissue injury was established. Management consisted of a bilateral transjugal approach with placement of adapted drainage tubes to create a neo-duct toward the oral cavity. Thorough knowledge of maxillofacial anatomical variations is critical for the safe performance of subcutaneous laser procedures. The accessory parotid gland represents a relevant surgical challenge due to its thinner fascial coverage. In this patient, the bilateral transjugal drainage technique was effective, technically simple and low-cost, achieving complete resolution without compromising the aesthetic outcome at one month after drain removal, although its reproducibility cannot be established from a single case. High-resolution facial ultrasound may be considered a useful adjunct in selected patients at increased anatomical risk, in order to identify anatomical variations that cannot be anticipated by clinical examination alone. Further reports and longer follow-up are necessary.