Neo-duct formation following iatrogenic parotid duct injury during aesthetic filler removal: A case report and review of management.

Abstract

Parotid duct injury is an uncommon but significant complication of facial aesthetic procedures, particularly with the rising prevalence of buccal fat removal, thread lifts, and permanent filler excision. Although iatrogenic parotid duct injury remains rare, recent literature suggests its incidence may be rising in parallel with the growing popularity of intraoral buccal fat pad excision in aesthetic surgery. Prompt diagnosis and appropriate management are essential to prevent chronic morbidity. We present a case of iatrogenic parotid duct injury in a 40-year-old woman following intraoral surgical removal of permanent cheek fillers. The patient developed post-prandial swelling indicative of sialocele. Conservative measures failed, and sialography confirmed ductal disruption. A minimally invasive intraoral neo-duct was successfully created using a 10 Fr feeding catheter, resulting in complete resolution and preserved salivary function at 18-month follow-up. This case highlights a growing pattern of parotid duct injury linked to aesthetic interventions. Diagnosis requires high suspicion, supported by amylase-rich aspirate and sialography. When primary repair is not feasible, intraoral neo-duct creation via catheterisation provides an effective, low-morbidity alternative. Comparative analysis with prior techniques demonstrates advantages of this approach in terms of simplicity, scar minimisation, and functional preservation. Intraoral neo-duct formation is a safe and effective strategy for managing complete parotid duct injuries where direct repair is not possible. Awareness of this complication and early intervention are key to optimal outcomes in aesthetic facial surgery.