Incidence, Risk Factors and Management of Salivary Fistula and Sialocele After Parotidectomy: Two-centers Study

Background Salivary fistula and sialocele are recognized as common postoperative complications following parotidectomy, contributing to patient morbidity and decreasing quality of life. Studies that focus on the incidence, risk factors, and effective management remain limited. Methods This is a retrospective cohort study conducted in two academic referral centers and included 95 patients who underwent different kinds of parotidectomy procedures from January 2022 to December 2024. The incidence, risk factors and management of salivary fistula and sialocele were studied using patients' file reports and follow-up data. Correlations with demographics, tumor information and surgery-related factors were analyzed. Results The incidence of salivary fistula or sialocele was 10.5%. Significant risk factors identified included smoking (80% in affected vs 17.6% in unaffected patients, p < 0.001), larger tumor size (mean 3.46 cm vs 2.82 cm, p = 0.038), tumor location in the parotid tail (90% vs 44.7%, p = 0.034 ), longer operative time (mean 96.0 min vs 81.35 min, p = 0.035), and the presence of concurrent postoperative complications (90.0% vs 31.8%, p = 0.001). Conservative management—such as pressure dressings, aspiration, and dietary modifications—was effective in 80% of cases, while only 2 patients (20%) required tympanic neurectomy. Age, sex, BMI, comorbidity, type of the tumour, type of surgery and surgical side were not statistically associated with fistula or sialocele formation. Conclusion Salivary fistula & sialocele occur in approximately one in ten cases of parotidectomy. Key risk factors are smoking, tumor size, operative duration, tumor location at the gland tail, and other concurrent complications. Conservative management is highly effective as initial therapy, and tympanic neurectomy is reserved for refractory cases.