How do Plastic Surgeons differentiate between parotid leak and seroma?

The answer to your question is that given the location of the fluid accumulation, the surest way to differentiate between a seroma and a parotid fistua is to send the fluid for an amylase test.  This will usually respond to drainage and compression, although sometimes it is helpful to treat with botox as well to reduce the rate of secretion.

To tell the difference between parotid gland secretions and a seroma  have the fluid analyzed by doing  an amylase test. Amylase is an enzyme found in saliva  produced by the parotid gland.  A Scopolamine  Patch, Botox, and staying away from spicy and sour foods are often effective  to resolve fluid collection from the parotid gland (sialocele/fistula) originating from the parotid gland.

 Location may be an important factor determining a seroma versus a parotid leak. An amylase test can be helpful but simple clinical observation of the area before and after eating can tell you if this is a parotid leak. The area will increase with eating because saliva is used to help digest food.  The leaking area will leaks allowed into the space in your face that being treated and this will most likely tell you that this is a parotid leak versus the seroma. 

The difference between parotid gland secretions and a seroma can typically be identified through laboratory studies, namely an amylase test.  Amylase is an enzyme found in saliva which is produced by the parotid gland.   There may be situations where the fluid collection may be located near the parotid gland (or by an accessory parotid gland) which may need to be tested to determine the exact nature of the fluid collection.  Many of the treatment strategies are similar for both types of fluid collections, but Botox can be used very effectively to control and help facilitate the resolution of a fluid collection (sialocele/fistula) originating from the parotid gland.I hope this helps.

Hello,The gold standard for this determination is a salivary amylase test. Being as how you had surgery in a common area for both fluids the test is the best way to have a definitive answer. Hopefully this is helpful
to you.
Be healthy and be well,
James M. Ridgway, MD, FACS

Thanks for sharing your concerns with us. The difference between parotid leak and seroma will be determinated when you send the liquid to study, if is a parotid leak will have some salivary products. The treatment of the seroma depends on the volume, if it has a little content is going to be resolve by itself but if it has a lot of content will need to be drainage. Best regards, Dr. Emmanuel Mallol Cotes.-

There are a few features that will differentiate the two post facelift complications.  If this represents a parotid fistula, the duration of the leakage can be lengthy; testing the fluid for amylase, an enzyme found in saliva would be an easy way to determine if this is a parotid fistula.  If this is indeed a leak from the parotid, treating the salivary gland with Botox can diminish saliva production and help the area heal faster.  Good luck!

Your surgeon is exactly right in ordering an amylase test. While the anatomical location of the collection is important, there is no substitute for hard data. You should follow up with your surgeon at recommended intervals. 

I am sorry that you are having concerns about your procedure
and thanks for sharing your question. I can appreciate your
concern and agree with your assessment.



Amilase is the correct test to
differentiate a fluid collection due to seroma or parotid leak. Once the
diagnosis is clarified, if you have a parotid leak, multiple things need to be
done. The most important is to decrease the stimulus for saliva production.



This starts with diet. Other maneuvers
such as pressure, drainage, drain, Botox, Scopolamine, and octreotide may be of
help.



Your Doctor is taking the correct
steps. Have an open conversation with her/him, as you progress with your
surgery.



Wishing you the best in your journey

Hello Seluj,The parotid gland is a large saliva producing gland starting just in front of the ear and extending out along the cheek.  It is in the same area where the flaps for a face lift are elevated.  If there is a clear fluid collecting after your surgery then the location alone would not be enough to determine what is the cause.  Your surgeon has sent out for the correct test to determine if what is coming out is saliva or not.  In addition to medications to decrease saliva, applying pressure if possible based on the location is helpful for both.  I hope this helps and good luck.