To describe a rare case of crocodile tears and lower lid sialocele formation secondary to a misdirected Stensen's duct in a patient with Treacher Collins Syndrome (TCS), emphasizing the diagnostic and surgical challenges. We reviewed the clinical course, diagnostic imaging, and surgical management of a 28-year-old woman with TCS presenting with lower lid and cheek swelling and epiphora exacerbated by eating. The patient's outcomes were monitored over 3 years post-surgery. The patient presented with recurrent swelling in the right lower lid and cheek, worsened by eating. Work up of the patient confirmed a sialocele secondary to a misdirected Stensen's duct. She underwent superficial parotidectomy with duct ligation, followed by successful lower eyelid reconstruction. Long-term follow-up revealed resolution of symptoms with no recurrence. This case highlights the importance of recognizing rare salivary gland complications in TCS patients following facial surgeries. A multidisciplinary approach is essential for accurate diagnosis and optimal outcomes.
Keywords: Treacher Collins Syndrome; craniofacial anomalies; sialocele; stensen’s duct; superficial parotidectomy.