Non-surgical management of parotid gland and duct injuries with botulinum toxin S. Arnaud, D. Batifol, P. Goudot, J. Yachouh

Annales de Chirurgie Plastique Esthétique 2008: 53: 36–40 Salivary fistulas and sialoceles are uncommon complications of traumatic and iatrogenic injuries of parotid glands. In cases when the initial surgery to repair the duct was not performed or unsuccessful, delayed treatment remains controversial and different methods have been proposed: paroitidectomy, surgical exploration and re-suturing section of duct leakage or Jacobson nerve, diet control and anticholinergic treatment. Most of these treatments are aggressive with varying degrees of success and constraints. The Authors presented five cases that the patients were treated successfully with botulinum toxin injections: one case presenting sialoceles after a cheek injury without exploration of parotid duct, a second patient with fistula after a facial ballistic trauma, a patient with fistula after cheek injury without parotid duct exploration, a case of sialocele after the end-oral removal of a sebaceous cheek cyst and a patient with fistula following an unsuccessful repair of traumatic duct injury. In all 5 patients, the same protocol was applied: one dose of 100 IU of botulinum toxin type A through 3 points of injection into the superficial part of the parotid gland under electromyographic monitoring to avoid injecting into the muscle. The toxin is an anticholinergic agent with a minimal active period of three months or more. After 5 days, sialoceles and fistulas were eliminated. In these cases, the three month follow-up showed stable results with no relapse and no observed side effects. In the opinion of the authors, treatment with botulinum toxin injection should be considered as a minimal invasive treatment of choice.

PATRICK DINER