Botulinum Toxin Treatment in Parotid Sialocele and Parotid Sialocutaneous Fistula

Abstract

Background and objective: Although parotid sialocele and parotid sialocutaneous fistula are rare in occurrence, they greatly affect patients' quality of life. The main cause of these conditions is the complication after parotidectomy. In recent years, one of the noninvasive treatments that have been gaining increasing recognition is botulinum toxin (BT) injection in remaining parotid tissue but there is still a lack of data due to the limited number of patients. This study aimed to assess the clinical characteristics of patients, BT injection technique, and effectiveness of BT in the management of these conditions.

Method: A retrospective descriptive review of patients who had been treated with BT for parotid sialocele and/or parotid sialocutaneous fistula at Department of Otorhinolaryngology, Srinagarind hospital from 1^st January 2011 to 30^th June 2021.

Result:  Six patients developed parotid sialocele and/or parotid sialocutaneous fistula after parotid gland surgery and one developed both of these conditions after having a penetrating injury on the face involving the parotid area. All patients were treated by injection of BT into the remaining parotid tissue with a post-injection pressure dressing.  The mean dosage of BT was 30 units (20-50 units). Complete healing was achieved after the single injection of BT in all patients. Patients with parotid sialocele did not experience further swelling after the first BT injection.  The mean duration of fistula healing after BT injection was 14 days (5-30 days). No side effects and recurrence were observed after treatment.

Conclusion: BT injection with a pressure dressing in the patient with parotid sialocele and parotid sialocutaneous fistula is not difficult, safe and highly effective. We recommend an early injection of BT within 6 weeks after the development of these conditions.