The Use of Botulinum Toxin in the Treatment of a Parotid Duct Injury During Mohs Surgery and Review of Management Options

Krishnan, R. S.; Clark, David P.; Donnelly, Heidi B.

doi:10.1111/j.1524-4725.2009.01159.x

Cited by 12 publications

(22 citation statements)

References 25 publications

(54 reference statements)

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“…The total number of subjects across all studies was 47 patients. The largest study had 16 participants while the smallest included manuscript had 1 subject . The mean sample size of all included studies was 3.5 (SD 40.8).…”

Section: Resultsmentioning

confidence: 99%

Botulinum toxin A is an effective therapeutic tool for the management of parotid sialocele and fistula: A systematic review

Maharaj

Mungul

Laher

2020

Laryngoscope Investig Oto

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Objectives In the management of parotid sialocele and fistula, various conservative and surgical methods have been described. Some studies have described the use of Botulinum toxin A (Botox A) for the management of parotid sialocele and fistula. This is a less invasive and potentially equally effective option. We therefore conducted a systematic review on the current body of literature relating to this specific use of Botox A. Methods A search strategy was conducted in July 2019 using the following electronic databases: Cochrane Database of Systematic Reviews, EMBASE, Google Scholar, PubMed, Scopus, and Web of Science. A search of all articles from inception until 31 August 2019 was performed. Results Literature searches of electronic databases identified 67 articles eligible for review, of which 15 fulfilled all criteria. These studies were small and in total only 47 patients were included. The majority of sialoceles and fistulas presented as a complication of surgery (77%) with the remaining cases occurring as a result of trauma. The typical age at presentation was between 32 and 88 years of age (mean age of 52 years). All patients were initially treated with and failed other conservative measures. Botox A injection was considered as a final conservative treatment option. The toxin was administered percutaneously in all cases of parotid sialocele and fistula. Dosage of Botox ranged from 10 to 200 units with majority of patients (58%) requiring only one injection. The overall success rate for patients treated with Botox A injections ranged between 70 and 100% for parotid sialoceles and fistulas. Conclusion Botox A injections are successful in the treatment of parotid sialoceles and fistulas and should be considered before the use of invasive conventional options. Further studies with larger numbers are needed to ratify this recommendation. Success rate for patients, treated with Botox A injection was between 70 and 100% for parotid sialocele and fistula. Patients who failed initial treatment with Botox A were re‐administered with Botox A and eventually resolved.

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Section: Resultsmentioning

confidence: 99%

Botulinum toxin A is an effective therapeutic tool for the management of parotid sialocele and fistula: A systematic review

Maharaj

Mungul

Laher

2020

Laryngoscope Investig Oto

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“…It crossed the line from the posteroinferior to the anterosuperior direction in 36.8%, it was on the reference line in 18.4%, and it was below the reference line in 2.6% (Hu et al, ). Among the 14 cases in which the PD crossed the reference line, this intersection was on the anterior third of the masseter muscle in two cases, on the middle third in nine, and on the posterior third in three (Krishnan et al, ). In our study, we noted that the PD crossed the same reference line (line 2 in our designation), and then continued above it following a curved trajectory.…”

Section: Discussionmentioning

confidence: 99%

“…Cases of sialocele resulting from facial rejuvenation procedures have also been reported, while PD laceration or compression have been observed with rhytidectomies (Nahlieli et al, ) and with Aptos thread techniques (Winkler et al, ). Injuries to the PD are also quite frequent during cutaneous tumor surgery, especially during Mohs procedures (Krishnan et al, ). Finally, complications have been observed with botulinum toxin injections (Kim et al, ; Hu et al, ).…”

Section: Introductionmentioning

confidence: 99%

Surface anatomy of the parotid duct and its clinical relevance

2015

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The trajectory of the parotid duct (PD) makes it vulnerable to injuries during facial trauma and facial rejuvenation procedures. The PD is usually represented as a straight line, although its description in the literature varies. Our objective was to study the trajectory of the PD and to define reliable cutaneous landmarks. We dissected 35 human cadaver half-heads. We defined three points: point I where the PD crossed a line (line 2) between point T (the intertragal incisura) and point C (the corner of the mouth), point S for the top of the PD, and point B where the PD penetrated the buccinator muscle. We measured the distance (D) between points T and C, the distance (d1) between points T and I, and the distance (d2) between points T and B. We also determined the height (h) of the orthogonal line between point S and line 2. We noted that for all of the half-heads that we examined, the PD followed a curved trajectory between points I and B above line 2. Point I was located 1/3 of the way along distance D. Point B was tangential to line 2, and was located 2/3 of the way along distance D. The average height measurement (h) was 1.4 cm. We demonstrated that the PD follows a curved trajectory from the 1/3 mark to the 2/3 mark along distance D, the top of this curve being 1.5 cm above the line TC.

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“…described three cases of iatrogenic fistula treated in the Padua ENT Department [9]. Patients with parotid duct injuries can be divided into cases that are recognised at the time of surgery and those that have a delayed diagnosis [11]. If a parotid duct injury is recognised at the time of surgery, primary repair with minimal tissue loss is the treatment of choice [12].…”

Section: Discussionmentioning

confidence: 99%

Stensen's duct injuries: the role of sialendoscopy and adjuvant botulinum toxin injection.

Kopeć

Wierzbicka²,

Szyfter³

2013

Videosurgery and Other Miniinvasive Techniques

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IntroductionStensen's duct injuries are uncommon but troublesome sequelae of facial surgery or other external traumas.AimTo investigate the feasibility of sialendoscopic control of Stensen's duct in iatrogenic injuries and the efficiency of botulinum toxin adjuvant therapy.Material and methodsIn 2008 and 2010, 5 patients with parotid sialoceles or fistulas, infrequent complications after plastic surgery or trauma, were treated in a single institution, Poznan University of Medical Sciences ENT Department. The group consisted of 5 patients with diagnosed Stensen's duct injuries, which were post-surgery and post-traumatic sequelae. All were treated by means of open surgery. Botulinum toxin injection was administered during the procedure to decrease the saliva secretion and to improve the healing process. A sialendoscopy was performed to control the lumen of the junction after the duct injury was repaired.ResultsComplete healing of the fistulas and sialoceles after the reparative surgery followed by a single botulinum toxin application was observed in all patients within 10-14 days. No side effects were noticed.ConclusionsOur findings suggest that sialendoscopy is a valuable tool and an important step of control in the surgery of parotid duct injuries and the injection of botulinum toxin is an effective and safe second-line treatment.

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The Use of Botulinum Toxin in the Treatment of a Parotid Duct Injury During Mohs Surgery and Review of Management Options

Cited by 12 publications

References 25 publications

Botulinum toxin A is an effective therapeutic tool for the management of parotid sialocele and fistula: A systematic review

Botulinum toxin A is an effective therapeutic tool for the management of parotid sialocele and fistula: A systematic review

Surface anatomy of the parotid duct and its clinical relevance

Stensen's duct injuries: the role of sialendoscopy and adjuvant botulinum toxin injection.

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