Alternative Approach to Traumatic Stensen’s Duct Injuries Accompanied by Glandular Involvement: Botulinum Toxin Injection to the Gland in Conjunction with Microsurgical Repair of the Duct in an Acute Setting

Abstract

There is high tendency to ignore the diagnosis as the incidence of the injury of parotid gland and its duct is relatively rare. In order to prevent the long-term complications such as facial deformities, sialoceles, cutaneous fistulae, salivary gland cysts and gustatory sweating (Frey’s syndrome) and to restore the parotid gland functions, it is important for the duct injuries to be diagnosed and treated immediately. 3 patients consulted to Plastic Surgery Clinic from the Emergency Room of Hacettepe University following maxillofacial trauma was reviewed in this study. Exploration of the facial nerve and Stenon duct was planned for all patients within the first 72 hours following the injury. Following intraoral catheterization of the Stenon duct through the papilla with an epidural catheter, microsurgical end-to-end anastomosis was performed. Concurrently, 100 Units of botulinum toxin A was injected at standardized 8 points on the parotid gland. Postoperative MR sialography revealed patency in all patients at the end of postoperative first year. The mean postoperative parotid volume of the injured and non-injured sides were 19,82±10,55 and 17,79±10,98 respectively and the results were found to be comparable. Fibrillation potentials in the postoperative electromyography recordings and clinical examination demonstrated the nerve regeneration. In conclusion, botulinum toxin A is appears to be effective in both treatment of the injuries of the duct accompanied by glandular involvement in the acute setting, as well as prevention of the long term complications.