Botulinum toxin to treat parotid saliva retention after transient postoperative Stenon's duct occlusion

Abstract

Botulinum toxin (BT) can effectively and safely reduce saliva production when injected into saliva glands. We are reporting its use to treat a saliva retention cyst after transient postoperative Stenon's duct occlusion. A 59-year-old female was operated on a right premaxillary benign myofibroplastic tumour. Intraoperatively the Stenon's duct could not be displayed and identified. After 5 days later the Redon drain was removed and a massive subcutaneous cyst occurred in front of the parotid gland. 330 ml of saliva, as identified by a positive amylase test, was punctured on 6 occasions during the next 10 days without any tendency for normalisation. BT (Xeomin®, Merz Pharmaceuticals, 100 MU/5 ml 0.9% NaCl/H2O) was then injected into 5 sites equally distributed over the right parotid gland under ultrasound guidance. Subsequent punctures 2, 7 and 12 days later produced 12, 8 and 3 ml of saliva. On day 13 the saliva retention cyst could no longer be identified. After 12 months there was still no cyst re-occurrence despite a normalised saliva production. Adverse effects could not be identified. BT can safely and effectively reduce saliva retention when the Stenon's duct is occluded in the course of an operation and thus may allow for spontaneous re-canalisation of the duct before complicated reconstruction operations are performed.