Treatment of iatrogenic sialoceles and fistulas in the parotid gland with ultrasound-guided injection of botulinum toxin A

Abstract

of the right condyle. He presented one week after operation with a sialocele and salivary fistula through the healing incision. He was treated using the technique described above with ecently, botulinum toxin A has been recognised as a treatent for hypersalivation.1 The A-type toxin is a 2-chain olypeptide comprising a protease enzyme that attacks one f the fusion proteins at a secretomotor or neuromuscular unction and prevents vesicles from anchoring on to the preynaptic membrane to release acetylcholine. Botulinum toxin reats salivary disorders by interrupting intraparotid autoomic activity. We describe 2 cases of iatrogenic injury to the parotid apsule secondary to retromandibular transparotid access for pen reduction and internal fixation of traumatic fracture of he mandibular condyle. Postoperatively, both patients had ormation of a sialocele and leakage of saliva from a cutaeous fistula to the overlying scar. Both were treated with ltrasound-guided injection of botulinum toxin A (Botox, llergan) to the superficial lobe of the parotid through a 2G needle. The procedures were done using local anaeshetic (1% lidocaine 5 ml/gland) injected around the skin at he intended puncture site and infiltrated around the parotid apsule. The first patient, a man with epilepsy who had sustained ilateral condylar fractures and a fracture of the angle of the andible, presented 3 days after operation with painful, tense ialoceles bilaterally (Fig. 1) and a left cutaneous salivary eak. Aspiration of the sialoceles under ultrasound guidnce was followed immediately by infiltration of 50 units f botulinum toxin A into the superficial lobe taking care to