Abstract
Surgery near the parotid may disrupt its parenchyma or duct and cause either a sialocele or salivary fistula. The management of parotid sialoceles and salivary gland fistulas has been generally difficult with numerous methods described. Botulinum toxin A has many uses in the practice of oral and maxillofacial surgery. This case report describes the management of a parotid gland fistula complicating a Mohs defect repair of a squamous cell carcinoma (SCC). On our patient we used an “aggressive conservative” therapy with a pressure dressing, glycopyrrolate, and botulinum toxin A. The use of botulinum toxin A is increasing in the practice of oral and maxillofacial surgery. Besides its well-known use for cosmetic purposes, botulinum toxin can be used for multiple other indications including the treatment of bruxism, masseteric hypertrophy, muscle spasm, oromandibular dystonia, orofacial motor tics, and myofascial pain disorder. 1-3 By inhibiting the release of presynaptic acetylcholine at the neuromuscular junction, botulinum toxin A also can be used to treat salivary gland disorders including sialorrhea, salivary gland fistulas, and sialoceles. 4-8
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