Botulinum toxin for chronic parotid sialadenitis: A case series and systematic review

Guidelines for the Use of Botulinum Toxin in Otolaryngology From the Korean Society of Laryngology, Phoniatrics and Logopedics Guideline Task Force

The Korean Society of Laryngology, Phoniatrics and Logopedics created a task force to establish clinical practice guidelines for the use of botulinum toxin (BT) in otolaryngology. We selected 10 disease categories: spasmodic dysphonia, essential vocal tremor, vocal fold granuloma, bilateral vocal fold paralysis, Frey's syndrome, sialocele, sialorrhea, cricopharyngeal dysfunction, chronic sialadenitis, and first bite syndrome. To retrieve all relevant papers, we searched the CORE databases with predefined search strategies, including Medline (PubMed), Embase, the Cochrane Library, and KoreaMed. The committee reported 13 final recommendations with detailed evidence profiles. The guidelines are primarily aimed at all clinicians applying BT to the head and neck area. In addition, the guidelines aim to promote an improved understanding of the safe and effective use of BT by policymakers and counselors, as well as in patients scheduled to receive BT injections.

A retrospective study of magnetic resonance sialography imaging applied in the prognostic evaluation of chronic obstructive parotitis

Background

Magnetic resonance sialography (MRS) can be used to clearly examine the main duct of the parotid and is widely applied in the diagnosis of chronic obstructive parotitis (COP). However, there are few studies on the classification, treatment options and prognosis of COP using MRS.

Methods

Clinical and imaging data were retrospectively collected from 41 patients with COP between January 2010 and December 2020 at the Ninth People's Hospital affiliated with Shanghai Jiao Tong University School of Medicine. All patients underwent MRS and were treated with intraductal irrigation. The patients were divided into 2 groups according to the presence or absence of symptomatic relapse during the 6-month follow-up period. The imaging features of parotid MRS included three parts: gland volume, stenosis classification and dilatation classification. The location/length of dilatation, the widest diameter of the dilated duct, and the condition of the branch ducts were also recorded and compared between the groups.

Results

A mean of 14.8±12.3 irrigations were performed. There were 15 patients with recurrence and 26 without recurrence. There was no significant difference in the parotid volume (P=0.460), stenosis grade (P=0.738) or maximum diameter of dilatation of the branch duct (P=0.723) between the recurrence and non-recurrence groups. Statistically significant differences were found in dilatation classification (P=0.009), length of dilatation (P=0.043), condition of the branch ducts (P=0.017) and dexamethasone use (P=0.031).

Conclusions

MRS is an available diagnostic and grading modality for COP. The imaging features and classification of the parotid main duct in MRS could be helpful for treatment selection. Patients who accept irrigation could be less likely to experience recurrence with a low dilatation grade and no branch duct dilatation.

A Nonrandomized Trial of the Effects of Near-Infrared Photobiomodulation Therapy on Bell's Palsy with a Duration of Greater Than 8 Weeks

Objective: To determine whether photobiomodulation therapy (PBMT) by class IV Multiwave Locked System laser treatment as an adjunctive therapy could relieve symptoms in patients with Bell's palsy with a duration of greater than 8 weeks. Materials and methods: This nonrandomized controlled trial was conducted from January 2020 to December 2022. Patients were eligible if they had Bell's palsy with a duration of greater than 8 weeks at the out-patient department of otorhinolaryngology in Beijing Tongren Hospital. The control group consisted of patients recruited between January 1, 2020, and December 31, 2020. The PBMT group consisted of patients recruited between January 1, 2021, and December 31, 2022. In this study, the PBM used has a wavelength of 808 and 905 nm, 1.2 W power (808 nm is 1 W, 905 nm is 200 mW), continuous mode emission (808 nm) and pulsed mode emission (905 nm), 8.35 J/cm2 dosimetry, administered 3 times per week, 72 times of total treatment. The primary outcome measures included the House-Brackmann facial nerve grading system, the Sunnybrook facial grading system, and the Facial Clinimetric Evaluation Scale (FaCE). Secondary outcome measures comprised electroneurography, electromyography, and the blink reflex. Results: A total of 54 participants were included (27 in the control group and 27 in the photobiomodulation group). After 6 months, the House-Brackmann grading system [risk difference, -0.59, confidence interval (95% CI), -0.81 to -0.38, relative risk, 0.27, 95% CI, 0.13-0.56, p < 0.001], Sunnybrook facial grading system (21.14, 95% CI, 11.71-30.58; p < 0.001), and FaCE (-0.20, 95% CI, 0.41-0.02; p = 0.07) had significant difference between the two groups. Latency of ala nasi muscle (10.92, 95% CI, 5.58-16.27; p < 0.001) was not statistically significant after treatment compared with the control group; however, most of the electrophysiological examinations have significant difference between the two groups, respectively. Conclusions: The results of this study suggest that PBMT may relieve symptoms for patients with Bell's palsy with a duration of greater than 8 weeks. Trial Registration: ClinicalTrials.gov Identifier: NCT05585333.