Botulinumtoxin A zur Therapie traumatischer Speichelfisteln

Rare Parotid Gland Diseases

The differential diagnosis for "rare" parotid gland diseases is broad and encompasses infectious, neoplastic, autoimmune, metabolic, and iatrogenic etiologies. The body of knowledge of parotid gland diseases has grown owing to advances in imaging and pathologic analysis and molecular technology. This article reviews rare parotid diseases, discussing the respective disease's clinical presentation, diagnosis, imaging, pathogenesis, treatment, and prognosis.

Stensen's duct injuries: the role of sialendoscopy and adjuvant botulinum toxin injection

INTRODUCTION

Stensen's duct injuries are uncommon but troublesome sequelae of facial surgery or other external traumas.

AIM

To investigate the feasibility of sialendoscopic control of Stensen's duct in iatrogenic injuries and the efficiency of botulinum toxin adjuvant therapy.

MATERIAL AND METHODS

In 2008 and 2010, 5 patients with parotid sialoceles or fistulas, infrequent complications after plastic surgery or trauma, were treated in a single institution, Poznan University of Medical Sciences ENT Department. The group consisted of 5 patients with diagnosed Stensen's duct injuries, which were post-surgery and post-traumatic sequelae. All were treated by means of open surgery. Botulinum toxin injection was administered during the procedure to decrease the saliva secretion and to improve the healing process. A sialendoscopy was performed to control the lumen of the junction after the duct injury was repaired.

RESULTS

Complete healing of the fistulas and sialoceles after the reparative surgery followed by a single botulinum toxin application was observed in all patients within 10-14 days. No side effects were noticed.

CONCLUSIONS

Our findings suggest that sialendoscopy is a valuable tool and an important step of control in the surgery of parotid duct injuries and the injection of botulinum toxin is an effective and safe second-line treatment.

Combined transdermal scopolamine and botulinum toxin A to treat a parotid fistula after a face-lift in a patient with siliconomas

A parotid fistula is a rare, extremely unpleasant disease. Patients with chronic pathologies of the facial soft tissues have a high complication rate after aggressive treatments. Alternative conservative treatments have recently been reported for this condition. The case is described of a parotid fistula following a face-lift in a patient affected by facial siliconomas. A 41-year-old Caucasian who had undergone repeated facial silicone injections developed a diffuse granulomatous reaction accompanied by facial disfigurement. Thirteen surgical operations were performed to remove the siliconomas and correct the deformities, the last of which was a face-lift. After this procedure, the patient developed a parotid fistula. Conservative treatment, consisting of a combination of transdermal scopolamine and botulinum toxin A injections, was adopted. These antisialogogues gradually reduced saliva secretion, thereby preparing the wound bed for a skin graft and eventual healing. The choice of conservative therapy, as opposed to a surgical approach, was made to avoid further risks in what was already a highly complicated condition. The use of this conservative approach is recommended to treat complicated cases of parotid fistula.