Management of parotid leakage following rhytidectomy

The Effect of Botulinum Toxin on an Iatrogenic Sialo-Cutaneous Fistula

A sialo-cutaneous fistula is a communication between the skin and a salivary gland or duct discharging saliva. Trauma and iatrogenic complications are the most common causes of this condition. Treatments include aspiration, compression, and the administration of systemic anticholinergics; however, their effects are transient and unsatisfactory in most cases. We had a case of a patient who developed an iatrogenic sialo-cutaneous fistula after wide excision of squamous cell carcinoma in the parotid region that was not treated with conventional management, but instead completely resolved with the injection of botulinum toxin. Based on our experience, we recommend the injection of botulinum toxin into the salivary glands, especially the parotid gland, as a conservative treatment option for sialo-cutaneous fistula.

An unusual complication following rhytidectomy: iatrogenic parotid injury resulting in parotid fistula/sialocele

Rhytidectomy is a common surgical procedure performed by today's aesthetic surgeons. Newer trends and techniques leading to deeper and more aggressive dissection have placed the parotid gland at increased risk for injury during this procedure. Despite there being a relative abundance of literature on traumatic parotid injury, there is a relative paucity of information on iatrogenic parotid injury after rhytidectomy. In addition, there is no consensus on management of these complications. In this article, the authors discuss 3 case reports, review the relevant literature, and propose a treatment algorithm. Early diagnosis and appropriate treatment are essential to properly manage this complication.

The role of botulinum toxin in postparotidectomy fistula treatment. A technical note

PURPOSE

Parotid fistula is a well-known complication of parotidectomy or penetrating injury of the parotid gland. The management of parotid fistula has been controversial, and numerous conservative and surgical treatment methods have been described.

METHODS

We report 3 cases of parotid fistula after partial parotidectomy, which were treated by botulinum toxin injection under electromyographic control into the residual substance of parotid gland.

RESULTS

Complete healing of the fistula was achieved with a single botulinum toxin treatment in all patients. No side effects were observed after the treatment. The patients are disease-free after 21, 18, and 14 months, respectively.

CONCLUSIONS

In the considered cases, the localized injection of botulinum toxin into the parotid gland resulted to an effective and long-lasting treatment of postparotidectomy fistula.

Complications of Rhytidectomy

Complications after rhytidectomy can be distressing for the patient and surgeon. Although meticulous surgical technique and a complete understanding of the causes of adverse outcomes can minimize the risk for severe complications, an open and honest rapport with the patient when complications do occur is essential for effective management. This article discusses the likely etiologies of face-lift complications, techniques to prevent them, and helpful treatments when complications occur.