Iodoform Gauze Packing is an Alternative Therapy for Postoperative Parotid Fistula.

Surgery-related salivary fistula is the result of intraoperative or postoperative parotid gland damage and extravasation of fluid secreted by acinar into the interstitial space. Most are treated conservatively. Local injection of botulinum toxin is an effective method, but it is relatively expensive and not available in some hospitals. In clinical practice, the authors observed that packing iodoform gauze from the fistula toward the parotid gland can quickly stop postoperative salivary fistula in several patients. This method is simple and easy to implement, and the effect is quick. The disappearance of the salivary fistula was observed on the next day after packing the iodoform gauze. Iodoform gauze packing is an alternative therapy for postoperative parotid fistula. It can be used in areas where botulinum toxin is not available.

Fístula parotídea tras biopsia cutánea: tratamiento con toxina botulínica / Parotid Fistula After Skin Biopsy: Treatment With Botulinum Toxin

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A Functional Approach to Posttraumatic Salivary Fistula Treatment: The Use of Botulinum Toxin.

This manuscript highlights key aspects regarding the practical use of botulinum toxin for the conservative nonsurgical treatment of a rarely encountered, but significant posttraumatic complication-the parotid salivary fistula. It adds information to the scarce existing literature on the subject. The authors outline the main differences between postoperative and trauma-related parotid injury regarding salivary fistula treatment. A total of 6 patients with trauma-related salivary fistulas have been treated by Abobotulinum toxin A injections over the course of 5 years. The technique is detailed, describing the doses used in the presence of parenchyma and duct injuries, the location and number of injection points in relation to the wound pattern. The results were favorable, leading to the healing of the salivary fistulas in all patients, with 1 injection session, without additional conservative treatment. In our experience, the use of botulinum toxin is of great benefit for treating salivary fistulas in a traumatic context.

Management and Follow-up Results of Salivary Fistulas Treated With Botulinum Toxin.

OBJECTIVES/HYPOTHESIS: Salivary fistulas are a common minor complication of parotid surgery. botulinum toxin has repeatedly been reported to be an adequate treatment of this entity. To date, there is little scientific evidence for clinical decision making after appearance of a salivary fistula. STUDY DESIGN: Retrospective chart analysis of 16 patients who had been treated with botulinum toxin for salivary fistula. METHODS: All patients who had been treated for salivary fistula at a tertiary referral hospital from 2010 to 2016 were included. Patient files were used to obtain characteristics of patients, treatment, and follow-up. RESULTS: Sixteen patients with salivary fistula received 27 injections of botulinum toxin. Nine patients required one injection for the fistula to heal, five patients needed two injections, and one patient needed three and four injections, respectively. No patient underwent additional surgery or radiotherapy. We observed no adverse effects in any patient treated with botulinum toxin. CONCLUSIONS: In most cases of salivary fistula, injections of botulinum toxin are a valid treatment. If the initial injection is not successful, injections may be repeated once. Otherwise, revision surgery should be considered. In general, treatment with botulinum toxin should be commenced in an earlier stage and with higher dosages. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:403-408, 2019.

Primary treatment of early fistula of parotid duct with botulinum toxin type A injection

Abstract: Salivary duct injury can be idiopathic, iatrogenic, or post-trauma and may result in sialocele or fistula. Most injuries regress spontaneously and botulinum toxin A is one of several therapeutic possibilities. We report a case of iatrogenic injury to the parotid duct after Mohs' micographic surgery for a squamous cell carcinoma excision in the left jaw region, treated by injection of botulinum toxin type A. Although the fistula by duct injury can be self-limiting, botulinum toxin injection by promoting the inactivity of the salivary gland allows rapid healing of the fistula.

Primary treatment of early fistula of parotid duct with botulinum toxin type A injection.

Salivary duct injury can be idiopathic, iatrogenic, or post-trauma and may result in sialocele or fistula. Most injuries regress spontaneously and botulinum toxin A is one of several therapeutic possibilities. We report a case of iatrogenic injury to the parotid duct after Mohs' micographic surgery for a squamous cell carcinoma excision in the left jaw region, treated by injection of botulinum toxin type A. Although the fistula by duct injury can be self-limiting, botulinum toxin injection by promoting the inactivity of the salivary gland allows rapid healing of the fistula.

Transdermal scopolamine in the management of postparotidectomy salivary fistula.

Parotid fistula represents an uncommon complication in parotid surgery. Its early recognition contributes to successful management. The condition is distressing for both the patient and the surgeon, since conservative and operative treatment frequently fail. There is no consensus on the optimal management of parotid gland fistula. The aim of this study is to describe a new, simple procedure in the treatment of this condition using transdermal scopolamine. We report 3 cases of salivary fistulae occurring after parotidectomy. The patients were admitted to our department with swelling in the parotid region and an output of clear drainage from the drain site during oral intake. The patients were treated with a scopolamine transdermal release system applied to hairless skin overlying the parotid region. A prompt and remarkable decrease in daily salivary output was observed. Fistulae healed completely within 3 days. No collateral effects were observed. Parotid fistulae do not generally occur as a complication of parotidectomies. Their management can be difficult, and several methods of treatment have been attempted. We believe that the use of transdermal scopolamine is a valid option in the treatment of parotid fistulae without causing collateral effects.

Botulinum toxin treatment of salivary fistulas following parotidectomy: follow-up results.

BACKGROUND: Salivary fistulas are a well-known sequel of parotidectomy, and successful treatment with botulinum toxin has been demonstrated in individual cases. Here, we report on 12 patients with fistulas treated following parotidectomy for various indications. METHODS AND RESULTS: Injection of botulinum toxin type A into the residual gland tissue was the initial treatment. After early intervention (within 6 weeks after development of the fistula), only one fistula remained (9 of 10 fistulas treated early only with botulinum toxin). One patient with early intervention did not want to wait for the botulinum toxin treatment to take effect and demanded early surgical revision, which was successful. In one patient with a permanent fistula, botulinum toxin treatment began 420 days after the operation and was unsuccessful. No side effects were evident after the treatment. CONCLUSION: In summary, botulinum toxin injections into the parotid tissue remaining after surgery appear to be an effective treatment for salivary fistulas following parotidectomy.

Salival fistulae: a rare complication after microtic ear reconstruction.

Parotid fistulae are a very infrequent complication after ear reconstruction in microtia when the local conditions are favorable. We report 2 cases of salival fistulae after microtic ear reconstruction. Timing of the diagnosis is important to decide the treatment. We recommend conservative management by restricted citric diet in early postoperative salival fistulae and Botox injections in the case that it persists.

[Non-surgical management of parotid gland and duct injuries: interest of botulinum toxin]. / Prise en charge non chirurgicale des plaies de la glande parotide et du canal de Stenon: intérêt de la toxine botulinique.

Salivary fistulas and sialoceles are rare complications of post-traumatic or postoperative parotid gland and duct injuries. Local injections of type A botulinum toxin represent a new and effective treatment for complications of these injuries, which is less invasive, stressful and lengthy than conventional methods. The authors report five cases in which three salivary fistulas and two sialoceles were successfully treated by botulinum toxin injections. The therapeutic protocol is described; it allows simple management of these complications and use of smaller doses than those described in the literature for treatment of sialoceles. The authors recommend use of botulinum toxin injections in first intention for management of salivary fistulas and sialoceles.

Non tuberculous mycobacteria infection of the parotid region: two familiar cases.

OBJECTIVE: We review two cases of non tuberculous mycobacteria infections of the parotid region in members of the same family. The parotid region represents a peculiar location for the disease and it is exceptional to discover cases in members of the same family. METHODS: Two unusual case reports of non tuberculous mycobacteria infections in two members of the same family are presented. We discuss the diagnostic criteria and review pertinent recent literature. To our knowledge, these are the first English language reports of NTM infections in member of the same family. RESULTS: We performed surgical exeresis of the lesions in parotid region together with the skin affected by the fistula; regular check-ups for 24 months after surgery. CONCLUSIONS: Surgical exeresis of regional structures is the treatment for non tuberculous mycobacteria infections non responsive to antibiotic therapy.

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.

[Botulinum toxin A as a treatment of traumatic salivary gland fistulas]. / Botulinumtoxin A zur Therapie traumatischer Speichelfisteln.

Injury of salivary gland tissue in the head and neck, as the result of extensive trauma, can often be overlooked on initial examination. In two case reports, the primary treatment and further follow-up of injuries of the head resulting in a parotid-maxillary sinus fistula as well as a fistula between the skin and sublingual gland are illustrated. The successful use of botulinum toxin in the treatment of traumatic salivary gland fistulas is documented in both cases. Alternative diagnostic and treatment measures of salivary gland fistulas are discussed. Surgical repair of salivary fistulas as primary treatment should be carefully considered. Treatment of a salivary fistula with the injection of botulinum toxin is possibly advantageous compared to spontaneous fistula closure. The injection of botulinum toxin shortens fistula closure time, is minimally invasive, effective and tolerable for the patient.

Reduction of salivary flow with botulinum toxin: extended report on 33 patients with drooling, salivary fistulas, and sialadenitis.

OBJECTIVES/HYPOTHESIS: The aim of the study was the evaluation of the clinical data of 33 patients who had had drooling attributable to various diseases, salivary fistulas, and sialadenitis and had been treated with injection of botulinum toxin type A (Botox). A controlled follow-up study documenting efficiency, possible side effects, and duration of the effect of treatment was also performed. STUDY DESIGN: Retrospective clinical evaluation. METHODS: Thirty-three patients with drooling attributable to head and neck carcinoma, neurodegenerative diseases, stroke, or idiopathic hypersalivation or with salivary fistula or chronic sialadenitis received injections of 20 to 65 U botulinum toxin type A into salivary glands under sonographic control. The entire salivary flow rate and the output per minute of the salivary analytes thiocyanate, total protein, alpha-amylase, acid phosphatase, kallikrein, and immunoglobulin A were measured at various times before and after injection. The patients were examined with regard to severity of their symptoms, including sonographic control investigation of their cephalic salivary glands. RESULTS: Twenty-six patients (79% of all patients) reported a distinct improvement of their symptoms after toxin injection. Seven patients noted a return of high salivation rates and requested a second injection after 4 to 7 months. Duration of toxin effect varied widely among individuals. In general, salivary flow rates and thiocyanate output dropped sharply within 1 week after injection and had increased again after a period of 12 to 16 weeks. Conversely, amylase outputs increased during this period, whereas the outputs of the other analytes remained roughly constant. Sonography did not reveal any major changes in salivary gland parenchyma, and side effects were not noted. CONCLUSION: Reduction of salivary flow in patients with drooling, salivary fistulas, or chronic sialadenitis by local injection of botulinum toxin type A into the salivary glands proved to be a dependable therapy for these disorders, as shown in the present extended report on 33 patients. Side effects were not observed. The effect of toxin application lasted for approximately 3 months. Based on their results, the authors recommend botulinum toxin injection as the therapy of choice in patients with the problem of drooling.

[Blocking secretion of exocrine glands in the head-neck area by administration of botulinum toxin A. Therapy of a rare disease picture]. / Sekretionshemmung exokriner Drüsen des Kopf-Hals-Bereiches durch Applikation von Botulinum Toxin A. Therapie seltener Krankheitsbilder.

BACKGROUND: Hypersecretion disorders of the exocrine glands of the head and neck area are a therapeutic problem in the field of otorhinolaryngology. In the present study, we demonstrate the effectiveness of local injections of botulinum toxin A to block secretions of exocrine glands of the head and neck area. PATIENTS AND METHODS: Four patients suffering from hypersecretion disorders received local injections of botulinum toxin A. Two patients suffered from disorders of the salivary glands: one presented an idiopathic hypersialorrhea and another a salivary fistula after parotidectomy. A third patient suffered from epiphora and a further patient presented severe hyperhidrosis on the pilose head region. In a retrospective clinical study, the outcome of therapy was evaluated by clinical examination and chemical parameters. RESULTS: Clear blocking of secretion in the treated glands could be demonstrated in all four cases. Possible side effects of the treatment could not be observed. CONCLUSIONS: The present study was able to demonstrate a clear blocking of secretion of the exocrine glands of the head and neck region through botulinum toxin A, offering an improvement in therapy especially for the innovative indication of blocking the salivary glands of the head.

Treatment of postparotidectomy salivary fistula with botulinum toxin.

We report on the successful treatment with botulinum toxin type A local injections of a salivary fistula that occurred after superficial parotidectomy. In a 58-year-old woman, transcutaneous discharge of saliva in the preauricular region had persisted in spite of 2 surgical revisions. Moreover, facial weakness and synkinesis had developed as a result of an iatrogenic lesion that had occurred at the time of primary surgery and required immediate reanastomosis of the main nerve trunk. Botulinum toxin A was injected into the deep lobe of the remaining parotid gland under ultrasonographic guidance. Additionally, botulinum toxin A was injected into the left orbicularis oculi muscle in order to improve the synkinesis. No adverse effects were observed. The sialorrhea was stopped for 11 months, and the synkinesis of the facial muscles was reduced significantly for 4 months. We conclude that botulinum toxin A injection is a successful alternative for the treatment of chronic salivary fistula.