Treatment of Parotid Fistula with Type A Botulinum Toxin: A Case Report.

Lee, Sang Yeul; Kim, Sam Soo

Case Report

Journal of Korean Cleft Palate-Craniofacial Association 2011;12(2):129-131.

¹Department of Plastic and Reconstructive Surgery, Kangwon National University, Chuncheon, Korea. serafin5@unitel.co.kr
²Department of Radiology, School of Medicine, Kangwon National University, Chuncheon, Korea.

Abstract

PURPOSE
The purpose of this report is to present a case of persistent parotid fistula treated successfully with preoperative botulinum toxin type A injection into the parotid parenchyma, followed by fistulectomy. METHODS: A 72-year-old female patient presented to the hospital with a 5-month history of clear, watery discharge from a tiny opening on the left cheek, which increased during food intake. A chemistry test of the fluid revealed an high amylase level. An ultrasonography of left parotid gland showed a 1.13x0.6cm sized fistula. After demarcating the left parotid gland with assistance of ultrasonography, a total 40 units of botulinum toxin type A(Botox, Allergan, Irvine, CA) was injected into 4 subdivisions of the left parotid gland. The clear serous discharge ceased completely on the 5th day after botulinum toxin injection. On the 7th day, a fistulectomy was performed under the local anesthesia.
RESULTS
The parotid fistula healed completely without complications. During the 6-month follow up period, there was no discharge from the cheek.
CONCLUSION
On the basis of our experience with type A botulinum toxin as a local anticholinergic agent in treating parotid fistula, preoperative botulinum toxin A injection seems to be very useful to prevent recurrence after fistulectomy.

Keywords: Botulinum toxin; Parotid fistula; Parotid abscess