RESUMO
The most common cause of parotid fistula is trauma, operative complications followed by malignancy and infection. Injury to the duct may be difficult to diagnose unless one has high index of suspicion while operating in the parotid region. Sequelae of inadequate diagnosis and treatment include parotid fistula and sialocele formation which are inconvenient for the patient and difficult to treat. We are reporting a case of parotid fistula due to injury to parotid duct following extensive debridement for necrotising fasciitis of cheek extending to the neck following tooth extraction.
RESUMO
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.