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.

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.

Derivation of a clinical decision rule for predictive factors for the development of pharyngocutaneous fistula postlaryngectomy / Derivação de uma regra de decisão clínica para predição de desenvolvimento de fístula faringocutânea pós laringectomia

INTRODUCTION: Pharyngocutaneous fistula after larynx and hypopharynx cancer surgery can cause several damages. This study's aim was to derive a clinical decision rule to predict pharyngocutaneous fistula development after pharyngolaryngeal cancer surgery.METHODS: A retrospective cohort study was conducted, including all patients performing total laryngectomy/pharyngolaryngectomy (n = 171). Association between pertinent variables and pharyngocutaneous fistula development was assessed and a predictive model proposed.RESULTS: American Society of Anesthesiologists scale, chemoradiotherapy, and tracheotomy before surgery were associated with fistula in the univariate analysis. In the multivariate analysis, only American Society of Anesthesiologists maintained statistical significance. Using logistic regression, a predictive model including the following was derived: American Society of Anesthesiologists, alcohol, chemoradiotherapy, tracheotomy, hemoglobin and albumin pre-surgery, local extension, N-classification, and diabetes mellitus. The model's score area under the curve was 0.76 (95% CI 0.64-0.87). The high-risk group presented specificity of 93%, positive likelihood ratio of 7.10, and positive predictive value of 76%. Including the medium-low, medium-high, and high-risk groups, a sensitivity of 92%, negative likelihood ratio of 0.25, and negative predictive value of 89% were observed.CONCLUSION: A clinical decision rule was created to identify patients with high risk of pharyngocutaneous fistula development. Prognostic accuracy measures were substantial. Nevertheless, it is essential to conduct larger prospective studies for validation and refinement.

INTRODUÇÃO: Fístula faringocutânea após cirurgia de câncer de laringe e hipofaringe causa diversos danos. Nosso objetivo foi derivar uma regra de decisão clínica (RDC) para predizer o desenvolvimento da fístula faringocutânea após cirurgia.MÉTODO: Estudo de coorte retrospectivo incluindo todos os pacientes submetidos à laringectomia total e faringolaringectomia (n = 171). Analisou-se a associação entre as variáveis pertinentes e o desenvolvimento da fístula e foi proposto um modelo preditivo.RESULTADOS: Na análise univariada, a ASA, quimioradioterapia (QRT) e traqueostomia antes da cirurgia foram associadas à fístula. Na análise multivariada, somente a ASA manteve-se estatisticamente significante. Por regressão logística, derivamos um modelo preditivo incluindo: ASA, álcool, QRT, traqueostomia, hemoglobina e albumina pré-operatórias, extensão local, N, DM. A curva ROC do modelo foi 0,76 (95% CI 0,64−0,87). O grupo de alto risco teve especificidade 93%, Likelihood positivo 7,10 e valor preditivo positivo 76%. Incluindo os grupos de médio baixo, médio alto e alto risco, temos sensibilidade de 92%, Likelihood negativo 0,25 e valor preditivo positivo 89%.CONCLUSÃO: Criamos uma RDC para identificar os pacientes de alto risco ao desenvolvimento da fístula faringocutânea. As medidas de acurácia prognóstica foram substanciais. Entretanto, é essencial conduzir estudos prospectivos maiores para validação/refinamento do modelo.

A Case of Parotid Gland Salivary Fistula Treated by Tympanic Neurectomy / 대한이비인후과학회지

The parotid gland salivary fistula is one of the complications following parotidectomy and can result in patient discomfort and wound infection. Various methods have been used for resolution of salivary gland fistula including non surgical and surgical management. Non-surgical managements such as pressure dressing, radiation therapy and pharmacotherapy are simple and safe but mostly require a relatively long period for healing. Surgical managements are recommended if conservative therapy and pharmacological intervention fail. Surgical options for parotid gland salivary fistula include total parotidectomy, salivary duct ligation, delayed primary repair of duct, and tympanic neurectomy. However, there is no uniform consensus regarding the surgical option of choice for parotid gland salivary fistula. Recently, we experienced a patient with a persistent parotid gland salivary fistula after parotidectomy, which was successfully treated by tympanic neurectomy. We found that the effect of tympanic neurectomy was not strong enough to be recommended as a method of choice for the clinical inactivation of persistent parotid gland salivary fistula. Therefore, we report this case for the first time in our country with the review of literatures.

A Case of Ectopic Salivary Gland with Fistula in the Anterior Neck / 대한이비인후과학회지

Ectopic salivary gland tissue represents an uncommon lesion, usually presenting as a discharging fistula in the anterior lower neck. Though the origin of this entity still remains unclear, it is thought to be a heteroplasia of the epithelium of the precervical sinus of His. We have experienced a case of ectopic salivary gland with cervical fistula in a 10-year-old. This was thought clinically to be the second branchial cleft cyst, but the pathology showed an ectopic salivary gland. This should be considered as one of the causes of a cystic neck mass or fistula in children.

Fístula salivar congênita: relato de três casos / Congenital salivary gland fistula: report of three cases

As fístulas salivares de origem congênita são má formações de incidência rara. Devem ser diferenciadas de fístulas de 2° arco branquial, pelas características clínicas distintas, como a ausência de episódios de infecção e drenagem abrupta, que aumenta durante a alimentação. Dúvidas ainda existem com relação à sua etiologia. As hipóteses existentes cogitam a migração anormal de tecidos embrionários e a heteroplasia de células ectodérmicas, que regridiriam no processo de diferenciação celular. A fistulografia da lesão mostra fundo de saco arboriforme e ajuda no diagnóstico diferencial da lesão. O tratamento é cirúrgico, com ressecção do trajeto da lesão e da glândula que a originou. Apresentamos três casos de fístulas salivares congênitas.

Salivary gland fistulas are rare malformations and should be differentiate from others draining sinuses pathologies, especially from the second branchial cleft sinuses. Precise pathogenesis is not fully understood. Clinically, the episodes of drainage are usually associated with a sense of fullness in the affected area and the amount of drainage usually increases during eating or mastication. A preoperative sinugram is helpful. The treatment is its excision. We present three cases of unusual salivary gland fistula.