Patient benefit from treatment with botulinum neurotoxin A for functional indications in otorhinolaryngology.

The objective of the study was to evaluate patient benefit and health-related quality of life after use of botulinum neurotoxin (BoNT) A for various otorhinolaryngological, functional (non-cosmetic) indications. The design consisted of a survey study of a patient cohort (n = 40) treated with BoNT A for functional indications. Patients were asked to answer the Glasgow Benefit Inventory (GBI), a retrospective questionnaire well validated for measuring the effect of otorhinolaryngological interventions on the health-related quality of life. GBI scores can range from -100 (maximal adverse effect), through 0 (no effect), to 100 (maximal positive effect). A total of 29 patients (72.5%) returned a valid questionnaire. Mean total GBI scores for the particular indications were 1.2 (sialorrhea, n = 7), 22.6 (gustatory sweating, n = 8), 20.6 (palatal tremor, n = 5), 15.0 (postlaryngectomy voice disorders due to pharyngoesophageal spasm, n = 5), 38.9 (adductor spasmodic dysphonia, n = 2) and 27.8 (oromandibular dystonia, n = 2), showing a mean overall positive effect of BoNT A treatment on the health-related quality of life, respectively. A varying percentage of patients reported an increase in their health-related quality of life, indicated by positive total GBI scores: sialorrhea 28.6%, gustatory sweating 87.5%, palatal tremor 60%, postlaryngectomy voice disorders 60%, spasmodic dysphonia 100% and oromandibular dystonia 100%. Use of BoNT A can be considered an effective therapeutic option for all the indications investigated. However, the possibility of raising patients' health-related quality of life with this kind of therapy varies significantly for different indications. Further studies are needed to analyze the patients who will benefit most from a treatment with BoNT A.

'Minor' morbidity after parotid surgery via the modified Blair incision.

OBJECTIVE: To assess the 'minor' morbidities subjectively experienced by the patient after parotid surgery; these include scar cosmesis and pain, 'contour' deformity following removal of parotid bulk, numbness of the pinna and gustatory sweating. DESIGN: Retrospective study SETTING: Tertiary Referral Centre. PATIENTS: 28 patients were included in the study. RESULTS: Contour deformity, scarring and paraesthesia of the pinna secondary to great auricular nerve sacrifice are the most noticeable sequelae following parotidectomy. DISCUSSION: Although facial nerve injury is the most serious morbidity following parotidectomy, it is relatively uncommon. Other 'minor' morbidities are more likely to cause post-operative problems. Despite there being a number of different approaches to the parotidectomy, with or without reconstruction, these have not been satisfactorily compared.

Botulinum toxin A for quality of life improvement in post-parotidectomy gustatory sweating (Frey's syndrome).

OBJECTIVE: To measure patient-reported quality of life before and after botulinum toxin A treatment of post-parotidectomy Frey's syndrome (gustatory sweating). PATIENTS AND METHODS: A questionnaire concerning functional, social and emotional aspects of Frey's syndrome (14 questions, with responses on a zero to three point scale) was administered to 17 patients (13 women and four men) before and one month after intradermal injection of botulinum toxin A. Parotidectomy had been performed one to 19 years previously, for benign (n = 10) or malignant (n = 7) tumours, with gustatory sweating occurring a median of 15 months after surgery (range: one month to 14 years). Pre- and post-treatment quality of life scores were compared using Wilcoxon's test (p < 0.05). RESULTS: Patients' reported functional quality of life improved significantly (p = 0.0004). Their social and emotional scores were not significantly modified (p = 0.155 and 0.142, respectively). Seven patients (41 per cent) found the injections painful, but all patients said that the effects were beneficial, that they would undergo new injections if necessary and that they would recommend this treatment to other patients. The benefit lasted over 1.5 years for 60 per cent of patients. No correlation was found between duration of the effect and the extent of parotidectomy (p = 0.067). CONCLUSIONS: Botulinum toxin A significantly improved patients' functional quality of life, without significant improvement in their social or emotional quality of life, according to our questionnaire results. The duration of the effect was longer than the reported physiological effect of botulinum toxin A on acetylcholine receptors.

Parotidectomy: assessment of a surgical technique including facelift incision and SMAS advancement.

BACKGROUND: Despite its proven safety and its relevance regarding the cosmetic outcome, the SMAS-lifting technique is not a routine procedure for many surgeons. AIM: To compare the classical (subcutaneous flap and neck incision) with the SMAS-lifting techniques for parotidectomies from the patient's perspective. PATIENTS AND METHODS: Both procedures are described, tricks are pointed out. In both procedures the posterior branch of the great auricular nerve was not preserved, hence the two procedures were not evaluated regarding sensitivity of the auricle and preauricular area. Forty consecutive patients were asked to classify their concerns before (1-4 months) and 1 year after surgery (10 classical technique and 30 SMAS-lifting technique). RESULT: Before parotidectomy, patients were concerned in a decreasing order with the facial nerve function, the scar, the soft-tissue defect in the dorsal part of the cheek and Frey's syndrome. Following use of the classical technique, patients were concerned in decreasing order with the soft-tissue defect, the scar and Frey's syndrome. Following the SMAS technique, no one was concerned with the scar, Frey's syndrome, or the soft tissue defect although a slight asymmetry could still be noticed. CONCLUSION: The SMAS-lifting technique might possibly appear to offer a new standard procedure for parotidectomy, except for malignant tumours or in obese patients.