The Use of BOTOX®(onabotulinumtoxin A) for the treatment of parotid sialocele and fistula post extirpation of buccal squamous cell carcinoma with immediate reconstruction utilizing microvascular free flap. A Report of Three Cases

Publication date: Available online 29 January 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): James Melville, Daniel Stackowicz, Jonathon S. Jundt, Jonathan W. Shum
Buccal squamous cell carcinoma is an aggressive form of oral carcinoma with a high recurrence rate.¹ Injury to the parotid duct is often unavoidable when surgically treating buccal squamous cell carcinoma due to the intimate anatomic relationship between the buccal mucosa, Stensen's duct and the parotid gland. It is often difficult to achieve negative margins and preserve the integrity of the parotid duct.² Sialocele formation is a frequent and untoward complication due to extravasation of saliva into the surgical defect which delays healing, creates fistulas and produces painful facial swelling. Currently, no consensus exists regarding the management of a parotid sialocele.³ Multiple authors have described varying modalities of treatment such as repeated percutaneous needle aspiration, pressure dressings, anti-sialagogue therapy, radiotherapy, botulinum toxin and surgical techniques including duct repair, diversion, ligation, drain placement, and parotidectomy.^4,5 With the approval of the University of Texas Health Sciences Center at Houston (UTHealth) IRB, we present three cases of parotid siaolcele and non-healing fistulas successfully treated with Botox (onabotulinumtoxin A) after tumor extirpation, neck dissection and reconstruction with a microvascular free flap. At our institution the radiation oncologist would prefer not to start adjunctive radiation treatment with a non-healing wound or a drain in the field of radiation. Ideally, a standard timing of adjuvant radiotherapy is 6-8 weeks post surgery and 60cGy should be completed before 7 month. With the use of Botox we were able resolve the non-healing wound and remove the drain at least 2 weeks before the initiation of adjunctive radiotherapy and minimize the delay in adjuvant treatment.



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