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Nonsurgical management of traumatic injuries of the parotid gland and duct using type a botulinum toxin.

Posttraumatic parotid gland and duct injuries represent a small proportion of the wounds seen in the emergency department. Lewis and Knottenbelt1 found that only 0.21 percent of 15,419 patients seen in a trauma unit had a parotid gland or duct injury caused by assault with a knife, bottle, or, more rarely, gun shot. This low rate may explain the missed diagnosis of parotid and duct injury on admission and after a varying period sialoceles or fistulas. These complications are disabling and must be prevented. Many therapies have been used, but most are unsatisfactory. Both surgical and nonsurgical approaches are accepted as treatment modalities for parotid gland and duct injuries. The local injection of type A botulinum toxin represents a new and effective treatment for the complications of these injuries; it is less invasive, stressful, and lengthy than conventional methods. We report a case in which a posttraumatic sialocele was successfully treated by type A botulinum toxin injection in first intention. We describe the therapeutic options for these injuries after a review of the literature: acute treatment is operative, and treatment of complications is conservative, with type A botulinum toxin injections. We propose a new protocol of targeted injections that allows the use of smaller doses than those described in the literature.