Combined transdermal scopolamine and botulinum toxin A to treat a parotid fistula after a face-lift in a patient with siliconomas.
A parotid fistula is a rare, extremely unpleasant disease. Patients with chronic pathologies of the facial soft tissues have a high complication rate after aggressive treatments. Alternative conservative treatments have recently been reported for this condition. The case is described of a parotid fistula following a face-lift in a patient affected by facial siliconomas. A 41-year-old Caucasian who had undergone repeated facial silicone injections developed a diffuse granulomatous reaction accompanied by facial disfigurement. Thirteen surgical operations were performed to remove the siliconomas and correct the deformities, the last of which was a face-lift. After this procedure, the patient developed a parotid fistula. Conservative treatment, consisting of a combination of transdermal scopolamine and botulinum toxin A injections, was adopted. These antisialogogues gradually reduced saliva secretion, thereby preparing the wound bed for a skin graft and eventual healing. The choice of conservative therapy, as opposed to a surgical approach, was made to avoid further risks in what was already a highly complicated condition. The use of this conservative approach is recommended to treat complicated cases of parotid fistula.
Dessy
L A
LA
Department of Plastic and Reconstructive Surgery, La Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy. lucadessy@hotmail.com
Mazzocchi
M
M
Monarca
C
C
Onesti
M G
MG
Scuderi
N
N
D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D018680:Cholinergic Antagonists / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005402:Fistula / Q000188:drug therapy*; D006801:Humans; D010305:Parotid Diseases / Q000188:drug therapy*; D015361:Rhytidoplasty / Q000009:adverse effects*; D012472:Salivation / Q000187:drug effects; D012601:Scopolamine / Q000627:therapeutic use*; D020034:Silicone Gels / Q000009:adverse effects
D018680:Cholinergic Antagonists; D020034:Silicone Gels; D012601:Scopolamine; D019274:Botulinum Toxins, Type A