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.
Department of Plastic and Reconstructive Surgery, La Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy. lucadessy@hotmail.com
L A
LA
Dessy
M
M
Mazzocchi
C
C
Monarca
M G
MG
Onesti
N
N
Scuderi
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