title: The use of botulinum toxin in the treatment of a parotid duct injury during Mohs surgery and review of management options.
abstract: BACKGROUND
  Aggressive skin cancers on the cheeks may involve the parotid duct. For such tumors to be successfully removed, at least part of the parotid duct must be excised as well. Failure to properly address parotid duct injuries that result from Mohs micrographic surgery exposes the patient to a variety of adverse sequelae.
  
  
  OBJECTIVE
  To discuss the various diagnostic and treatment options that should be considered when managing parotid duct injuries that result from skin cancer extirpation.
  
  
  METHODS
  We describe a patient who sustained a parotid duct injury after Mohs micrographic surgery for treatment of squamous cell carcinoma. The patient was treated with intraparotid injections of botulinum toxin.
  
  
  RESULTS
  Two weeks after treatment of the injury with botulinum toxin, the patient reported complete resolution of his symptoms.
  
  
  CONCLUSIONS
  If a parotid duct injury is diagnosed at the time of tumor extirpation, then surgical repair of the duct should be attempted, but if surgical repair is not possible or if an injury remains unrecognized until well after tumor extirpation, then surgery is not necessary. In such cases, conservative, nonsurgical measures, such as treatment with botulinum toxin, will provide excellent results.
authors.affiliation: Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. ravi.krishnan@gmail.com
authors.forename: Ravi S
authors.initials: RS
authors.lastname: Krishnan
authors.forename: David P
authors.initials: DP
authors.lastname: Clark
authors.forename: Heidi B
authors.initials: HB
authors.lastname: Donnelly
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D002610:Cheek; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery / Q000009:adverse effects*; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D010305:Parotid Diseases / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D010306:Parotid Gland / Q000293:injuries*; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A