Management of Parotid Fistula with Sodium Tetradecyl Sulphate and Intraparenchymal Botulinum Toxin Injection

A salivary gland fistula occurs when there is abnormal communication between the skin and the salivary gland or duct. Most of the cases are due to complications of head and neck surgery such as parotidectomy or trauma. At the moment, there are no consensus treatment guidelines for managing salivary gland fistulas. Most cases are treated conservatively; however, the management of ductal fistula can be challenging and typically requires more aggressive measures than conservative ones. We report a case of an elderly with a neck abscess complicated with a parotid fistula after incision and drainage. He presented with wound breakdown and persistent saliva leakage from the wound. The fistulogram showed communication between the Stensen's duct and the external fistula opening. We performed sclerotherapy by injecting Sodium Tetradecyl Sulphate into the fistula tract and ultrasound-guided intraparenchymal Botulinum Toxin type A injection over the affected parotid gland. The management of salivary gland fistula is discussed, focusing on the role of Botulinum Toxin type A injection and Sodium Tetradecyl Sulphate for the management of the fistula.