Use of Botulinum Toxin for Treatment of Fistulas Following Head and Neck Reconstruction

Abstract

Botulinum toxin, which is used clinically since 1970, is now widely applied for aesthetic purposes. But other indications still exist. Botulinum toxin has been used to reduce the secretions of the parotis gland in two cases of oro-cutaneous fistulas that occurred following head and neck reconstructions with free flaps. The aim was to facilitate the closure of the fistulas by decreasing the flow rate. The flux was reduced in a few days in both of the patients and the fistula of the first patient was totally closed in five days and it lasted one month for the other patient. The effect of the toxin is dose dependant and temporary. And the effective period differs between the tissues applied. This period would last as long as 20 months in salivary glands. Botulinum toxin would be safely used to facilitate closure of oro-cutaneous fistulas with its effect on reduction of the secretaions.