Update: Prevention and Treatment of Parotid/Submandibular Gland Fistula/Sialocele Following Rhytidectomy With Botulinum Toxin A.

Dissecting deep to the superficial musculoaponeurotic system (SMAS), a popular option for facelifts, has the potential for injury to the parotid gland leading to postoperative sialoceles and fistulas. Similarly, deep plane procedures in the neck that include partial submandibular gland resection may lead to salivary gland leaks. We previously described the management of sialocele following rhytidectomy. Since then, administration of botulinum toxin A has emerged as the primary treatment and prevention of this rare complication. The technique of administration and dosage of botulinum toxin in the treatment algorithm is not well defined. We present a literature review and our current protocol for the most efficacious injection technique and dosing to prevent and treat injury to the parotid and submandibular glands.