USE OF BOTULINUM TOXIN IN THE MANAGEMENT OF POST-PAROTIDECTOMY COMPLICATIONS: FREY SYNDROME, SIALOCELE AND SALIVARY FISTULA
DOI:
https://doi.org/10.31435/ijitss.2(50).2026.5831Keywords:
Botulinum Toxin; Parotidectomy; Frey Syndrome; Sialocele; Salivary Fistula; Postoperative ComplicationsAbstract
Background: Parotidectomy is a commonly performed procedure associated with postoperative complications such as Frey syndrome, sialocele, and salivary fistula, which may significantly impair patient quality of life and require additional management. Botulinum toxin is increasingly used as a minimally invasive therapeutic option in this setting.
Aim: The aim of this study was to evaluate current evidence regarding the use of botulinum toxin in the prevention and treatment of complications following parotidectomy.
Material and methods: This study was designed as a narrative review based on previously published scientific literature. A comprehensive search of PubMed, Scopus, and Google Scholar databases was conducted, including studies published up to 2025. Articles addressing the use of botulinum toxin in Frey syndrome, sialocele, and salivary fistula were included and analyzed qualitatively.
Results: The reviewed studies consistently demonstrated high clinical effectiveness of botulinum toxin in the management of post-parotidectomy complications. In Frey syndrome, most patients achieved substantial or complete reduction of gustatory sweating, with therapeutic effects typically lasting 6–12 months. In cases of sialocele and salivary fistula, botulinum toxin reduced salivary secretion, promoted lesion closure, and shortened recovery time compared to conservative management. Reported adverse effects were uncommon and generally mild and transient.
Conclusions: Botulinum toxin is an effective and safe option in the management of post-parotidectomy complications. Despite the need for repeated administration in some cases, it represents a minimally invasive alternative to surgical treatment. Further prospective studies are required to establish standardized protocols and long-term outcomes.
References
Lambiel, S., Dulguerov, N., Courvoisier, D. S., & Dulguerov, P. (2021). Minor parotidectomy complications: A systematic review. The Laryngoscope, 131(3), 571–579. https://doi.org/10.1002/lary.28912
Lee, D. J., Lee, Y. M., Park, H. J., Lee, J. W., & Cha, W. (2021). Intraoperative botulinum toxin injection for superficial partial parotidectomy: A prospective pilot study. Clinical Otolaryngology, 46(5), 998–1004. https://doi.org/10.1111/coa.13767
Kinberg, E. C., Garneau, J. C., Eljazzar, R., Genden, E. M., Teng, M. S., Miles, B. A., Rosenberg, J., Lawson, W., & Yao, M. (2022). Postparotidectomy sialocele: 6-year review of underlying factors. Head & Neck, 44(3), 745–748. https://doi.org/10.1002/hed.26969
Marchese, M. R., Bussu, F., Settimi, S., Scarano, E., Almadori, G., & Galli, J. (2021). Not only gustatory sweating and flushing: Signs and symptoms associated to the Frey syndrome and the role of botulinum toxin A therapy. Head & Neck, 43(3), 949–955. https://doi.org/10.1002/hed.26561
Motz, K. M., & Kim, Y. J. (2016). Auriculotemporal syndrome (Frey syndrome). Otolaryngologic Clinics of North America, 49(2), 501–509. https://doi.org/10.1016/j.otc.2015.10.010
Wang, C. C., & Wang, C. P. (2005). Preliminary experience with botulinum toxin type A intracutaneous injection for Frey’s syndrome. Journal of the Chinese Medical Association, 68(10), 463–467. https://doi.org/10.1016/S1726-4901(09)70075-9
Wood, C. B., & Netterville, J. L. (2019). Temporoparietal Frey syndrome: An uncommon variant of a common syndrome. The Laryngoscope, 129(9), 2071–2075. https://doi.org/10.1002/lary.27632
de Bree, R., van der Waal, I., & Leemans, C. R. (2007). Management of Frey syndrome. Head & Neck, 29(8), 773–778. https://doi.org/10.1002/hed.20568
Send, T., Bertlich, M., Eichhorn, K. W., Bootz, F., & Jakob, M. (2019). Management and follow-up results of salivary fistulas treated with botulinum toxin. The Laryngoscope, 129(2), 403–408. https://doi.org/10.1002/lary.27416
Jeffe, J. S., & Sulman, C. G. (2015). The use of botulinum toxin B in the treatment of a post-traumatic sialocele in a 4-year-old child: A case report. International Journal of Pediatric Otorhinolaryngology, 79(12), 2446–2449. https://doi.org/10.1016/j.ijporl.2015.09.031
Yang, X., Ge, S., Tao, Y., Li, J., Shang, W., & Song, K. (2023). Assessment of the observation management of sialocele after partial superficial parotidectomy. Oral Diseases, 29(3), 996–1004. https://doi.org/10.1111/odi.14079
Chow, T. L., & Kwok, S. P. (2003). Use of botulinum toxin type A in a case of persistent parotid sialocele. Hong Kong Medical Journal, 9(4), 293–294.
Pendolino, A. L., Capaccio, P., Restivo, D. A., Manfredini, D., & Marchese-Ragona, R. (2018). Simple and effective treatment of chronic salivary fistulas after parotidectomy. The British Journal of Oral & Maxillofacial Surgery, 56(7), 640–641. https://doi.org/10.1016/j.bjoms.2018.07.002
Maharaj, S., Mungul, S., & Laher, A. (2020). Botulinum toxin A is an effective therapeutic tool for the management of parotid sialocele and fistula: A systematic review. Laryngoscope Investigative Otolaryngology, 5(1), 37–45. https://doi.org/10.1002/lio2.350
Graillon, N., Le Roux, M. K., Chossegros, C., Haen, P., Lutz, J. C., & Foletti, J. M. (2019). Botulinum toxin for ductal stenosis and fistulas of the main salivary glands. International Journal of Oral and Maxillofacial Surgery, 48(11), 1411–1414. https://doi.org/10.1016/j.ijom.2019.04.015
Safarpour, D., & Jabbari, B. (2023). Botulinum toxin treatment for cancer-related disorders: A systematic review. Toxins, 15(12), 689. https://doi.org/10.3390/toxins15120689
Marchese-Ragona, R., Marioni, G., Restivo, D. A., & Staffieri, A. (2006). The role of botulinum toxin in postparotidectomy fistula treatment: A technical note. American Journal of Otolaryngology, 27(3), 221–224. https://doi.org/10.1016/j.amjoto.2005.09.009
Beerens, A. J., & Snow, G. B. (2002). Botulinum toxin A in the treatment of patients with Frey syndrome. The British Journal of Surgery, 89(1), 116–119. https://doi.org/10.1046/j.0007-1323.2001.01982.x
Jansen, S., Jerowski, M., Ludwig, L., Fischer-Krall, E., Beutner, D., & Grosheva, M. (2017). Botulinum toxin therapy in Frey’s syndrome: A retrospective study of 440 treatments in 100 patients. Clinical Otolaryngology, 42(2), 295–300. https://doi.org/10.1111/coa.12719
Arad-Cohen, A., & Blitzer, A. (2000). Botulinum toxin treatment for symptomatic Frey’s syndrome. Otolaryngology–Head and Neck Surgery, 122(2), 237–240. https://doi.org/10.1016/S0194-5998(00)70246-4
Dulguerov, P., Quinodoz, D., Cosendai, G., Piletta, P., & Lehmann, W. (2000). Frey syndrome treatment with botulinum toxin. Otolaryngology–Head and Neck Surgery, 122(6), 821–827. https://doi.org/10.1016/S0194-59980070008-8
Laskawi, R., Drobik, C., & Schönebeck, C. (1998). Up-to-date report of botulinum toxin type A treatment in patients with gustatory sweating (Frey’s syndrome). The Laryngoscope, 108(3), 381–384. https://doi.org/10.1097/00005537-199803000-00013
Pantel, M., Volk, G. F., Guntinas-Lichius, O., & Wittekindt, C. (2013). Botulinum toxin type B for the treatment of a sialocele after parotidectomy. Head & Neck, 35(1), E11–E12. https://doi.org/10.1002/hed.21778
Laskawi, R., Winterhoff, J., Köhler, S., Kottwitz, L., & Matthias, C. (2013). Botulinum toxin treatment of salivary fistulas following parotidectomy: Follow-up results. Oral and Maxillofacial Surgery, 17(4), 281–285. https://doi.org/10.1007/s10006-012-0375-0
Sheykhveisi, M., Khaauthori, E., Mashhadi, L., Esmaily, H., & Khazaeni, K. (2025). The role of botulinum toxin for the management of post parotidectomy sialocele: A randomized controlled trial. Indian Journal of Otolaryngology and Head & Neck Surgery, 77(3), 1215–1219. https://doi.org/10.1007/s12070-024-05226-1
Alimohammadi, M., Fooladi, A. A. I., Mirnejad, R., Alavioun, S. M., Vaghari, A., Farahani, N., Abbasi, A., Hushmandi, K., & Khoshnazar, S. M. (2025). Innovative implications of botulinum toxin in head and neck cancer: Exploring novel opportunities and future prospects. Pathology, Research and Practice, 272, 156037. https://doi.org/10.1016/j.prp.2025.156037
Eckardt, A., & Kuettner, C. (2003). Treatment of gustatory sweating (Frey’s syndrome) with botulinum toxin A. Head & Neck, 25(8), 624–628. https://doi.org/10.1002/hed.10262
Naumann, M., Zellner, M., Toyka, K. V., & Reiners, K. (1997). Treatment of gustatory sweating with botulinum toxin. Annals of Neurology, 42(6), 973–975. https://doi.org/10.1002/ana.410420619
Cantarella, G., Berlusconi, A., Mele, V., Cogiamanian, F., & Barbieri, S. (2010). Treatment of Frey’s syndrome with botulinum toxin type B. Otolaryngology–Head and Neck Surgery, 143(2), 214–218. https://doi.org/10.1016/j.otohns.2010.04.009
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Copyright (c) 2026 Natalia Hariasz, Kamil Arciszewski, Karolina Orda, Dominika Walczak, Jakub Szumiło, Klaudia Kasperska, Mariana Markiv, Michał Słowik, Paweł Stenzel, Jędrzej Świercz

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