return to: Botox injection to salivary glands for hypersalivation; Botulinum neurotoxin preparations; Salivary Duct Stenosis

see: online publication addressing botox infusion 

Modified Procedure Note

Procedure: Right parotid duct cannulation dilation with Botox (25 units in 1 cc) insufflation followed by 6 cc of back insufflation of saline

Preop Diagnosis: Hypersalivation (poor tolerance of saliva status post total laryngectomy with hypoglossal nerve lack of function)

Postop Diagnosis: Same

Surgeon: Hoffman

Assistant: xxxx

Anesthesia: Premedication with Augmentin, topical viscous lidocaine to the right buccal area

Description of Procedure: Following identification the patient informed consent and a brief timeout in the microscope room microscopy was used to identify a right parotid duct that was readily visualized but with initial difficulty cannulating with a primed 22-gauge angiocath in retrospect identified due to poor angulation - followed by nearly direct perpendicular entry was affected with the 0.015 inch guidewire over which the 22-gauge Angiocath (by the modified Seldinger technique) was then placed with backflow of saliva allowing for placement of a three-way stopcock to which a 10 cc syringe containing saline through the alternative opening had been primed and attached.

Botox was then instilled to a volume of 1.0 cc (25 units) and then "chased" by incremental 1 cc aliquots at a time placement up to 6 cc of saline with only minimal discomfort but a sensation of fullness correlating with an images that were taken showing more fullness to the right parotid gland.

The 22-gauge angiocatheter was held and kept in place for 4 minutes then removed with the mouth rinsed administration of lemon drops and massage and intermittent rinsing her mouth concluded. Images including video facial motion were taken immediately there after the patient was observed in clinic for a half hour after the procedure and then discharged home with follow-up arranged.

References

Schwalje AT, Hoffman HT. Intraductal Salivary Gland Infusion With Botulinum Toxin. Laryngoscope Investig Otolaryngol. 2019 Sep 3;4(5):520-525. doi: 10.1002/lio2.306. PMID: 31637296; PMCID: PMC6793609.