The role of botulinum toxin in obstructive salivary disease
Obstructive salivary gland disease consists of the occurrence of repeated episodes of painful swelling of a salivary gland due to obstruction of its duct by a stone, a stenosis or inflammation of the epithelium of its duct itself (sialodochitis) and the progressive establishment of a chronic inflammation in the affected salivary gland.
In the last two decades, a real revolution has taken place in the therapeutic management of this category of diseases.
While until the early 2000s, the treatment of obstructive salivary disease was the total removal of the gland under general anesthesia with the risk of a series of complications (the main one being facial paralysis due to facial nerve injury), since the beginning of the century, a series of minimally invasive techniques have been developed, which are based on the endoscopy of the salivary gland ducts with specially developed mini-sialendoscopes up to 1.6 millimeters thick.
With the help of sialendoscopy, stone removal, intraluminal lithotripsy and dilation of duct strictures are achieved, techniques thanks to which it is possible to avoid surgical removal and functionally save the affected gland in a percentage of over 95%!
Without a doubt, the greatest challenge of the aforementioned causes of obstruction concerns stenosis of the excretory duct. The tendency for restenosis in chronic fibrous strictures, after their sialendoscopic dilation, leads to persistence of symptoms – fortunately in a rather small percentage of these patients.
This is where the application of botulinum toxin to the affected gland comes to provide a solution. In addition to the well-known aesthetic applications on the face and the functional indications in the salivary glands (drooling, gustatory hyperhidrosis – Frey, postoperative first-bite syndrome, postoperative salivary parotid fistulas), botulinum toxin is a completely satisfactory solution for persistent duct stenosis that is resistant to dilation.
Botox significantly reduces saliva production from the affected gland, without causing dry mouth, while at the same time acting as a suppressant on the pain stimulus through neuromodulation mechanisms. 3-4 days after the administration of Botox, saliva production from the affected gland is drastically reduced, resulting in the absence of saliva accumulation in the gland and an impressive reduction in the intensity and frequency of episodes of painful swelling, which lasts in some cases up to 6-7 months.
The maximum effect is usually achieved after the second administration, while within two years there is usually a complete cessation of symptoms and the patient returns to normal without symptoms of obstruction and with an excellent quality of life.
In conclusion, the combined use of innovative “mini” endoscopic techniques and the application of botulinum toxin has practically eliminated the percentage of patients with obstructive salivary gland disease who will ultimately require removal of their gland!
