25 Neurotoxin Injection for Parotid Gland Hypertrophy
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Indications
Hypertrophy of the parotid gland can be caused by many different factors. Ruling out neoplasms and other diseases should be undertaken before beginning treatment to shrink the gland with BoNTA. Benign glandular enlargement from aging and xerostomia conditions are sometimes appropriate indications for neurotoxin injection. HIV patients can develop lymphoepithelial enlargement of the parotid, and bulimic patients can also develop benign parotid enlargement.
Anatomic Considerations
The parotid gland rests anterior to the ear, beneath the superficial musculoaponeurotic system (SMAS) and platysma muscles, over the lateral mandible. The external carotid artery and posterior facial vein pass just posterior to the gland. The five branches of the facial nerve, which provides motor innervation to facial mimetic musculature, pass through the middle of the gland.
Injection Technique
A 30-gauge, 1-inch (2.5-cm) needle is inserted perpendicular to the gland, and 20 to 30 BU (or 60 to 90 DU) of BoNTA is injected as the needle is withdrawn via several passes through the parenchyma of the gland. It is definitely discernable that the needle has entered the firmer body of the gland after passing through the SMAS/platysma muscle. Patients will also be able to sense when the needle is in the gland as they will feel an electric or tingling sensation that is clearly different from what they felt before the needle passed into the gland. It is necessary to use a longer needle (1 inch/2.5 cm) to reach the gland.
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