Efficacy and Safety of Botulinum Toxin Type A in the Treatment of Benign Parotid Hypertrophy: a Prospective, Single-arm Clinical Trial

Abstract

Background: Benign parotid hypertrophy makes the earlobe area appear swollen and weakens the lateral facial contour and aesthetics. Efficacious treatment for benign parotid hypertrophy is not available. The authors evaluated the efficacy and safety of botulinum toxin type A for benign parotid hypertrophy treatment. Methods: Thirty-six participants with benign parotid hypertrophy were enrolled and treated with botulinum toxin type A injection. After 6 months of follow-up, changes in the thickness and length of the superficial lobe of the parotid gland were assessed. Analyses of patient subgroups and image analyses were also undertaken to assess improvement. Results: Thirty-three participants completed this study. Superficial lobe of the parotid gland thickness was reduced significantly after botulinum toxin type A injection, but the longitudinal diameter of the parotid gland was not changed significantly (p < 0.001 and p = 0.146, respectively). Subgroup analyses showed that the degree of parotid gland hypertrophy affected treatment efficacy and degree of improvement, but age and sex did not (p < 0.001, p = 0.137, and p = 0.138, respectively). Image analyses showed improvement in the facial contour (p < 0.05). Serious adverse reactions or complications were not observed. Conclusion: Botulinum toxin type A can be used to treat benign parotid hypertrophy, reduce parotid gland volume, and improve the facial contour. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Ultrasound‐guided thread lifting for the prevention of parotid gland and diagnosing parotid duct complications

“…The parotid gland can be clearly visualized when enlarged at the medial side of the tragus area. 17 Doppler ultrasound can be used during the thread lifting as it allows visualizing the cannula during the process. However, it is difficult to use because thread insertion requires using both hands, thus limiting the availability of the hands to hold the ultrasound probe.…”

“…Ultrasound helps detect the exact location of the parotid gland in individual patients. The parotid gland can be clearly visualized when enlarged at the medial side of the tragus area 17 . However, it usually cannot be detected clearly, especially in the cheek area.…”

“…The parotid gland can be clearly visualized when enlarged at the medial side of the tragus area. 17 However, it usually cannot be detected clearly, especially in the cheek area. Inserting the thread at the subcutaneous layer at the parotid gland area is recommended.…”

Discussion: The Volumetric Effect of Botulinum Toxin Type A Injection on the Parotid Gland: A Randomized Controlled Trial

“…10 A prospective study on adults with benign parotid hypertrophy found that repetitive injections could lessen gland thickness at 3 and 6 months, with minimal side effects. 11 In the article by Jeong et al, the single BTX-A injection resulted in volume reduction at 2 weeks with a rebound effect at 3 months, which is atypical based on prior literature. 1 No explanation for this phenomenon is provided, but presumably, given that these facial trauma patients did not have a prior diagnosis of parotid hypertrophy and they may have had traumatic facial swelling preoperatively, the effect of BTX-A may have been confounded.…”

“…10 A prospective study on adults with benign parotid hypertrophy found that repetitive injections could lessen gland thickness at 3 and 6 months, with minimal side effects. 11…”