Objective: Review potential adverse events of parotitis with botulinum toxin injections for sialorrhea.

Background: Sialorrhea is a common non-motor symptom of Parkinson’s disease. Botulinum toxin (BoNT) injections represent a commonly used and effect treatment option for sialorrhea. Side effects include hematoma, pain, infection, dry mouth, and weakness. We found no published evidence to suggest that parotitis and sialolithiasis have occurred as a result of BoNT injections for the treatment of sialorrhea.

Method: Clinical, laboratory, imaging, and photographic data of our established clinic patient will be presented. We include detailed injection information, such as procedure notes and BoNT doses of the injection session presented in this report.

Results: An 86 years old male with a 9-year history of Parkinson’s disease and a 5-year history of sialorrhea was receiving treatment with BoNT injections. Seven days after his 6th round of injections (with rimabotulinumtoxinB) the patient reported a small area of redness at the injection site. This has worsened over the next 5 days at which time the patient was seen in clinic. On exam we found significant erythema, warmth, and swelling on left face and parotid area. He was then referred to the ER, where the formal diagnosis of parotitis was made. He had imaging and laboratory confirmation of this and was admitted to the hospital. He was subsequently diagnosed with sialolithiasis as well. Excellent benefits (80% or better) and no adversities were seen during the first 5 injection sessions (onabotulinumtoxinA).

Conclusion: We hereby present a case of parotitis and sialolithiasis following salivary gland BoNT injections. While infections in general are known to occur with BoNT injections, this particular complication following intraglandular has been previously reported. While dose conversions between different BoNT brands is inaccurate and discouraged, we suspect that the BoNT dose used during the injection session before these complications developed may have been greater than that used during the 5 previous sessions. Parotitis and sialolithiasis may represent under-reported potential adversities in intraglandular BoNT injections. Further work on factors potentially affecting risk of these complications, such as dosing, injection technique, antiseptic measures, should be further investigated.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/parotitis-as-adverse-event-following-bont-injections-for-sialorrhea/