Exploring Salivary Gland Complications: Case of Acute Parotitis After Botulinum Toxin Injection for Bruxism

A recent case study has described a case of acute parotitis in a 60-year-old female following Botulinum toxin (BTX) injections to the masseter muscle (to treat bruxism). The botulinum toxin also impacted the parotid gland and facial nerve leading to reduced saliva production and weakness in the corresponding facial muscles.

The case published in the Journal of Oral and Maxillofacial Surgery highlights the possible salivary gland complications after BTX injection into the masticatory muscles.

The case concerns a 60-year-old female who presented to the emergency room (ER) with complaints of swelling and pain in the right side of the face, accompanied by xerostomia, which was initiated a week before her ER visit. The patient indicated that she received a botulinum toxin injection in the masseter muscle three weeks before she visited the ER for her known bruxism. She reported experiencing mild muscle weakness at the right commissure, which had improved a few days before her arrival.

Botulinum toxin injection is a widely used treatment for bruxism; however, there is a lack of literature regarding potential complications affecting the salivary glands. To fill this knowledge gap, Nadav Grinberg, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, and colleagues conducted an electronic search of PubMed and Embase databases to create a literature review to delve into the etiology behind the presented case and suggest potential preventive measures to avoid salivary gland complications.

Key findings:

• Thirty-one articles are reviewed and discussed.
• Currently, there is no consensus on the causes of the mentioned complication.
• Various factors have been proposed, encompassing anatomical, physiological, biological, and physical aspects.

"Various methods have been proposed for the safe injection of botulinum toxin, and enhanced medical training and knowledge are essential to ensure predictable outcomes," the researchers wrote.

In conclusion, while botulinum toxin remains a valuable tool in aesthetic and therapeutic applications, the emergence of parotitis as a postoperative complication underscores the need for vigilance. As more patients seek out these procedures, healthcare providers must remain informed about potential risks and implement strategies to ensure patient safety. Ongoing research and case monitoring will be essential in further understanding this complication and improving clinical outcomes.

Reference:

Grinberg, N., Whitefield, S., Kleinman, S., Frenkel, G., & Peleg, O. (2024). Botulinum Toxin-Induced Parotitis: A Postoperative Complication Following Masseter Muscle Injection. Journal of Oral and Maxillofacial Surgery, 82(5), 525-530. https://doi.org/10.1016/j.joms.2024.02.007