Negative effects on oral motor function after submandibular and parotid botulinum neurotoxin A injections for drooling in children with developmental disabilities

Abstract

AimTo evaluate negative effects on oral motor function after concurrent submandibular and parotid (four‐gland) botulinum neurotoxin A (BoNT‐A) injections as a treatment for paediatric drooling.MethodThis was a retrospective cohort study of 125 children (median age 7 years 7 months [interquartile range 4 years 5 months]) with developmental disabilities, including cerebral palsy, treated with four‐gland injections. Most children (90.4%) were previously exposed to submandibular injections. Frequency, severity, and duration of negative effects on oral motor function (i.e. saliva swallowing, eating, drinking, articulation) were evaluated and compared to a reference cohort treated with submandibular injections.ResultsNegative effects on oral motor function were reported in 45 children (36.0%), predominantly manifesting as eating‐related problems (64.4%). Most negative effects (62.2%) were classified as mild and resolved within 4‐weeks post‐injunction (53.3%). Compared to the reference cohort, frequency (36.0% vs 33.0%) and duration (53.3% vs 53.6% resolving within 4 weeks) of negative effects were comparable, although problems were more often moderately severe (33.3% vs 10.1%).InterpretationWhile negative effects on oral motor function were relatively common after four‐gland BoNT‐A injections, most problems were mild and resolved promptly. No substantial differences to a reference cohort treated with submandibular injections were observed, although further research should establish the generalizability of these findings in a treatment‐naive population. Nevertheless, when submandibular injections prove ineffective, clinicians can confidently consider four‐gland injections.