Successful Management of Drooling with Botulinum Toxin A in Neurologically Disabled Children

Abstract

Treatment of drooling by topical injection of botulinum toxin A into the salivary glands is a reliable and also side-effect-free therapeutic option for children with neurological disorders. All children involved in our study experienced a distinct improvement of their quality of life.

Drooling quantification: Correlation of different techniques

“…This approach described a similar technique where two dental rolls are inserted into the oral cavity for two minutes. An electronic scale was used to measure the weight of cotton rolls before and after oral insertion (Ellies et al, 2002;HassinBaer, Scheuer, Buchman, Jacobson, & Ben-Zeev, 2005) . Although, this is a non-invasive method that quantifies the volume of produced saliva, it cannot measure the amount of saliva beyond the margin of the lower lip (Jongerius et al, 2001).…”

Histological and immunohistochemical findings of the action of botulinum toxin in salivary gland: systematic review

“…The consequences of hypersalivation include facial and perioral dermatitis (Yang et al, 2006;Bloem et al, 2009); increased perioral and oral infections, halitosis, hygiene difficulties, social isolation, aspiration risk and loss of fluids and electrolytes (Yang et al, 2006;Jankovic, 2009); difficulties to speak and pneumonia (Alter, 2010); and risk of lung infections (Ellies et al, 2002), which generate great impact on the patient's life. On the other hand, the decrease in salivary flow and xerostomia, the person may develop severe weakness in oral health, difficulty with speech, chewing, swallowing, changes in the mucous membrane, tooth loss (Sanioto et al, 2013), among others as microbial infections such as candidiasis caused by pathogenic species of Candida (Rodrigues et al, 2004).…”

“…Anticholinergic drug substances such as Atropine, Benztropine, Glycopyrrolate, and Benzhexol Hydrochloride are some options, which reduce the volume of saliva in the oral cavity by blocking the action of parasympathetic autonomic nervous system on acetylcholine receptors on the salivary glands (Ellies et al, 2006a;Coskun et al, 2007;Bavikatte et al, 2012). Other ways include antihistaminic drugs (Alter, 2010); surgery such as ablation of salivary glands, tympanic neurectomy, transposition or retropositioning of excretory ducts or ligation of excretory ducts (Ellies et al, 2002;Savarese et al, 2004;Manrique et al, 2007); radiotherapy (Bavikatte et al, 2012;Kasarskis et al, 2011;Corso et al, 2011); speech therapy (Crysdale, 1980); techniques of body position, and the "biofeedback" (Tscheng, 2002;Savarese et al, 2004;Bloem et al, 2009;Valencia and Mendoza, 2011).…”

Ultrasonography guided botulinum toxin a injection for excessive drooling in children

“…Mild side effects, such as viscous saliva, chewing difficulties, dry mouth and transient weakness of mouth closure have been reported in the literature (2,6,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). The majority of these side effects occur due to the muscle weakness that is related to the diffusion of the BTX outside the salivary gland (7).…”

“…Injections have been successfully administered to the salivary glands, including the parotid glands (5,15,16), submandibular glands (7,11,13) or a combination of both (4,12,14,18,19). Submandibular glands are capable of secreting 60%-70% of resting saliva when the individual is not eating (7,17), while the majority of saliva used during eating and drinking is secreted from the parotid glands (3,19).…”