Ultrasound Guidance Superiority in Pediatric Sialorrhea Treatment With Intraglandular Botulinum Toxin Application: A Four-Year Retrospective Study

Abstract

Introduction The management of sialorrhea in children with multiple disabilities is extremely important not only for aesthetic/psychosocial reasons but also for functional and clinical ones. There are several recommended management methods with strong evidence of the effectiveness of intraglandular application of botulinum toxin A. Materials and methods In this four-year retrospective report, we compare two populations who received intraglandular type A botulinum toxin injections in the pediatric unit of the Physical Medicine and Rehabilitation (PM&R) Department at a central hospital. The injections were administered using either ultrasound guidance (US) or anatomical landmarks. Results Out of a total of 29 patients with neurological conditions, 16 met the eligibility criteria for this study. The study group comprised seven females (44%) and nine males (56%), with a median age of 9 years. The average pre-procedure sialorrhea staging was four. A total of 23 procedures were performed, with 16 conducted under ultrasound guidance (US) and seven via anatomical landmarks (non-US). In the US group, a statistically significant difference in sialorrhea staging was observed at one and three months post-procedure (p<0.05), but not at six months post-procedure. Conversely, no statistically significant difference in sialorrhea staging was found at any time point in the non-US group. The comparison between the two groups supports the use of ultrasound guidance, showing superior outcomes at one and three months post-procedure (p<0.05). Conclusion The results of this study align with global trends seen in medical publications and guidelines advocating for the use of ultrasound in this procedure. Future prospective and larger-scale studies are essential to validate these findings.