Hostname: page-component-77f85d65b8-t6st2 Total loading time: 0 Render date: 2026-03-27T20:01:52.168Z Has data issue: false hasContentIssue false
  • English
  • Français

Ultrasound-guided botulinum toxin A injection: an alternative treatment for dribbling

Published online by Cambridge University Press:  19 July 2007

M B Marina ,
A Sani ,
A H Hamzaini  and
B B Hamidon
M B Marina*
Affiliation:
Department of Otorhinolaryngology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
A Sani
Affiliation:
Department of Otorhinolaryngology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
A H Hamzaini
Affiliation:
Department of Radiology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
B B Hamidon
Affiliation:
Division of Neurology, Department of Medicine, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
*
Address for correspondence: Dr Marina bt Mat Baki, Dept of Otorhinolaryngology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Fax: +603 91737840, E-mail: marinadr72@yahoo.co.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Dribbling (sialorrhoea) affects about 10 per cent of patients with chronic neurological disease. The variety of treatments currently available is unsatisfactory. This study was a clinical trial of the efficacy of ultrasound-guided, intraglandular injection of botulinum toxin A for dribbling, performed within the otorhinolaryngology department of the National University of Malaysia. Both pairs of parotid and submandibular glands received 25 U each of botulinum toxin A.

Twenty patients were enrolled in the study. The median age was 15 years. All 20 patients (or their carers) reported a distinct improvement in symptoms after injection. Using the Wilcoxon signed rank test, there were significant reductions in dribbling rating score, dribbling frequency score, dribbling severity score, dribbling visual analogue score and towel changes score, comparing pre- and post-injection states (p<0.001). There were no complications or adverse effects during or after the injection procedure.

Intraglandular, major salivary gland injection of botulinum toxin A is an effective treatment to reduce dribbling. Ultrasound guidance enhances the accuracy of this procedure and minimises the risk of complication.

Keywords

SialorrhoeaBotulinum Toxin Type ASalivary GlandInjectionUltrasonography

Information

Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 6 , June 2008 , pp. 609 - 614
Copyright
Copyright © JLO (1984) Limited 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

Presented at the Singapore & Malaysia ENT Joint Clinical Meeting, 25 March 2006, National University Hospital, 5 Lower Kent Ridge Road, Singapore, at the 26th Annual General Meeting of the Malaysia ORL-Head and Neck Organisation, 26 May 2006, Langkawi, Malaysia, and at the Asian Oceanian Congress of Radiology, 7 August 2006, Hong Kong, China.

References

1 Porta, M, Gamba, M, Bertachi, G, Vaj, P. Treatment of sialorrhoea with ultrasound guided botulinum toxin type A injection in patient with neurological disorder. J Neurol Neurosurg Psychiatry 2001;70:538–40CrossRefGoogle Scholar
2 Kelm, C, Mair, EA. Four-duct ligation: a simple and effective treatment for chronic aspiration from sialorrhoea. Arch Otolaryngol Head Neck Surg 1999;125:796–801Google Scholar
3 Blasco, PA, Stansburry, JCK. Glycopyrrolate treatment of chronic drooling. Arch Pediatr Adolesc Med 1996;150:932–5CrossRefGoogle ScholarPubMed
4 Greensmith, AL, Johnstone, BR, Reid, SM, Hazard, CJBN, Johnson, HM, Reddihough, DS. Prospective analysis of the outcome of surgical management of drooling in the pediatric population: a 10-year experience. J Am Soc Plast Surg 2005;116:1233–42Google Scholar
5 Suskind, DL, Tilton, A. Clinical study of botulinum A toxin in the treatment of sialorrhoea in children with cerebral palsy. Laryngoscope 2002;113:73–81CrossRefGoogle Scholar
6 Ellies, M, Laskawi, R, Rohrbach-Volland, S, Alglebe, C. Up-to-date report of botulinum toxin A therapy in patients with drooling caused by different etiologies. J Oral Maxillofac Surg 2003;61:454–7CrossRefGoogle ScholarPubMed
7 Jongerius, PH, Joosten, F, Hoogen, FJ, Gabreels, FJM, Rotteveel, JJ. The treatment of drooling by ultrasound-guided intraglandular injections of botulinum toxin type A into the salivary glands. Laryngoscope 2003;113:107–11CrossRefGoogle ScholarPubMed
8 Naumann, M, Jost, WF, Toyka, KV. Botulinum toxin in the treatment of neurological disorders of the autonomic nervous system. Arch Neurol 1999;56:914–16CrossRefGoogle ScholarPubMed
9 Blasco, PA. Management of drooling: 10 years after the consortium on drooling, 1990. Dev Med Child Neurol 2002;44:778–81CrossRefGoogle Scholar
10 Bhatia, KP, Munchau, A, Brown, P. Botulinum toxin is a useful treatment in excessive drooling of saliva. J Neurol Neurosurg Psychiatry 1999;67:697–8CrossRefGoogle Scholar
11 Baer, SH, Scheuer, E, Buchman, AS, Jacobson, I, Zeev, BB. Botulinum toxin treatment for drooling in children with neurological disorders. Mov Disord 2002;17(suppl 5):735Google Scholar
12 Jongerius, PH, Rotteveel, JJ, Hoogen, FVD, Joosten, F, Hulst, KV, Gabreels, FJM. Botulinum toxin A: a new option for treatment of drooling in children with cerebral palsy. Presentation of a case series. Eur J Pediatr 2001;160:509–12CrossRefGoogle ScholarPubMed
13 Bothwell, JE, Clarke, K, Dooley, JM, Gordon, KE, Anderson, R, Wood, EP et al. Botulinum toxin A as a treatment for excessive drooling in children. Pediatr Neurol 2001;27:18–22CrossRefGoogle Scholar
14 Mancini, F, Zangaglia, R, Cristina, S, Sommaruga, MG, Martignoni, E, Nappl, G, Pacchetti, C. Double-blind, placebo controlled study to evaluate the efficacy and safety of botulinum toxin type A in the treatment of drooling in parkinsonism. Mov Disord 2003;18:685–8CrossRefGoogle ScholarPubMed
15 Geiss, R, Naumann, M, Werner, E, Riemann, R. Injections of botulinum toxin A into the salivary glands improve sialorrhoea in amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2000;69:121–3CrossRefGoogle Scholar
16 Jost, WH. Treatment of drooling in Parkinson's disease with botulinum toxin. Mov Disord 1999;14:1057–93.0.CO;2-4>CrossRefGoogle ScholarPubMed
17 Pal, PK, Calne, DB, Calne, SRN, Tsui, JKC. Botulinum toxin A as treatment for drooling saliva in Parkinson's disease. Neurology 2000;54:244–9CrossRefGoogle Scholar