Ultrasound-guided, intraglandular injection of botulinum toxin A in children suffering from excessive salivation.
BACKGROUND
The aim of this study was to describe the authors' minimally invasive procedure developed to significantly decrease excessive salivation in children suffering from chronic neurological diseases, using botulinum toxin A.


OBJECTIVE
Ultrasound-guided, intraglandular injection of botulinum toxin blocks the parasympathetic innervation of salivary glands, resulting in a temporary decrease in saliva production and improved quality of life, lasting about three to four months.


METHODS
Prior to introducing the method into clinical practice, animal experiments were conducted in order to verify the lack of histological changes three months following botulinum toxin administration. Twenty-one children were included in the clinical study, with ages ranging from two and a half to 14 years.


RESULTS
The animal studies did not reveal any histological changes three months after botulinum toxin administration. Although botulinum toxin A proved to be ineffective in a single case, the majority of the other 20 patients responded well, with a highly significant reduction of their symptoms. The parents of 18 responder children requested repeated treatment with botulinum toxin A. However, two families refused to be further involved in the study, despite good results. The protein content of saliva, regulated by sympathetic innervation, was not affected by the treatment.


CONCLUSIONS
This minimally invasive method, applied repeatedly three to four times a year, may be a viable alternative to surgical procedures such as submandibular duct relocation, duct ligature or nervus tympanicus neurectomy.
Gerlinger
I
I
Department of Otorhinolaryngology & Head and Neck Surgery, University of Pécs, Hungary. gerlingerimre@hotmail.com
Szalai
G
G
Hollódy
K
K
Németh
A
A
D000293:Adolescent; D000818:Animals; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D012798:Sialorrhea / Q000188:drug therapy*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A