title: Control of salivary secretions in esophageal atresia with laryngeal cleft using Botulinum toxin Type A.
abstract: A baby born with esophageal atresia and a laryngeal cleft is presented. Retained salivary secretions and aspiration were a constant management problem whilst the baby was waiting for delayed primary repair of the atresia. The use of anticholinergic agents resulted in thickening of secretions which were difficult to suction and ultimately led to increasing respiratory compromise. Intraglandular salivary gland injection of Botulinum toxin type A was performed using ultrasound guidance. The mean daily salivary flow output prior to treatment was 59 ml. On glycopyrrolate the mean daily salivary output on glycopyrrolate was 16 ml. After Botulinum injection the mean daily salivary output was 7 ml in the 3 weeks after injection. Over the next 14 weeks this increased to 34 ml. There were no adverse effects or significant thickening of secretions after BTX injection. This is the first reported use of Botulinum toxin injection in the management of salivary aspiration in esophageal atresia with laryngeal cleft.
authors.affiliation: Department of Ear, Nose & Throat Surgery, The Sheffield Children's Hospital, Western Bank, Sheffield, South Yorkshire, UK. ravi.theva@sch.nhs.uk
authors.forename: M S
authors.initials: MS
authors.lastname: Thevasagayam
authors.forename: Kenton
authors.initials: K
authors.lastname: Gan
authors.forename: Eduard
authors.initials: E
authors.lastname: Eksteen
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D004933:Esophageal Atresia / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007267:Injections; D007830:Larynx / Q000002:abnormalities*; D011015:Pneumonia, Aspiration / Q000209:etiology; D012469:Salivary Glands; D012472:Salivation / Q000187:drug effects*
chemical_list: D019274:Botulinum Toxins, Type A