title: Botulinum toxin A injection of salivary glands in children with drooling and chronic aspiration.
abstract: OBJECTIVE
  To review outcomes of ultrasound (US)-guided percutaneous submandibular gland injection of botulinum toxin A (BTX-A) in the treatment of drooling and chronic aspiration.
  
  
  METHODS
  A 3-year retrospective review was performed of 220 US-guided salivary gland injections in 36 patients. There were 21 male patients and 15 female patients with an age range of 1.4 to 19.8 years (mean, 8.6 y) and a weight range of 7.8 to 73 kg (mean, 24.4 kg). The mean pretreatment analysis period was 48 months and the mean follow-up period was 21 months. The study group was divided into groups with anterior (n = 9) and posterior (n = 27) drooling, with those with both (n = 10) included in the posterior group.
  
  
  RESULTS
  All procedures were technically successful. Bilateral submandibular injections were performed in 34 procedures and bilateral submandibular and parotid injections were performed in 38 procedures. Of the 27 patients with posterior drooling, improvement occurred in 24 patients (88%), no improvement was seen in two (8%), and one (4%) was lost to follow-up. Of the nine patients with anterior drooling, six (66%) showed improvement, there was no response in two (22%), and one (12%) was lost to follow-up. The total number of hospitalizations for respiratory issues and presumed aspiration pneumonia decreased by 56.4% per year in the patients with posterior drooling. There was one procedure-related complication: an episode of self-limited oral bleeding.
  
  
  CONCLUSIONS
  Salivary gland BTX-A injection for salivary control shows promising results in decreasing saliva production and frequency of respiratory symptoms in children with drooling and chronic aspiration.
authors.affiliation: Department of Radiology of The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
authors.forename: Andres H
authors.initials: AH
authors.lastname: Pena
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Cahill
authors.forename: Leonardo
authors.initials: L
authors.lastname: Gonzalez
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Baskin
authors.forename: Heakyung
authors.initials: H
authors.lastname: Kim
authors.forename: Richard B
authors.initials: RB
authors.lastname: Towbin
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007267:Injections; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage; D011015:Pneumonia, Aspiration / Q000150:complications / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D012189:Retrospective Studies; D012469:Salivary Glands; D012798:Sialorrhea / Q000150:complications / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A