title: Drooling: are botulinum toxin injections into the major salivary glands a good treatment option?
abstract: There are several treatment options available for drooling; botulinum toxin injections into the major salivary glands are one. There is no consensus as to how many and which glands should be injected. A research project on this topic was terminated because of adverse effects. Individual results and the adverse effects are described and discussed in this article. Six individuals with cerebral palsy were randomly allocated to 2 treatment groups, with five individuals receiving ultrasound-guided injections to parotid and submandibular glands and one receiving injections to the submandibular glands only. Reduction of observed drooling was registered in 3, while 4 patients reported subjective improvement (Visual Analog Scale). Two participants reported adverse effects, including dysphagia, dysarthria, and increased salivary viscosity. Injections with botulinum toxin can be a useful treatment option but there is a risk of adverse effects. Multidisciplinary evaluation and informed discussions with patients/caregivers are important factors in the decision-making process.
authors.affiliation: National Resource Centre for Oral Health in Rare Medical Conditions, Lovisenberg Diakonale Hospital, Oslo, Norway. hino@tako.no
authors.forename: Hilde
authors.initials: H
authors.lastname: Nordgarden
authors.forename: Ingvild
authors.initials: I
authors.lastname: Østerhus
authors.forename: Anne
authors.initials: A
authors.lastname: Møystad
authors.forename: Pamela
authors.initials: P
authors.lastname: Asten
authors.forename: Ulf L-H
authors.initials: UL
authors.lastname: Johnsen
authors.forename: Kari
authors.initials: K
authors.lastname: Storhaug
authors.forename: Jens Øyvind
authors.initials: JØ
authors.lastname: Loven
mesh_terms: D000293:Adolescent; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000150:complications / Q000188:drug therapy; D002648:Child; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009498:Neurotoxins / Q000627:therapeutic use*; D012469:Salivary Glands / Q000187:drug effects / Q000502:physiology*; D012472:Salivation / Q000187:drug effects; D012798:Sialorrhea / Q000188:drug therapy* / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
chemical_list: D018726:Anti-Dyskinesia Agents; D009498:Neurotoxins; D019274:Botulinum Toxins, Type A