title: Ultrasound-Guided Botulinum Toxin Type A Salivary Gland Injection in Children for Refractory Sialorrhea: 10-Year Experience at a Large Tertiary Children's Hospital.
abstract: BACKGROUND
  Sialorrhea is problematic for neurologically impaired children, and botulinum toxin A salivary gland injection has been reported as effective in reducing sialorrhea. This article assesses the success and safety of ultrasound-guided weight-based botulinum toxin A injection for the management of sialorrhea in children.
  
  
  METHODS
  A total of 111 patients (63 males; 48 females; average age 7 years) with refractory sialorrhea were treated with ultrasound-guided botulinum toxin type A salivary gland injections (144 procedures) from July 1, 2004, to July 1, 2014, using a single weight-based protocol. Patient history, procedural records, and clinical follow-up documents were retrospectively reviewed. Clinical data were compared with reported effectiveness and complications using odds ratios.
  
  
  RESULTS
  A total of 144 procedures were performed in 111 patients with refractory sialorrhea. Cerebral palsy was the most common underlying etiology for sialorrhea (29%), whereas others included encephalopathy (5%), anoxic brain injury (4%), and a variety of chromosomal anomalies (5%). There was a 100% technical success rate. Overall treatment effectiveness was 68%. Repeat injections were not associated with increased clinical success. No procedure-related deaths or major complications were identified; the minor complication rate was less than 2%.
  
  
  CONCLUSIONS
  The protocol used for ultrasound-guided injection of botulinum toxin A proved to be safe and effective in children suffering from sialorrhea. Image guidance technique may lead to a reduction in rates of adverse events reported in other series. Subsequent procedures do not improve upon initial efficacy.
authors.affiliation: Division of Pediatric Interventional Radiology, Department of Radiology, Stanford University Medical Center, Palo Alto, California. Electronic address: mlungren@stanford.edu.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Lungren
authors.affiliation: Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio.
authors.forename: Sarah
authors.initials: S
authors.lastname: Halula
authors.affiliation: Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio.
authors.forename: Sarah
authors.initials: S
authors.lastname: Coyne
authors.affiliation: Division of Otolaryngology, Department of Surgery, Stanford University Medical Center, Palo Alto, California.
authors.forename: Douglas
authors.initials: D
authors.lastname: Sidell
authors.affiliation: Division of Pediatric Interventional Radiology, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: John M
authors.initials: JM
authors.lastname: Racadio
authors.affiliation: Division of Pediatric Interventional Radiology, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Manish N
authors.initials: MN
authors.lastname: Patel
mesh_terms: D000293:Adolescent; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000009:adverse effects; D002547:Cerebral Palsy / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007267:Injections / Q000009:adverse effects / Q000379:methods; D008297:Male; D009498:Neurotoxins / Q000008:administration & dosage* / Q000009:adverse effects; D019233:Retreatment / Q000009:adverse effects; D012189:Retrospective Studies; D012469:Salivary Glands / Q000000981:diagnostic imaging / Q000187:drug effects*; D012798:Sialorrhea / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000379:methods; D055815:Young Adult
chemical_list: D009498:Neurotoxins; D019274:Botulinum Toxins, Type A
keywords: Botox; botulinum toxin A; pediatric; sialorrhea; ultrasound