title: Botulinum toxin injections for chronic sialorrhoea in children are effective regardless of the degree of neurological dysfunction: A single tertiary institution experience.
abstract: OBJECTIVE
  To determine the effectiveness of submandibular salivary gland Botulinum Toxin Type-A (BTX-A) injection in the treatment of drooling in children with varying degrees of neurological dysfunction.
  
  
  METHODS
  A retrospective review of pre- and post-procedure drooling frequency and severity scores of patients receiving BTX-A between January 2008 and January 2013. Stratification to different subgroups of neurological impairment was performed according to Gross Motor Function Classification System (GMFCS) score. Drooling severity was assessed using Thomas-Stonell and Greenberg symptom questionnaires administered at time of initial consultation and 3 months after treatment.
  
  
  RESULTS
  48 sets of BTX-A injections in 26 patients with an average age of 9.45 years (range 7 months-18 years) were included in the study. Marked improvement in drooling was seen in 60.4% of patients, a marginal or brief improvement was seen in 20.8% and there was no improvement in 18.8%. No adverse events were reported following any of the BTX-A injections. BTX-A was safe and effective in the eight patients with pre-existing swallowing dysfunction. Subsequent drooling surgery was performed in 15 (57.7%) of the cohort, all 15 patients responded to BTX-A injections. In patients with Cerebral Palsy, there was no correlation between the severity of the neurological dysfunction as measured by the Gross Motor Function Classification System (GMFCS) score and the response to BTX-A treatment.
  
  
  CONCLUSIONS
  Injection of BTX-A to the submandibular glands of children with neurological disorders is a safe procedure and results in a reduction in drooling in the majority of patients. Children with severe neurological dysfunction respond to BTX-A injections as effectively as their less impaired peers and the degree of response does not appear to be associated with the severity of neurological disability. BTX-A injection is a good initial procedure when drooling surgery is being considered.
authors: Department of Pediatric Otolaryngology, Starship Children's Health, Park Road, Grafton, Auckland, 1023, New Zealand. Electronic address: MuraliM@adhb.govt.nz.
authors: Murali
authors: M
authors: Mahadevan
authors: Department of Pediatric Otolaryngology, Starship Children's Health, Park Road, Grafton, Auckland, 1023, New Zealand.
authors: Maayan
authors: M
authors: Gruber
authors: Department of Pediatric Otolaryngology, Starship Children's Health, Park Road, Grafton, Auckland, 1023, New Zealand.
authors: Darin
authors: D
authors: Bilish
authors: Child Rehabilitation Service, Starship Children's Health, Park Road, Grafton, Auckland, 1023, New Zealand.
authors: Kathryn
authors: K
authors: Edwards
authors: Department of Paediatric Radiology, Starship Children's Health, Park Road, Grafton, Auckland, 1023, New Zealand.
authors: David
authors: D
authors: Davies-Payne
authors: Department of Pediatric Otolaryngology, Starship Children's Health, Park Road, Grafton, Auckland, 1023, New Zealand.
authors: Graeme
authors: G
authors: van der Meer
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000150:complications*; D005260:Female; D006801:Humans; D007223:Infant; D007267:Injections; D008297:Male; D009422:Nervous System Diseases / Q000150:complications; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D012189:Retrospective Studies; D012798:Sialorrhea / Q000188:drug therapy* / Q000209:etiology; D013363:Submandibular Gland; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Botox(®); Botulinum toxin type-A; Cerebral palsy; Drooling; Sialorrhoea; Submandibular glands