title: Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea.
abstract: Neurological diseases can be complicated by sialorrhea, an excessive flow of saliva. Patients suffering from moderate to severe sialorrhea have an impaired quality of life, often worsened by correlated complications such as aspiration pneumonia, oral infections, dental caries, and maceration of the skin. Diverse therapeutic approaches have been proposed for the treatment of sialorrhea, including surgery and the use of anticholinergic agents, with limited results and the possible occurrence of serious adverse events. Recently, botulinum toxin (BoNT) injection within the major salivary glands has been proposed in patients refractory to anticholinergic therapy, with the aim of inhibiting local acetylcholine release and gland activity. In order to obtain a better outcome in terms of reduction of saliva production, efficacy, duration, and avoidance of major adverse events, we developed an ultrasound-guided BoNT-type A injection technique accurately described in the text. Here we present a method of treating sialorrhea with bilateral parotid and submandibular gland BoNT-type A injections under ultrasound guidance. Four quadrants of the parotid gland and two quadrants of the submandibular gland are visualized and injected using two accesses and one access, respectively. The ultrasound-guided procedure provides a simple, non-invasive, real-time visualization of the muscular and glandular tissues and their surrounding structures, optimizing treatment efficacy and safety.
authors.affiliation: Clinical and Biological Sciences Department, Neurology Unit, University of Torino, San Luigi Gonzaga Hospital.
authors.forename: Pierangelo
authors.initials: P
authors.lastname: Barbero
authors.affiliation: Oncology Department, Radiology Unit, University of Torino, San Luigi Gonzaga Hospital.
authors.forename: Marco
authors.initials: M
authors.lastname: Busso
authors.affiliation: Clinical and Biological Sciences Department, Neurology Unit, University of Torino, San Luigi Gonzaga Hospital; caartusi@gmail.com.
authors.forename: Carlo Alberto
authors.initials: CA
authors.lastname: Artusi
authors.affiliation: Clinical and Biological Sciences Department, Neurology Unit, University of Torino, San Luigi Gonzaga Hospital.
authors.forename: Stefania
authors.initials: S
authors.lastname: De Mercanti
authors.affiliation: Clinical and Biological Sciences Department, Dietologic and Nutrition Unit, University of Torino, San Luigi Gonzaga Hospital.
authors.forename: Marco
authors.initials: M
authors.lastname: Tinivella
authors.affiliation: Oncology Department, Radiology Unit, University of Torino, San Luigi Gonzaga Hospital.
authors.forename: Andrea
authors.initials: A
authors.lastname: Veltri
authors.affiliation: Clinical and Biological Sciences Department, Neurology Unit, University of Torino, San Luigi Gonzaga Hospital.
authors.forename: Luca
authors.initials: L
authors.lastname: Durelli
authors.affiliation: Clinical and Biological Sciences Department, Neurology Unit, University of Torino, San Luigi Gonzaga Hospital.
authors.forename: Marinella
authors.initials: M
authors.lastname: Clerico
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003731:Dental Caries; D006801:Humans; D007267:Injections / Q000009:adverse effects; D011788:Quality of Life; D012798:Sialorrhea / Q000628:therapy*; D013363:Submandibular Gland; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D019274:Botulinum Toxins, Type A