Accuracy of Ultrasound-Guided and Non-ultrasound-Guided Botulinum Toxin Injection Into Cadaver Salivary Glands

Abstract

Objective To compare the accuracy of ultrasound (US)-guided and non-US-guided botulinum toxin (BTX) injection into the salivary glands (parotid and submandibular glands) of cadavers. Methods Two rehabilitation physician injected dye into three sites in the salivary glands (two sites in the parotid gland and one site in the submandibular gland) on one side of each cadaver (one was injected on the right side, while the other was injected on the left side), using either a non-US-guided injection procedure based on superficial landmarks or a US-guided procedure. Orange dye was used for the US-guided procedure, and green dye was used for the blind procedure. Two physicians uninvolved with the injection procedures and who were blinded to the method of injection dissected the cadavers to identify whether the dye was accurately injected into each target site. Results The accuracies of the blind and US-guided injections into the parotid gland were 79.17% and 95.83%, respectively. In the submandibular gland, the accuracies of the blind and US-guided injections were 50.00% and 91.67%, respectively. The difference in accuracy between the two procedures was statistically significant only in the submandibular gland (p=0.025). There were no significant differences in the accuracy of US-guided and non-US-guided injections between the two physicians for the two sites in the parotid gland (p=0.278 and p=0.146, respectively). Conclusion US-guided BTX injection into the submandibular gland offers significantly greater accuracy over blind injection. For the treatment of drooling by injecting BTX into the submandibular gland, clinicians should consider using US guidance for improved accuracy.

Localization of Salivary Glands for Botulinum Toxin Treatment: Ultrasound Versus Landmark Guidance

“…One may now conclude that a correction of the suggested landmarks to a more posterior point would be sufficient, but even by injecting within this safety zone a comparison of guidance techniques in cadavers showed a significantly higher injection accuracy of US versus LM guidance for the SG (92% vs. 50%). 7 The poor target rate with LM guidance in the case of the SG is most likely attributable to the individual anatomical variance. There is, on the one hand, a known variability in volume of the SG, which differs between 1.6 and 15 mL.…”

“…Deliver injection 1 cm anterior to this… ” and the submandibular gland (SG) at “… the midpoint between the angle of the mandible and the tip of the chin. Inject 1 finger breath medial to the inferior surface of the mandible at this point ” in reference to McGeachan et al However, current guidelines recommend the use of ultrasound (US), a view that is corroborated by the finding of significantly higher accuracy in targeting the SG under US guidance compared to anatomical landmarks (LM) . This prompted us to compare the LM approach and the US approach in adult volunteers to assess the accuracy of targeting methods to provide relevant information for clinicians treating sialorrhea with BoNT.…”

Prolongiertes Weaning

“…Bei großen Speichelseen oberhalb des Larynx können Anticholinergika (z. B. Scopolamin-Pflaster), als individueller Heilversuch auch Botulinumtoxin-Injektionen in die Speicheldrüsen [572], zur Verminderung der Speichelproduktion eingesetzt werden. Hierdurch werden das passagere Entblocken der Trachealkanüle, die Zunahme des physiologischen Luftflusses und die Verbesserung der Propriozeption der oberen Atemwege ermöglicht.…”

Feasibility of Ultrasound-Guided Trigger Point Injection in Patients with Myofascial Pain Syndrome

“…Injections are frequently performed based on anatomical landmarks on palpation, thus termed as a blind technique [34]. It remains uncertain, however, whether there is an appropriate placement or misplacement of injected treatment agents at the MTrPs [35].…”