Botulinum toxin in the management of sialorrhoea: a systematic review

Abstract

Sialorrhoea can be a significant problem in both adults and children and can cause both physical and psychosocial problems. Botulinum toxin has enjoyed an emergence in the treatment of sialorrhoea, a systematic review of the evidence for botulinum toxin reveals two randomised controlled trials (RCTs) and four other trials that fulfilled our inclusion criteria. Both RCTs demonstrate the effectiveness of botulinum toxin in the management of sialorrhoea. There was no clear evidence for one antigenic type of botulinum toxin over another and minimal evidence for the optimal dose of botulinum toxin for each antigenic type. No advantage is conferred in using ultrasound guidance in injecting the glands. None of the RCTs or other studies directly compared submandibular versus parotid injection or directly compared botulinum toxin against surgery. Minor side effects were reported in one of the RCTs but overall botulinum toxin is a safe, minimally invasive and effective means in the treatment of sialorrhoea with the potential to become the treatment of choice. Our review demonstrates that further randomised controlled trials are required to more fully evaluate this new modality of treatment.

Treatment of sialorrhoea in patients with Parkinson??s disease: best current evidence

“…Botulinum toxin has a duration of effect that lasts from a few weeks to 7 months and hence requires less frequent administration than anticholinergic medications [33]. However, it should be noted that with such a wide discrepancy in individual response to botulinum toxin, treatment could potentially be difficult to manage [34]. In addition, botulinum toxin should be used with extreme caution in PD patients experiencing significant dysphagia due to the potiential risk of transiently worsening swallowing.…”

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

“…Patients with neurological disorders often suffer from drooling while in the resting state rather than during eating. Thus, control of the saliva secreted by the submandibular gland is more important than control of the saliva from the parotid gland [13]. Since the submandibular gland is smaller than the parotid gland and can present in varying positions [13], injection into the target area can be difficult.…”

“…Thus, control of the saliva secreted by the submandibular gland is more important than control of the saliva from the parotid gland [13]. Since the submandibular gland is smaller than the parotid gland and can present in varying positions [13], injection into the target area can be difficult. In addition, adjacent structures around the submandibular gland, such as fat tissue and complex musculature, make it difficult to palpate the gland itself; thus, making it difficult to accurately inject BTX into the gland.…”

Speech Impairment, Phonation, Writing, Salivation, and Swallowing in Patients with Parkinson’s Disease

“…Sialorrhea deined as an overlow of saliva from the mouth (drooling) and negatively afects both patient's quality of life and social interactions [20,21]. Its etiology includes acute and chronic neurological disorders (such as PD), hypersecretion (inlammatory processes in oral cavity), adverse efects of some drugs, or anatomic abnormalities afecting oral cavity [22].…”