Botulinumtoxin bei funktioneller Hypersalivation – alles eine Frage der Dosis?

Abstract

Botulinum toxin injection as a treatment of hypersalivation is an effective method with only minor side effects, even in increased dosage levels. Nevertheless, certain modifications according to each individual treatment are required. Possible side effects such as swallowing problems or non-responding situations should always be part of informed consent, especially as the latter is even possible for higher dosage levels.

Current Aspects of Treatment Options of Chronic Sialorrhea in Children

“…Excessive salivation frequently occurs in children suffering from cerebral palsy (rates between 10% and 58%) [1, 4, 5, 7, 11, 14, 18, 22, 33-35, 39, 40, 42, 43]. This is caused by early brain damage before or at birth or in infancy, which becomes apparent in the first years of life in physical limitations and reduced intelligence [2,3,6,[8][9][10]. Depending on the severity of the disease, the affected children suffer from movement disorders, swallowing difficulties and lack of control over certain muscle groups in the mouth area, among other things .…”

“…Saliva contains mucin, opiorphin, IgA and haptocorrin and to a highest content of water [ 6 , 7 , 9 , 12 , 34 , 35 ]. Saliva production will be controlled by parasympathetic and sympathetic nerve system.…”

“…Saliva production in children is measured in children in a rate up to 1.5 L/day, whereas 3.5 mL/min is defined as hypersalivation, accordingly 5 L/day. Saliva is produced in general in six salivary glands, in two parotid glands, in two submandibular glands and two sublingual glands (both sides included) [ 1 , 3 , 5 , 6 , 9 , 14 ]. In unactivated state, saliva will be produced in submandibular and sublingual glands, whereas in activated state, the parotid glands on both sides play a more important role in producing saliva [ 1 , 8 , 9 , 26 , 41 ].…”

“…Saliva is produced in general in six salivary glands, in two parotid glands, in two submandibular glands and two sublingual glands (both sides included) [ 1 , 3 , 5 , 6 , 9 , 14 ]. In unactivated state, saliva will be produced in submandibular and sublingual glands, whereas in activated state, the parotid glands on both sides play a more important role in producing saliva [ 1 , 8 , 9 , 26 , 41 ]. Salivary production is normal in newborn, finishes around the 15-18th months of age and is pathological at age 4 [ 1 , 3 , 5 , 6 , 9 , 14 ].…”

Hypersalivation – Aktualisierung der S2k-Leitlinie (AWMF) in gekürzter Darstellung

“…In der lang andauernden Phase der verminderten Hypersalivation können intensivierte oder bislang wegen der Speichelaspiration nicht mögliche schlucktherapeutische Übungen eine zugrunde liegende Dysphagie entscheidend verbessern. Gerade bei der langfristigen Betreuung der Patienten sind Dosisanpassungen nicht ungewöhnlich und in einzelnen Fällen viele Einheiten für den gewünschten Effekt notwendig [78]. Bei Patienten mit Kopf-Hals-Tumoren und Hypersalivation sind z. T. Kompromisse zu schließen, um einen zu zähen Speichel im Sinne einer Überdosierung zu vermeiden.…”