Recurrent jaw dislocation after botulinum toxin treatment for sialorrhoea in amyotrophic lateral sclerosis

Tan, Eng‐King; Lo, Yew Long; Seah, A.; Auchus, Alexander P.

doi:10.1016/s0022-510x(01)00565-2

Cited by 72 publications

(40 citation statements)

References 7 publications

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“…Incidental side-effects have been reported, such as flu-like symptoms lasting for less than 2 days, swallowing difficulties, viscous saliva and dryness of the mouth, transient slight weakness of the masseter muscle or mouth openers, and, rarely, jaw dislocation. [1][2][3][4][5][6] Human saliva serves multiple functions in the oral cavity, including moistening of food, facilitation of mastication and swallowing, and cleaning and lubrication of the oral mucosa. 7 The seromucous sublingual, submandibular, and palatine glands secrete mucins that coat and protect the epithelial tissue of the oral cavity and give the typical viscoelastic character to saliva.…”

Section: Discussionmentioning

confidence: 99%

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Thickened saliva after effective management of drooling with botulinum toxin A

Erasmus

Hulst

Hoogen

et al. 2010

Develop Med Child Neuro

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AIM The aim of this study was to evaluate the rheological properties of saliva after submandibular botulinum toxin type A (BoNT-A) injections.METHOD We enrolled 15 children (11 males and six females; age range 3-17y, mean age 9y 10mo) diagnosed with spastic (n=9) or dyskinetic (n=6) quadriplegic cerebral palsy (CP); Gross Motor Function Classification System level IV or V; and two children with intellectual disability (IQ <70) who experienced moderate to severe drooling. Salivary flow rate and drooling quotient were measured at baseline and at different times after BoNT-A injections up to 24 weeks. The mucin concentration of saliva was analysed before and after BoNT-A treatment.RESULTS Both submandibular salivary flow rate (baseline 0.38mL ⁄ min; 24wks after injection 0.26mL ⁄ min) and drooling quotient (baseline 42.5%; 24wks 28.80%) were substantially reduced, with a concomitant increase in mucin concentration within 8 weeks after BoNT-A injection (from 0.612 to 1.830U ⁄ mL). The parents of nine children observed thickened saliva. Swallowing and chewing were problematic in seven children. Two of these children needed treatment with mucolytics because of pooling of thickened saliva in the throat. INTERPRETATIONWhen making decisions about the use of BoNT-A, the risk of problems with masticatory and swallowing functions as a result of thickening of saliva after BoNT-A treatment should be taken into account.Local injection of botulinum toxin type A (BoNT-A) into the salivary glands is used to prevent drooling. BoNT-A causes a temporary inhibition of SNAP-25, the presynaptic acetylcholine exocytotic synaptosome-associated protein which has a molecular weight of 25kDa. As a result, the gland's capacity to secrete water is depressed. After BoNT-A injection, basal saliva secretion is usually sufficient to moisten the oral cavity and to facilitate swallowing of food. Incidental side-effects have been reported, such as flu-like symptoms lasting for less than 2 days, swallowing difficulties, viscous saliva and dryness of the mouth, transient slight weakness of the masseter muscle or mouth openers, and, rarely, jaw dislocation. [1][2][3][4][5][6] Human saliva serves multiple functions in the oral cavity, including moistening of food, facilitation of mastication and swallowing, and cleaning and lubrication of the oral mucosa. 7 The seromucous sublingual, submandibular, and palatine glands secrete mucins that coat and protect the epithelial tissue of the oral cavity and give the typical viscoelastic character to saliva. Salivary mucins are primarily wetting agents that play a role in lubricating the tissue-environmental interface to reduce friction. 8,9 We have observed that in some children the saliva becomes sticky after intraglandular botulinum toxin injection and postulated that sticky saliva may cause swallowing problems as a result of an increase in protein concentrations and hence salivary viscosity, resulting in greater friction. 10 Previous studies have focused on the effect of BoNT-A on salivary proteins such as se...

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Section: Discussionmentioning

confidence: 99%

“…A total dose of 30U up to 50U of Botox (Allergan BV, Nieuwegein, the Netherlands) was used. Drooling intensity and salivary flow were measured at baseline and at 2,4,8,16, and 24 weeks after injection. A least two mucin activity measurements within 8 weeks after treatment with BoNT-A were required for inclusion in the study.…”

Section: Methodsmentioning

confidence: 99%

Thickened saliva after effective management of drooling with botulinum toxin A

Erasmus

Hulst

Hoogen

et al. 2010

Develop Med Child Neuro

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“…Since then, there has been limited data reporting a significant reduction of sialorrhea in patients suffering from neurodegenerative disorders, including PD patients, following injections of BTX-B into the parotid glands, both with and without ultrasound guidance [11]. Transient mild side effects, like mouth dryness and dysphagia worsening, were reported at a similar rate as following botulinum toxin type A treatment [12][13][14].…”

Section: Discussionmentioning

confidence: 99%

Long-lasting benefits of botulinum toxin type B in Parkinson’s disease-related drooling

et al. 2009

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“…An mög li chen Ne ben wir kun gen der lo kalen In jek ti ons be hand lung sind eine Kie ferschluss schwä che [9,32], eine Kie fer dis loka ti on [55], Schluck stö run gen [9] so wie Mund tro cken heit [46] be schrie ben worden. Wei te re po ten zi el le Ne ben wir kun gen sind auf grund der ana to mi schen Ge ge benhei ten Ver let zun gen der Äste des N. fa cialis oder der A. caro tis, eine lo ka le In fek tionen oder eine Spei chel stein bil dung.…”

Section: Ne Ben Wir Kun Genunclassified

Die Behandlung der Sialorrhö mit Botulinum-Toxin

et al. 2005

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Hypersalivation (sialorrhea) is a common complaint of patients with neurodegenerative disorders such as Parkinson's disease or amyotrophic lateral sclerosis and a frequently disabling side effect of atypical antipsychotic drugs. Conventional treatment including oral anticholinergic or antihistamine medication is often limited by adverse effects and lack of efficacy. Over the past few years, several studies reported decreased drooling after injections of botulinum toxin into the salivary glands. This review describes the current state of treatment of sialorrhea with botulinum toxin.

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Recurrent jaw dislocation after botulinum toxin treatment for sialorrhoea in amyotrophic lateral sclerosis

Cited by 72 publications

References 7 publications

Thickened saliva after effective management of drooling with botulinum toxin A

Thickened saliva after effective management of drooling with botulinum toxin A

Long-lasting benefits of botulinum toxin type B in Parkinson’s disease-related drooling

Die Behandlung der Sialorrhö mit Botulinum-Toxin

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