Ultrasound-Guided Botox Injections of Salivary Glands in Children with Drooling

Meece, Roger W.; Fishlock, Keith F.; Bayley, Elizabeth W.; Keller, Marc S.

doi:10.1016/j.jradnu.2009.12.002

Cited by 16 publications

(25 citation statements)

References 12 publications

(17 reference statements)

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“…However, in the presence of saliva overflow, the most probable cause is an incoordination of tongue mobility, as it has been demonstrated that the quantity of saliva produced remains constant. In CP patients an abnormal coordination of head and trunk, and orofacial and palatolingual musculature, should be also considered 27-29.…”

Section: Discussionmentioning

confidence: 99%

Can muscle vibration be the future in the treatment of cerebral palsy-related drooling? A feasibility study.

Russo¹,

Calabrò

Sale

et al. 2019

Int. J. Med. Sci.

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Background: Drooling is an involuntary loss of saliva from the mouth, and it is a common problem for children with cerebral palsy (CP). The treatment may be pharmacological, surgical, or speech-related. Repeated Muscle Vibration (rMV) is a proprioceptive impulse that activates fibers Ia reaching the somatosensory and motor cortex. Aim: The aim of the study is to evaluate the effectiveness of rMV in the treatment of drooling in CP. Design, setting and population: This was a rater blinded prospective feasibility study, performed at the “Gli Angeli di Padre Pio” Foundation, Rehabilitation Centers (Foggia, Italy), involving twenty-two CP patients affected by drooling (aged 5-15, mean 9,28 ± 3,62). Children were evaluated at baseline (T0), 10 days (T1), 1 month (T2) and 3 months (T3) after the treatment. Methods: The degree and impact of drooling was assessed by using the Drooling Impact Scale (DIS), the Drooling Frequency and Severity Scale (DFSS), Visual Analogue Scale (VAS) and Drooling Quotient (DQ). An rMV stimulus under the chin symphysis was applied with a 30 min protocol for 3 consecutive days. Results: The statistical analysis shows that DIS, DFSS, VAS, DQ improved with significant differences in the multiple comparisons between T1 vs T2, T1 vs T3 and T1 vs T4 (p≤0.001). Conclusion This study demonstrates that rMV might be a safe and effective tool in reducing drooling in patients with CP. The vibrations can improve the swallowing mechanisms and favor the acquisition of the maturity of the oral motor control in children with CP.

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Section: Discussionmentioning

confidence: 99%

Can muscle vibration be the future in the treatment of cerebral palsy-related drooling? A feasibility study.

Russo¹,

Calabrò

Sale

et al. 2019

Int. J. Med. Sci.

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“…Although the procedure is usually performed under GA, evidence shows it to be an effective, minimally invasive treatment for drooling that is associated with few complications. The most favourable results have been shown to occur around 3 months after injection; with a requirement for re-injection becoming apparent at around 6 months [ 11 , 12 ]. Although some studies have utilised the same injection protocol [ 11 , 12 ], the ideal dosage and frequency of injections may need clarification through further studies.…”

Section: Managementmentioning

confidence: 99%

Surgical Management of the Drooling Child

Lawrence

Bateman

2018

Curr Otorhinolaryngol Rep

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Purpose of ReviewOur goal is to present the most up-to-date options in the surgical management of drooling in the paediatric population. While the clinical assessment of the drooling child and conservative management options are discussed, this review focuses on the most recent evidence for surgical interventions to treat drooling in children.Recent FindingsIn terms of advances in the management of drooling, further experience and outcomes with the use of botulinum toxin injections is discussed. Moreover, the latest evidence-base for salivary duct ligation and relocation procedures are presented. Finally, the trans-oral approach to submandibular gland excision for the management of drooling may gain popularity through the aim of reducing surgical morbidity.SummaryThe drooling child should be managed with an evidence-based stepwise approach delivered by a multidisciplinary team (MDT). Children with normal neurological development should be treated conservatively through parental reassurance. There are numerous interventions available for the drooling child with impaired neuromuscular development. When conservative measures fail, treatment options include botulinum toxin injections and surgical procedures such as salivary duct ligation, salivary duct relocation and salivary gland excision. Management must be targeted to the individual needs and comorbidities of the child to maximise treatment outcomes.

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“…367 papers identified 232 papers identified 1 Cochrane protocol identified 18 9 literature reviews; no systematic review with meta-analysis 12,35,[41][42][43][44][45][46][47] 26 papers reviewed for content 135 duplicates deleted 190 papers deleted on basis of title and abstract 5 randomized controlled trials 17-21 and 11 prospective studies [22][23][24][25][26][27][28][29][30][31] with usable information by outcome and included in meta-analysis 5 case studies (n≤4) and retrospective reviews discarded [48][49][50][51][52] 1 study discarded: no patients with cerebral palsy 53 6 papers discarded owing to lack of available quantitative data to be incorporated in meta-analysis. 10,11,[54][55][56][57] 3 studies discarded as they had injections of botulinum toxin with ≤3 monthly intervals [58][59][60] 1 study excluded as it included adult patients up to age 74 years 61 Figure 1: Included and excluded studies.…”

Section: Description Of Studiesmentioning

confidence: 99%

Salivary gland botulinum toxin injections for drooling in children with cerebral palsy and neurodevelopmental disability: a systematic review

Rodwell

Edwards

Ware

et al. 2012

Develop Med Child Neuro

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Aim The aim of this paper was to systematically review the efficacy and safety of botulinum toxin (BoNT) injections to the salivary glands to treat drooling in children with cerebral palsy and neurodevelopmental disability. Method A systematic search of The Cochrane Central Register of Controlled Trials, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE, and the Physiotherapy Evidence Database (PEDro) was conducted (up to 1 October 2011). Data sources included published randomized controlled trials (RCTs) and prospective studies. Results Sixteen studies met inclusion criteria. Three outcome measures support the effectiveness of BoNT for drooling. One RCT found an almost 30% reduction in the impact of drooling on patients’ lives, as measured by the Drooling Impact Scale (mean difference −27.45; 95% confidence interval [CI] −35.28 to −19.62). There were sufficient data to pool results on one outcome measure, the Drooling Frequency and Severity Scale, which supports this result (mean difference −2.71; 95% CI −4.82 to −0.60; p<0.001). There was a significant reduction in the observed number of bibs required per day. The incidence of adverse events ranged from 2 to 41%, but was inconsistently reported. One trial was terminated early because of adverse events. Interpretation BoNT is an effective, temporary treatment for sialorrhoea in children with cerebral palsy. Benefits need to be weighed against the potential for serious adverse events. More studies are needed to address the safety of BoNT and to compare BoNT with other treatment options for drooling.

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Ultrasound-Guided Botox Injections of Salivary Glands in Children with Drooling

Cited by 16 publications

References 12 publications

Can muscle vibration be the future in the treatment of cerebral palsy-related drooling? A feasibility study.

Can muscle vibration be the future in the treatment of cerebral palsy-related drooling? A feasibility study.

Surgical Management of the Drooling Child

Salivary gland botulinum toxin injections for drooling in children with cerebral palsy and neurodevelopmental disability: a systematic review

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