The official journal of the Korean Society for Neurorehabilitation (KSNR), and Asia-Oceanian Soceity for Neurorehabilitation (AOSNR)
pISSN 1976-8753 eISSN 2383-9910
Open Access, Peer-reviewed
Indexed in PubMed, PubMed Central, DOAJ and Korea Citation Index (KCI)
    Brain Neurorehabil. 2011 Sep;4(2):121-125. Korean.
    Published online Sep 30, 2011.
    https://doi.org/10.12786/bn.2011.4.2.121
    Copyright © 2011 Korean Society for Neurorehabilitation
    Original Article

    Effects of Botulinum Toxin A Injection into Salivary Glands of Patients with Brain Lesion Suffering from Posterior Drooling

    Zee Ihn Lee, M.D., Dong Hwi Park, M.D., Dong Hyun Jo, M.D., Won-Duck Choi, M.D. and Seung Deuk Byun, M.D.
      • Department of Rehabilitation Medicine, Daegu Fatima Hospital, Korea.
    • Corresponding author (Email: bdome@hanmail.net )
    Received February 28, 2011; Accepted July 15, 2011.

    Abstract

    Objective

    The aim of the study was to evaluate the effectiveness of ultrasouond-guided salivary gland injection of botulinum toxin A (BTX-A) for posterior drooling.

    Method

    11 patients with brain lesion (9 cerebral palsy, 1 hypoxic ischemic encephalopathy and 1 mental retardation) with posterior drooling (an initial PDAS score greater than 2) and related pulmonary problems were recruited. Drooling severity was measured at baseline, 4 weeks, 3 months and 6 months after botulinum toxin A injection, by using Teacher Drooling Scale (TDS), Visual Analogue Scales (VAS), Drooling Score System (DSS)-severity, frequency and Posterior Drooling/Aspiration System (PDAS).

    Results

    The TDS, DSS-severity, DSS-frequency, VAS, PDAS were significantly reduced at 4 weeks and 3 months after BTX-A injection into salivary glands compared to pre-injection (p<0.05). However, there were no significant changes at 6 months compared to pre-injection level.

    Conclusion

    BTX-A injection into salivary glands may improve anterior drooling in patients with brain lesions. Furthermore BTX-A injection into salivary glands may also decrease the posterior drooling which might related to respiratory symptoms in aspiration pneumonia.

    Keywords
    botulinum toxin type A; drooling; salivary glands

    Figures

    Fig. 1
    These figure shows the ultrasound guided botulinum toxin injection into salivary gland. Submandibular gland before botulinum toxin injection (A) after botulinum toxin injection (B).

    Tables

    Table 1
    Characteristics of Patients

    Table 2
    Posterior Drooling/Aspiration Scale

    Table 3
    Mean TDS, DSS-Severity, Frequency, VAS, PDAS Score Changes after Botulinum Toxin Injection

    References

      1. Blasco PA, Allarie JH. Drooling in the developmentally disabled: management practices and recommendations. Consortium on Drooling. Dev Med Child Neurol 1992;34:849–862.
      1. Jongerius PH, Hulst K, Hoogen FJ, Rotteveel JJ. The treatment of posterior drooling by botulinum toxin in a child with cerebral palsy. J Pediatr Gastroenterol Nutr 2005;41:351–353.
      1. Jeong MH, Yun MS, Ko TS. Parotid and submandibular botulinum toxin A injection for excessive Drooling children. J Korean Child Neurol Soc 2008;16:71–77.
      1. Pena AH, Cahill AM, Gonzalez L, Baskin KM, Kim HK, Towbin RB. Botulinum toxin A injection of salivary glands in children with drooling and chronic aspiration. J Vasc Interv Radiol 2009;20:368–373.
      1. Kang IS, Kwon JG, Lee SU, Lee ZI, Park GY, Park HW. Detection of saliva aspiration using salivagram in bedridden patients with brain lesion. J Korean Acad Rehabil Med 2010;34:503–507.
      1. Park HW, Sim YJ, Bang MS. A survey of drooling in children with cerebral palsy. J Korean Acad Rehabil Med 2007;31:535–540.
      1. Savarese R, Diamond M, Elovic E, Millis SR. Intraparotid injection of botulinum toxin A as a treatment to control sialorrhoea in children with cerebral palsy. Am J Phys Med Rehabil 2004;83:304–311.
      1. Suskind DL, Tilton A. Clinical study of botulinum-A toxin in the treatment of sialorrhea in children with cerebral palsy. Laryngoscope 2002;112:73–81.
      1. Bushara KO. Sialorrhea in amyotrophic lateral sclerosis: a hypothesis of a new treatment-botulinum toxin A injections of the parotid glands. Med Hypotheses 1997;48:337–339.
      1. Banerjee KJ, Glasson C, O'Flaherty SJ. Parotid and submandibular botulinum toxin A injections for sialorrhoea in children with cerebral palsy. Dev Med Child Neurol 2006;48:883–887.
      1. Dogu O, Apaydin D, Sevim S, Talas DU, Aral M. Ultrasound-guided versus 'blind' intraparotid injections of botulinum toxin-A for the treatment of sialorrhoea in patients with Parkinson's disease. Clin Neurol Neurosurg 2004;106:93–96.
      1. Gerlinger I, Szalai G, Hollody K, Nemeth A. Ultrasound-guided, intraglandular injection of botulinum toxin A in children suffering from excessive salivation. J Laryngol Otol 2007;121:947–951.
      1. Jongerius PH, Rotteveel JJ, van den Hoogen F, Joosten F, van Hulst K, Gabreels FJ. Botulinum toxin A: a new option for treatment of drooling in children with cerebral palsy. Presentation of a case series. Eur J Pediatr 2001;160:509–512.
      1. Jongerius PH, Joosten F, Hoogen FJ, Gabreels FJ, Rotteveel HH. The treatment of drooling by ultrasound-guided intraglandular injections of botulinum toxin type A into the salivary glands. Laryngoscope 2003;113:107–111.
      1. Jongerius PH, Frank JA, van den Hoogen FJ, van Limbeek J, Gabreels FJ, van Hulst K, Rotteveel JJ. Effect of botulinum toxin in the treatment of drooling: A controlled clinical trial. Pediatrics 2004;114:620–627.
      1. Jongerius PH, Rotteveel JJ, van Limbeek J, Gabreels FJ, van Hulst K, van den Hoogen FJ. Botulinum toxin effect on salivary flow rate in children with cerebral palsy. Neurology 2004;63:1371–1375.
    MeSH Terms
    Botulinum Toxins
    Botulinum Toxins, Type A
    Brain
    Cerebral Palsy
    Humans
    Hypoxia-Ischemia, Brain
    Pneumonia, Aspiration
    Salivary Glands
    Sialorrhea
    Sorbitol
    Stress, Psychological
    Tyramine
    Weights and Measures
    Metrics
    Share
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