Ultrasound guided botulinum toxin injections into salivary glands: minimal invasive and safe treatment for drooling

      Drooling, the unintentional loss of saliva from the mouth, creates major hygienic and psychosocial problems. It may be caused by excessive production of saliva (due to antipsychotics and cholinergic agonists) or by poor swallowing function (neurologic diseases, post-laryngectomy patients, etc.). The prolonged excessive drooling can cause various health conditions ranging from perioral skin infections to lung aspirations.
      Traditionally, drooling was treated by pharmacologic agents, holding many adverse effects while presenting questionable success rate. Surgery was considered in recalcitrant cases or in cases with intolerable drug reactions, with obvious morbidity and mortality issues. Lately, the use of botulinum toxin injected into salivary gland has been proposed as another treatment method for drooling.
      Botulinum toxin was introduced into medicine 30 years ago and became the first bacterial toxin used as a drug. It is a potent neurotoxin that temporarily inactivates release of acetylcholine from nerve endings and thus blocks nerve stimuli to target areas. Only few publications explored the efficacy and safety of botulinum toxin injections into salivary glands as a treatment for drooling.
      This presentation describes our experience with ultrasound-guided intraglandular injections of botulinum toxin into the submandibular and parotid glands for the treatment of drooling. During a 1-year period, twenty patients were treated using this technique. We describe patient's characteristics, operative technique, outcome of treatment, onset and duration of effect, and adverse events.
      Ultrasound-guided intra-glandular botulinum toxin injection is a simple, safe, and efficacious therapeutic modality that should be considered by oral and maxillofacial surgeons treating patients with drooling.