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Pediatr Neurol. 2016 Jan;54:70-5. doi: 10.1016/j.pediatrneurol.2015.09.014. Epub 2015 Sep 28.

Ultrasound-Guided Botulinum Toxin Type A Salivary Gland Injection in Children for Refractory Sialorrhea: 10-Year Experience at a Large Tertiary Children's Hospital.

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Division of Pediatric Interventional Radiology, Department of Radiology, Stanford University Medical Center, Palo Alto, California. Electronic address:
Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio.
Division of Otolaryngology, Department of Surgery, Stanford University Medical Center, Palo Alto, California.
Division of Pediatric Interventional Radiology, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.



Sialorrhea is problematic for neurologically impaired children, and botulinum toxin A salivary gland injection has been reported as effective in reducing sialorrhea. This article assesses the success and safety of ultrasound-guided weight-based botulinum toxin A injection for the management of sialorrhea in children.


A total of 111 patients (63 males; 48 females; average age 7 years) with refractory sialorrhea were treated with ultrasound-guided botulinum toxin type A salivary gland injections (144 procedures) from July 1, 2004, to July 1, 2014, using a single weight-based protocol. Patient history, procedural records, and clinical follow-up documents were retrospectively reviewed. Clinical data were compared with reported effectiveness and complications using odds ratios.


A total of 144 procedures were performed in 111 patients with refractory sialorrhea. Cerebral palsy was the most common underlying etiology for sialorrhea (29%), whereas others included encephalopathy (5%), anoxic brain injury (4%), and a variety of chromosomal anomalies (5%). There was a 100% technical success rate. Overall treatment effectiveness was 68%. Repeat injections were not associated with increased clinical success. No procedure-related deaths or major complications were identified; the minor complication rate was less than 2%.


The protocol used for ultrasound-guided injection of botulinum toxin A proved to be safe and effective in children suffering from sialorrhea. Image guidance technique may lead to a reduction in rates of adverse events reported in other series. Subsequent procedures do not improve upon initial efficacy.


Botox; botulinum toxin A; pediatric; sialorrhea; ultrasound

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