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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.

Author information

1
Division of Pediatric Interventional Radiology, Department of Radiology, Stanford University Medical Center, Palo Alto, California. Electronic address: mlungren@stanford.edu.
2
Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio.
3
Division of Otolaryngology, Department of Surgery, Stanford University Medical Center, Palo Alto, California.
4
Division of Pediatric Interventional Radiology, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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%.

CONCLUSIONS:

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.

KEYWORDS:

Botox; botulinum toxin A; pediatric; sialorrhea; ultrasound

[Indexed for MEDLINE]

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