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Facial Plastic Surgery Clinics of North... Nov 2003Botulinum toxin (BTX) is a safe and reliable drug for the treatment of Frey's syndrome and hypersialorrhea. Currently, the intradermal injection of BTX is the standard... (Review)
Review
Botulinum toxin (BTX) is a safe and reliable drug for the treatment of Frey's syndrome and hypersialorrhea. Currently, the intradermal injection of BTX is the standard treatment of Frey's syndrome. A disappearance of Frey's syndrome for 1 to 1.5 year could almost be promised. Recently, BTX was introduced for the treatment of hypersialorrhea. Although some questions exist about the optimal dosage and the type of major salivary glands that should be treated, hypersialorrhea was reduced in almost all affected children and adults for up to 6 months by using ultrasound-guided intraglandular BTX injections.
Topics: Botulinum Toxins, Type A; Humans; Injections; Injections, Intramuscular; Neuromuscular Agents; Salivary Glands; Sialorrhea; Sweating, Gustatory
PubMed: 15062255
DOI: 10.1016/S1064-7406(03)00075-0 -
NeoReviews Jan 2021
Topics: Humans; Infant; Sialorrhea
PubMed: 33386316
DOI: 10.1542/neo.22-1-e58 -
International Journal of Pediatric... Jan 2003Sialorrhea can have a significant negative effect on quality of life, impeding social interactions and severely limiting employment opportunities. Many surgical options... (Review)
Review
OBJECTIVE
Sialorrhea can have a significant negative effect on quality of life, impeding social interactions and severely limiting employment opportunities. Many surgical options to control sialorrhea have been reported. One of the newest procedures is combined ligation of the submandibular and parotid ducts, reported only once in the literature in one series of five patients to date. We have compared results in our first 21 patients undergoing this procedure with results reported in the literature for other procedures to treat sialorrhea.
MATERIALS AND METHODS
We retrospectively reviewed medical records of all 21 children we treated with four-duct ligation, a relatively simple intraoral procedure to control sialorrhea, between August 1999 and September 2000 and contacted primary caregivers by telephone to answer a questionnaire regarding objective and subjective results of surgery. Surgery was considered successful when caregivers rated patients as 'much better' or 'better' after surgery.
RESULTS
Follow-up was completed in all 21 of the patients 1-14 months after surgery. The success rate of four-duct ligation ('much better' or 'better' after surgery) was 81%, and no patient's sialorrhea problem was worse after surgery. Major complications occurred in two (10%) of the patients (one ranula and one case of sialoadenitis), which were both successfully treated surgically. Minor complications occurred in four (19%) of the patients, tongue swelling that prolonged hospitalization, a ranula that resolved, and prolonged submandibular gland swelling that resolved (two cases). More than half of patients were discharged the day of or the day after surgery.
CONCLUSIONS
Four-duct ligation should be considered when surgery is indicated to treat sialorrhea.
Topics: Follow-Up Studies; Hospitalization; Humans; Length of Stay; Ligation; Postoperative Complications; Retrospective Studies; Sialorrhea; Treatment Outcome
PubMed: 12560141
DOI: 10.1016/s0165-5876(02)00281-1 -
The Annals of Otology, Rhinology, and... Feb 2019The aim of this study was to assess the effectiveness of bilateral submandibular duct relocation and bilateral sublingual gland excision in combination with botulinum... (Review)
Review
OBJECTIVES:
The aim of this study was to assess the effectiveness of bilateral submandibular duct relocation and bilateral sublingual gland excision in combination with botulinum toxin A injection into the parotid glands in children with sialorrhea. Previously in the literature, either surgery or botulinum toxin injection but not their combination has been reported.
METHODS:
Preoperative and at least 6-month postoperative assessments using the Drooling Severity Scale and Drooling Frequency Scale (Thomas-Stonell and Greenberg classification) and the Teacher Drooling Scale and by interviewing parents and caregivers face to face or via telephone were performed. Also, decreases in the daily number of bib changes and hourly frequency of saliva wiping were recorded as success. Complications were recorded.
RESULTS:
The Drooling Frequency and Severity Scale, the Teacher Drooling Scale, daily number of bib changes, and hourly frequency of saliva wiping decreased significantly in 21 patients (95.5%) and remained unchanged in 1 patient (4.5%). Postoperative bleeding was observed in 1 patient (4.5%).
CONCLUSIONS:
Drooling is a complex problem that benefits from a multidisciplinary approach. Many treatment methods exist, each with advantages and disadvantages. In this study botulinum toxin A injection was applied in conjunction with bilateral submandibular duct relocation and bilateral sublingual gland excision surgery, achieving a success rate of 95.5%. Moreover, minimal complications and no recurrence after at least 6-month follow-up were observed. The authors therefore recommend further use of this combination treatment. Larger and longer term studies may also help clarify its effectiveness.
Topics: Adolescent; Blood Loss, Surgical; Botulinum Toxins, Type A; Cerebral Palsy; Child; Child, Preschool; Combined Modality Therapy; Follow-Up Studies; Humans; Neuromuscular Diseases; Parents; Patient Satisfaction; Personal Satisfaction; Sialorrhea; Submandibular Gland; Treatment Outcome
PubMed: 30371109
DOI: 10.1177/0003489418808305 -
European Journal of Neurology Aug 2010Many individuals with neurological problems or anatomical abnormalities of the jaw, lips or oral cavity may drool, which can impact on health and quality of life. A...
Many individuals with neurological problems or anatomical abnormalities of the jaw, lips or oral cavity may drool, which can impact on health and quality of life. A thorough evaluation of the patient's history, examination of the oral region by a speech pathologist and, in individuals over 3 years, a dental examination is warranted. Questionnaires with established validity such as the Drooling Impact Scale are useful assessment tools. A hierarchical approach to treatment is taken from least invasive therapies, such as speech pathology, to more invasive, such as injection of botulinum neurotoxin type-A (BoNT-A) into the salivary glands (parotid and submandibular). The wishes of the individual and their carer are crucial considerations in determining the suitability of the intervention for the patient. In the presence of dysphagia and cerebral palsy (CP), careful assessment is required prior to the injection of BoNT-A. Favourable responses to intervention include a reduction in the secretion of saliva and in drooling, as well as psychosocial improvements. BoNT-A is usually well tolerated, although potential side effects should be discussed with the patient and carer.
Topics: Adult; Botulinum Toxins, Type A; Cerebral Palsy; Child; Deglutition Disorders; Humans; Internationality; Neurotoxins; Outcome Assessment, Health Care; Physical Examination; Randomized Controlled Trials as Topic; Salivary Glands; Sialorrhea
PubMed: 20633182
DOI: 10.1111/j.1468-1331.2010.03131.x -
International Journal of Pediatric... Dec 2022Neurodevelopmentally impaired (NI) children with chronic sialorrhea are at elevated risk for aspiration and respiratory tract infections. Direct resection or ligation...
OBJECTIVES
Neurodevelopmentally impaired (NI) children with chronic sialorrhea are at elevated risk for aspiration and respiratory tract infections. Direct resection or ligation ("DROOL") of the submandibular glands (SMG) with parotid duct ligation are surgical interventions intended to decrease salivary output. The objective of this study is to determine the impact of DROOL surgery on the incidence of nonviral respiratory-related (NVR) post-procedure hospital encounters including emergency department visits and admissions.
METHODS
Retrospective case series of NVR related outcomes after DROOL surgery in children performed at a single institution, tertiary referral center.
RESULTS
A total of 35 gastrostomy tube-dependent patients (60% male, average age 8.2 [SD 6.0] years) with NI underwent DROOL surgery (86% SMG excision). Pre- and post-surgical follow-up time was 3.6 and 3.2 years, respectively. Presurgical and postsurgical NVR hospital encounters occurred in 28 (80%) and 14 (40%) patients, respectively (p < 0.01). Mean (SD) postoperative NVR hospital encounters occurred less frequently when compared to presurgical period (0.4 [0.6] vs. 1.0 [1.2] per year, p < 0.01) with average change of -0.7 encounters per year (SD 1.4, 95% CI -1.0 to -0.2). Patients with encounters within a year preceding DROOL (OR 4.9, p = 0.04, 95% CI 1.1-22.8), or those with at least 3 preoperative encounters (OR 8.0, p = 0.01, 95% CI 1.6-40.3) were significantly associated with a postsurgical NVR event. Fewer patients used anti-sialorrhea medication postoperatively compared to preoperatively (60% vs. 17%, p < 0.01). No patient developed surgical site complications requiring operative interventions.
CONCLUSIONS
DROOL surgery for chronic sialorrhea in patients with NI was associated with decreased hospitalization and ED visits for NVR respiratory events post-procedurally. Sialorrhea may be an actionable source of recurrent respiratory illnesses requiring hospitalizations.
Topics: Child; Humans; Male; Female; Sialorrhea; Retrospective Studies; Submandibular Gland; Salivary Ducts; Hospitalization
PubMed: 36327912
DOI: 10.1016/j.ijporl.2022.111362 -
Journal of Neurology Sep 2009Drooling (saliva loss) is a frequently reported symptom in patients with Parkinson's disease (PD), but an accurate estimate of the prevalence of drooling is lacking. The... (Review)
Review
Drooling (saliva loss) is a frequently reported symptom in patients with Parkinson's disease (PD), but an accurate estimate of the prevalence of drooling is lacking. The aim of this study was to systematically review the prevalence of drooling in published research papers. A systematic PubMed and CINAHL search was done, including studies published until January 2009. Eight studies were found, presenting prevalence rates of drooling based on responses of PD patients to questionnaires. The statistical heterogeneity was highly significant (P < 0.0001), with prevalence rates ranging from 32 to 74%. The pooled prevalence estimate with random effect analysis was of 56% (95% CI 44-67) for PD patients and 14% (95% CI 3-25) for healthy controls; the pooled relative risk (RR) with random effect analysis was 5.5 (95% CI 2.1-14.4). All studies reported data of community dwelling idiopathic PD patients, with a mean age around 65 years and mild PD in 50-60% of the cases. Heterogeneity was mainly caused by differences in definition or frequency of drooling. The highest prevalence rates included nocturnal drooling where others noted only diurnal drooling. Analysis of the data of two studies showed that drooling is reported frequently by 22-26% of the patients. Prevalence rates were lower in milder PD patients. The summarized findings demonstrate that drooling can be present in half of all PD patients. In about a quarter of PD patients, drooling appears to be a frequently occurring problem. We recommend to report drooling in future studies with more detailed consideration of severity, frequency and nocturnal versus diurnal complaints.
Topics: Humans; Parkinson Disease; Prevalence; Sialorrhea
PubMed: 19288042
DOI: 10.1007/s00415-009-5098-2 -
European Journal of Paediatric... Nov 2014After the age of 4 years, drooling becomes pathological and impacts the quality of life of children with cerebral palsy. Intraglandular injection of Botulinum toxin is... (Review)
Review
BACKGROUND
After the age of 4 years, drooling becomes pathological and impacts the quality of life of children with cerebral palsy. Intraglandular injection of Botulinum toxin is one of the treatments available to limit this phenomenon.
AIMS
The objectives of this review were to validate the efficacy of Botulinum toxin injections for drooling in children with cerebral palsy, determine recommendations and identify potential side effects.
METHODS
We conducted a literature review from 2001 in the following databases: Embase, Pubmed and Cochrane using the keywords: sialorrhea, drooling, hypersalivation, Botulinum toxin, cerebral palsy and children. Only the articles evaluating the efficacy of Botulinum toxin in children with cerebral palsy over the age of 4 were researched.
RESULTS
Eight studies were found: 2 case studies, 3 open and non-controlled studies and 3 randomized controlled trials. Efficacy results in this indication are quite encouraging and the use of BTX injections is safe but the overall level of evidence of these studies was quite low.
CONCLUSION
However, intraglandular injection of Botulinum toxin has a place among the therapeutic array available for the management of sialorrhea in this population even if no standardized protocol is available yet.
Topics: Botulinum Toxins; Cerebral Palsy; Child; Clinical Trials as Topic; Databases, Bibliographic; Humans; Neurotoxins; Salivary Glands; Sialorrhea
PubMed: 24931915
DOI: 10.1016/j.ejpn.2014.05.007 -
Drugs & Aging 2008Although often less recognized than motor symptoms, non-motor effects represent an important source of disability for many parkinsonian patients. Of these non-motor... (Review)
Review
Although often less recognized than motor symptoms, non-motor effects represent an important source of disability for many parkinsonian patients. Of these non-motor symptoms, sialorrhoea, defined as the inability to control oral secretions resulting in excessive saliva accumulation in the oropharynx, constitutes perhaps one of the most bothersome and troubling problems, often causing social embarrassment and isolation. In patients with Parkinson's disease (PD), this symptom is thought to be due to restricted swallowing and dysfunction, rather than to hypersecretion of saliva. Only a few well designed studies have been conducted to determine the optimal treatment for sialorrhoea in PD. A combination of approaches appears to be necessary to obtain successful results.
Topics: Aged; Humans; Parkinson Disease; Sialorrhea
PubMed: 19021300
DOI: 10.2165/0002512-200825120-00003 -
Archives of Disease in Childhood Oct 2003Drooling frequently occurs in children with multiple handicaps; application of anticholinergic drugs is a potential strategy to treat drooling. A computer aided search... (Review)
Review
Drooling frequently occurs in children with multiple handicaps; application of anticholinergic drugs is a potential strategy to treat drooling. A computer aided search of original studies concerning the treatment of drooling was carried out. The methodological and statistical integrity of the identified studies were assessed with previously defined criteria. The articles were weighed for their separate contribution to the evidence. The search resulted in 64 reports, of which seven studies passed the screening and were subjected to further assessment and discussion by three referees. Because of the small number of reports and the methodological restriction within the studies, no meta-analysis could be performed. No general conclusion could be made about the efficacy of anticholinergic drugs in treatment of drooling in children with multiple handicaps. There was some evidence that three anticholinergic drugs (benztropine, glycopyrrolate, and benzhexol hydrochloride) are effective in the treatment of drooling, but it could not be concluded that one drug is preferable.
Topics: Child; Cholinergic Antagonists; Disabled Children; Humans; Randomized Controlled Trials as Topic; Research Design; Sialorrhea; Treatment Outcome
PubMed: 14500313
DOI: 10.1136/adc.88.10.911