US-guided botulinum toxin injection for excessive drooling in children

Authors: Türkmen Çiftçi, Devrim Akıncı, Nursel Yurttutan, Okan Akhan

We aimed to evaluate the safety and efficacy of botulinum toxin A (BTX-A) injections under ultrasonography (US) guidance for children with excessive drooling.

Between January 2006 and January 2011, 44 BTX-A injections into bilateral submandibular glands were performed in 20 children (mean age, 9.1 years; range, 3–16 years; gender, 15 boys and 5 girls) under intravenous sedation. Efficacy of the injections was evaluated 4–12 weeks after the injection. Severity of drooling was assessed using the Teacher Drooling Scale (TDS). If the patient or the patient’s caregiver reported a good initial response, injections were then repeated periodically when drooling reached the preinjection score. If there was no response or suboptimal response, a booster injection of BTX-A was given after one month.

Technical success rate was 100%. No procedure-related major or minor complication was detected. One family (5%) reported intermittent problems with swallowing due to viscous saliva. A successful outcome was defined as a minimum two point reduction in TDS score. This outcome occurred for 8 of 20 patients four weeks after the first injection. After consecutive sessions, clinical success was achieved at the end of the 12 weeks for 16 patients (80%). The mean TDS score decreased from 4.75 to 2.1 at the end of the study for all patients (P < 0.05). Four patients did not respond to BTXA injection. Submandibular resection was applied to 3 of 4 unresponsive patients. Two patients had complete remission after surgery, but one patient showed excessive drooling that could not be controlled.
US-guided submandibular BTX-A injection is a safe and effective procedure in treating drooling in children. It can be performed under intravenous sedation and does not require general anesthesia.