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Review
. 2019 Dec;8(2):273-288.
doi: 10.1007/s40120-019-00155-6. Epub 2019 Sep 21.

Therapy of Sialorrhea with Botulinum Neurotoxin

Wolfgang H Jost  1 , Tobias Bäumer  2 , Rainer Laskawi  3 , Jaroslaw Slawek  4 , Björn Spittau  5 , Armin Steffen  6 , Martin Winterholler  7 , Ganesh Bavikatte  8
Affiliations
Review

Therapy of Sialorrhea with Botulinum Neurotoxin

Wolfgang H Jost et al. Neurol Ther. 2019 Dec.

Abstract

Botulinum neurotoxin (BoNT) is considered the treatment of choice for various symptoms and diseases such as focal dystonia and focal spasticity. The effects of BoNT on the salivary glands have also been known for years, but their use was limited because of a lack of approval studies. Now the indication of sialorrhea is approved in some countries for incobotulinumtoxinA, such as the USA and Europe, and therapy could also become the treatment of choice. According to the pivotal study, a dose of 100 units of incobotulinumtoxinA, which is divided into the parotid and submandibular glands, is recommended. RimabotulinumtoxinB is approved in the USA only. To define the value of this therapy, we must consider anatomy, physiology, and available therapies. Therapy includes conservative measures such as functional dysphagia therapy, oral or transdermal application of anticholinergics, and, in selected cases, radiotherapy and surgical procedures. A combination of different approaches is optional. On the basis of the evidence and clinical experience, BoNT injections will be the first line of pharmacotherapy for chronic sialorrhea.

Keywords: Anticholinergics; Botulinum toxin; Drooling; Dysphagia; Sialorrhea.

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Conflict of interest statement

Wolfgang H. Jost is a consultant and/or speaker for the various BoNT manufacturers. Tobias Bäumer is a consultant and/or speaker for the various BoNT manufacturers. Rainer Laskawi is a consultant and/or speaker for the various BoNT manufacturers. Jaroslaw Slawek is a consultant and/or speaker for the various BoNT manufacturers. Armin Steffen is a consultant and/or speaker for the various BoNT manufacturers. Martin Winterholler is a consultant and/or speaker for the various BoNT manufacturers. Ganesh Bavikatte is a consultant and/or speaker for the various BoNT manufacturers. Björn Spittau has nothing to disclose.

Figures

Fig. 1
Fig. 1
Anatomy of the main salivary glands
Fig. 2
Fig. 2
Sonography of the main salivary glands
See this image and copyright information in PMC

References

    1. Jost WH, Friedman A, Michel O, et al. SIAXI: placebo-controlled, randomized, double-blind study of incobotulinumtoxinA for sialorrhea. Neurology. 2019;92:e1982–e1991. doi: 10.1212/WNL.0000000000007368. - DOI - PMC - PubMed
    1. Kochhar A, Larian B, Azizzadeh B. Facial nerve and parotid gland anatomy. Otolaryngol Clin N Am. 2016;49:273–284. doi: 10.1016/j.otc.2015.10.002. - DOI - PubMed
    1. Pedersen AML, Sørensen CE, Proctor GB, Carpenter GH, Ekström J. Salivary secretion in health and disease. J Oral Rehabil. 2018;45:730–746. doi: 10.1111/joor.12664. - DOI - PubMed
    1. Proctor GB, Carpenter GH. Salivary secretion: mechanism and neural regulation. Monogr Oral Sci. 2014;24:14–29. doi: 10.1159/000358781. - DOI - PubMed
    1. Holmberg KV, Hoffman MP. Anatomy, biogenesis and regeneration of salivary glands. Monogr Oral Sci. 2014;24:1–13. doi: 10.1159/000358776. - DOI - PMC - PubMed

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