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. 2023 Aug;13(8):e3164.
doi: 10.1002/brb3.3164. Epub 2023 Jul 17.

Botulinum toxin in the treatment of sialorrhea in severe neurological patients with tracheotomy

Mengmeng Shao  1 , Keyang Chen  2 , Xiaoyun Wu  1 , Jingjing Lin  1 , Mingxia Jiang  1 , Feinan Zhuo  1 , Zhaojian Ying  3 , Yuanyuan Huang  1
Affiliations

Botulinum toxin in the treatment of sialorrhea in severe neurological patients with tracheotomy

Mengmeng Shao et al. Brain Behav. 2023 Aug.

Abstract

Objective: To observe the clinical effect of botulinum toxin type A (BTA) injection into the salivary glands of the severe neurological patients with tracheotomy METHODS: Seven patients with severe neurological disorders after tracheotomy and obvious drooling symptoms were enrolled. BTA was injected into bilateral parotid glands and submandibular glands under the guidance of ultrasound. Unstimulated salivary flow rate (uSFR) and Drooling Severity and Frequency Scale (DSFS) were used to evaluate drooling before injection, 1 week, and 4 weeks after injection. We compared the extubation time, time of changing from balloon cannula to metal cannula, hospitalization time and incidence of recurrent pulmonary infection between these patients and other patients accepted conventional curation.

Results: (1) The drooling severity scale (DSFS-S), the drooling frequency scale (DSFS-F), the drooling frequency and severity scale total score (DSFS-T) were significantly lower at 4 weeks after BTA injection compared to prior-treatment (p < .001). (2) uSFR of 1 week and 4 weeks were both statistically decreased than the untreated condition (p < .001). (3) Compared with the conventional group, the time of changing from balloon cannula to metal cannula was shortened obviously (p < .05) and incidence of recurrent pulmonary infection was clearly decreased (p < .05) after BTA treatment CONCLUSION: Ultrasound-guided BTA injection into salivary glands can effectively reduce saliva secretion. We also found that the time of changing cannula was shortened obviously and the incidence of recurrent pneumonia infection was reduced. BTA injection of salivary glands to cure drooling could advance to the clinical therapy in severe neurological patients after tracheotomy.

Keywords: botulinum toxin type A (BTA); drooling; severe neurological patient; tracheotomy; ultrasound guidance.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

FIGURE 1
FIGURE 1
Flowchart of study patients.
FIGURE 2
FIGURE 2
The Drooling Severity and Frequency Scales before BTA injection and at 1 week and 4 weeks after the injection.
FIGURE 3
FIGURE 3
The unstimulated salivary flow rate (uSFR) before BTA injection and at 1 week and 4 weeks after the injection.
See this image and copyright information in PMC

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