Botulinum toxin A (BTX-A) injections to the salivary glands are effective in the treatment of drooling, and complications are rare. However, there are only a few previous reports on the long-term use of BTX-A injections. This study retrospectively analyzes our experience of treating drooling with repeated BTX-A injections in patients with neurodegenerative diseases. All patients who received repeated BTX-A injections to the submandibular glands at Tampere University Hospital in 2004-2013 were included in the analysis. Six patients, aged from 6 to 21 years, were included in the study, and a total of 41 bilateral BTX-A injections were administered to their submandibular glands. The average number of injections per patient was 6 (range: 3-11). The average interval between the injections was 9.8 months (range: 4-18), and 95% (39/41) of the injections were performed with good response. The complication rate of the BTX-A injections was 2.4% (1/41), since one of the patients had swallowing problems after an injection. BTX-A injections to the submandibular glands are effective and have a low morbidity rate, and repeated injections can be recommended as long-term treatment of drooling.

1.
Johnson H, Scott A: A Practical Approach to Saliva Control. Tucson, Communication Skill Builders Inc., 1993.
2.
Blasco PA, Allaire JH; participants of the Consortium on Drooling: Drooling in the developmentally disabled: management practices and recommendations. Dev Med Child Neurol 1992;34:849-862.
3.
Tahmassebi JF, Curzon ME: The cause of drooling in children with cerebral palsy - hypersalivation or swallowing defect. Int J Paediatr Dent 2003;13:106-111.
4.
Garret JR: The proper role of nerves in salivary secretion. J Dent Res 1987;66:387-397.
5.
Hussein I, Kershaw A.E, Tahmassebi JF, Fayle SA: The management of drooling in children and patients with mental and physical disabilities: a literature review. Int J Paediatr Dent 1998;8:3-11.
6.
Jongerius PH, Rotteveel JJ, van den Hoogen F, Joosten F, van Hulst K, Gabreels FJM: Botulinum toxin A: a new option for treatment of drooling in children with cerebral palsy. Presentation of a case series. Eur J Pediatr 2001;160:509-512.
7.
Dolly JO, Ashton AC, Mclnnes C, Wadswort JDF, Poulain B, Tauc L, Shone CC, Melling J: Clues to the multi-phasic inhibitory action of botulinum neurotoxin on release of transmitters. J Physiol 1990;3:237-246.
8.
Borodic GE, Ferrante R: Effects of repeated botulinum toxin injections on orbicularis oculi muscle. J Clin Neuroophthalmol 1992;12:121-127.
9.
Jongerius PH, Rotteveel JJ, van Limbeek J, Gabreels FJM, van Hulst K, van den Hoogen FJ: Botulinum toxin effect on salivary flow rate in children with cerebral palsy. Neurology 2004;63:1371-1375.
10.
Banerjee KJ, Glasson C, O'Flaherty SJ: Parotid and submandibular botulinum toxin A injections for sialorrhoea in children with cerebral palsy. Dev Med Child Neurol 2006;48:883-887.
11.
Reddihough D, Erasmus CE, Johnson H, McKellar MW, Jongerius PH: Botulinum toxin assessment, intervention and aftercare for paediatric and adult drooling: international consensus statement. Eur J Neurol 2010;17 Suppl 2:109-121.
12.
Montgomery S. McCusker S, Hendry J, Lumley E, Kubba H: Botulinum toxin A for children with salivary control problems. Int J Ped Otorhinol 2014;78:1970-1973.
13.
Erasmus CE, Van Hulst K, Van Den Hoogen FJ, Van Limbeek J, Roeleveld N, Veerman EC, Rotteveel JJ, Jongerius PH: Thickened saliva after effective management of drooling with botulinum toxin A. Dev Med Child Neurol 2010;52:e114-e118.
14.
Basciani M, di Rienzo F, Fontana A, Copetti M, Pellegrini F, Intiso D: Botulinum toxin type B for sialorrhoea in children with cerebral palsy: a randomized trial comparing three doses. Dev Med Child Neurol 2011;53:559-564.
15.
Jongerius PH, Joosten F, Hoogen FJA, Gabreels FJM, Rotteveel JJ: The treatment of drooling by ultrasound-quided intraglandular injections of botulinum toxin type A into the salivary glands. Laryngoscope 2003;113:107-111.
16.
Jost WH: Treatment of drooling in Parkinson's disease with botulinum toxin. Mov Disord 1999;14:1057.
17.
Ellies M, Gottstein U, Rohrbach-Volland MD, Arglebe C, Laskawi R: Reduction of salivary flow with botulinum toxin: extended report on 33 patients with drooling, salivary fistulas and sialadenitis. Laryngoscope 2004;114:1856-1860.
18.
Berweck S, Schroeder AS, Lee SH, Bigalke H, Heinen F: Secondary non-response due to antibody formation in a child after three injections of botulinum toxin B into the salivary glands. Dev Med Child Neurol 2007;49:62-64.
19.
Brei TJ: Management of drooling. Semin Pediatr Neurol 2003;10:265-270.
20.
Jongerius PH, Van Den Hoogen FJ, Van Limbeek J, Gabreels FJ, Van Hulst K, Rotteveel JJ: Effect of botulinum toxin in the treatment of drooling, a controlled clinical trial. Pediatrics 2004;114:620-627.
21.
Bachrach SJ, Walter RS, Trzcinski K: Use of glycopyrrolate and other anticholinercic medications for sialorrhea in children with cerebral palsy. Clin Pediatr 1998;37:485-490.
22.
Formeister E, Dahl J, Rose A: Surgical management of chronic sialorrhea in pediatric patients: 10-year experience from one tertiary care institution. Int J Ped Otorinol 2014;78:1387-1392.
23.
Smith WP, Peters WJ, Markus AF: Submandibular gland surgery: an audit of clinical findings, pathology, and postoperative morbidity. Ann R Coll Surg Engl 1993;75:164-167.
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