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Xu H, Ge H, Shan X, Cai Z. Alteration of myoepithelial cells during botulinum toxin type A-inhibited salivary secretion. Oral Dis 2024; 30:1163-1172. [PMID: 36971615 DOI: 10.1111/odi.14576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Intraglandular injection of botulinum toxin type A (BoNT/A) effectively treats sialorrhea. Myoepithelial cells (MECs) are essential for salivary secretion. The role of MECs in BoNT/A-inhibited salivary secretion, and its underlying mechanisms remain unknown. MATERIALS AND METHODS BoNT/A was injected into rat submandibular glands (SMGs). At 1, 2, 4, 8, and 12 weeks postinjection, salivary flow rate of SMGs was measured. Electron microscopy, immunohistochemistry, immunofluorescence, and Western blot analysis were used to detect morphological and functional changes in MECs and chemical denervation in SMGs. RESULTS BoNT/A temporarily decreased salivary secretion in rat SMGs and this inhibitory effect lasted 4 weeks. During the inhibitory period, MECs atrophied and expressed reduced α-smooth muscle actin (α-SMA), vimentin, and phosphorylated myosin light chain 2 (p-MLC2), suggesting that BoNT/A attenuated MEC contractility. Furthermore, BoNT/A cleaved synaptosome-associated protein 25 (SNAP-25) and decreased the expression and activity of acetylcholinesterase (AChE), indicating that BoNT/A-induced chemical parasympathetic denervation of SMGs by cleaving SNAP-25. CONCLUSIONS BoNT/A temporarily caused MEC atrophy and decreased MEC contractility in rat SMGs, which contributed to reversible inhibition of salivary secretion. The underlying mechanisms involved temporary parasympathetic denervation caused by SNAP-25 cleavage. These findings provide new insights into the mechanisms of BoNT/A-inhibited salivary secretion.
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Affiliation(s)
- Hui Xu
- Department of Wangfujing General Dentistry, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Huabing Ge
- Department of Wangfujing General Dentistry, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Xiaofeng Shan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zhigang Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
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Ha TAN, Shih MC, Lambert EM. Comparing botulinum toxin and 4-duct ligation for Sialorrhea in children - A systematic review. Am J Otolaryngol 2024; 45:104119. [PMID: 38043299 DOI: 10.1016/j.amjoto.2023.104119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/19/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION Sialorrhea or drooling can result in physical and psychosocial complications, such as aspiration and social isolation. Treatment options include botulinum toxin into the salivary glands and 4-duct ligation (i.e., simultaneous ligation of the bilateral parotid and submandibular ducts). This systematic review aimed to compare the efficacy and complication rates of botulinum toxin and 4-duct ligation for the treatment of drooling in children. METHODS Following PRISMA guidelines, PubMed, Embase, Web of Science, and Cochrane Library were searched from inception through June 17, 2021 for studies examining the efficacy of botulinum toxin or 4-duct ligation for drooling in children. Data were summarized by pooled counts, percentages, and means. Complication rates were compared by a chi-squared test. RESULTS A total of 22 studies (n = 606) examining botulinum toxin and 5 studies (n = 124) examining 4-duct ligation were included. From 12 botulinum toxin studies (n = 211), mean drooling frequency and severity scores was 7.5 at baseline. Mean difference from baseline was -2.6 (n = 92) at 4 weeks follow-up, -2.1 at 8 weeks (n = 41), -2.1 at 12 weeks (n = 56), and - 2.1 at 16 weeks (n = 58). From 4 4-duct ligation studies (n = 103), mean baseline drooling frequency and severity score was 8.4. Mean difference was -3.7 at mean follow-up of 35.6 months (n = 103). Eighteen botulinum studies (n = 343) recorded 53 (15.5 %) complications, including thickened saliva (n = 9), dysphagia (n = 4), and cheek abscesses (n = 4). Four 4-duct ligation studies (n = 108) recorded 25 (23.1 %) complications, including parotid gland swelling (n = 4), aspiration pneumonia (n = 3), and oxygen desaturation (n = 3). There was no statistically significant difference in complication rates between botulinum toxin and four-duct ligation (p = 0.065). CONCLUSION Botulinum toxin injection and 4-duct ligation are both effective in improving sialorrhea in children and have comparable complication rates.
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Affiliation(s)
- Tu-Anh N Ha
- Baylor College of Medicine, Bobby R. Alford Department of Otolaryngology, 1977 Butler Boulevard, Houston, TX 77030, USA; Texas Children's Hospital, Department of Surgery, Division of Otolaryngology, Houston, TX, USA
| | - Michael C Shih
- Baylor College of Medicine, Bobby R. Alford Department of Otolaryngology, 1977 Butler Boulevard, Houston, TX 77030, USA; Texas Children's Hospital, Department of Surgery, Division of Otolaryngology, Houston, TX, USA
| | - Elton M Lambert
- Baylor College of Medicine, Bobby R. Alford Department of Otolaryngology, 1977 Butler Boulevard, Houston, TX 77030, USA; Texas Children's Hospital, Department of Surgery, Division of Otolaryngology, Houston, TX, USA.
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Toyoda Y, Percec I. Discussion: The Volumetric Effect of Botulinum Toxin Type A Injection on the Parotid Gland: A Randomized Controlled Trial. Plast Reconstr Surg 2024; 153:344-345. [PMID: 38266135 DOI: 10.1097/prs.0000000000011034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Yoshiko Toyoda
- From the Division of Plastic and Reconstructive Surgery, University of Pennsylvania
| | - Ivona Percec
- From the Division of Plastic and Reconstructive Surgery, University of Pennsylvania
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Yang CL, Huang JP, Tan YC, Wang TT, Zhang H, Qu Y. The effectiveness and safety of botulinum toxin injections for the treatment of sialorrhea with Parkinson's disease: a systematic review and meta-analysis. BMC Pharmacol Toxicol 2023; 24:52. [PMID: 37828600 PMCID: PMC10571401 DOI: 10.1186/s40360-023-00694-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/03/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Botulinum toxin (BoNT) injection is an important adjunctive method to treat sialorrhea. The purpose of this systematic review was to analyze the effect and safety of BoNT injections in the intervention of sialorrhea with Parkinson's disease (PD). METHODS We searched PubMed, Web Of Science (WOS), Scopus, Cochrane CENTRAL, and Embase from inception until April 2022. Randomized controlled trials or randomized crossover trials comparing BoNT with placebo in sialorrhea with PD were eligible. PRISMA guidelines were used to carry out the meta-analysis. The Drooling Severity Frequency Scale (DSFS) score and the number of adverse events (AEs) were the primary and secondary outcomes, respectively. Standardized mean differences (SMDs) and risk differences (RDs) are used to express continuous and categorical outcomes, respectively. Heterogeneity among these studies was evaluated using I2 tests. We used the GRADE tool to assess the certainty of evidence (COE). RESULTS Eight articles involving 259 patients compared BoNT injections with a placebo for PD with sialorrhea. This meta-analysis showed a significant reduction in DSFS scores between BoNT injections and placebo (SMD=-0.98; 95% CI, -1.27 to 0.70, p<0.001; COE: high). This meta-analysis showed a significant difference in AEs between BoNT injections and placebo (RD=0.15; 95% CI, 0.05 to 0.24, p=0.002; COE: low). CONCLUSIONS The pooled results suggest that BoNT injections have some effect on DSFS scores with sialorrhea caused by PD. There are also mild adverse events, which generally recover within a week or so. The results indicate that BoNT injection is one of the treatments for sialorrhea caused by PD, but we need to pay attention to adverse events. In addition, the follow-up time was extended to observe oral hygiene, ulceration or dental caries, and digestive function. TRIAL REGISTRATION Our review protocol was registered on PROSPERO (42021288334).
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Affiliation(s)
- Chun-Lan Yang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
- Minda Hospital of Hubei Minzu University, Enshi, Hubei, 445000, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Jia-Peng Huang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Ying-Chao Tan
- Enshi Prefecture Central Hospital, Enshi, Hubei, 445000, PR China
| | - Ting-Ting Wang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Han Zhang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Yun Qu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China.
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China.
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Heikel T, Patel S, Ziai K, Shah SJ, Lighthall JG. Botulinum Toxin A in the Management of Pediatric Sialorrhea: A Systematic Review. Ann Otol Rhinol Laryngol 2023; 132:200-206. [PMID: 35176902 PMCID: PMC9834812 DOI: 10.1177/00034894221078365] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Botulinum toxin A is known to be effective and safe in managing sialorrhea in pediatric patients; however, there is no consensus on a protocol for optimal injection sites and appropriate dosing for injection. METHODS This review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. PubMed, EMBASE, and other databases were queried to identify articles that evaluated botulinum toxin type A for the treatment of sialorrhea in the pediatric population. A total of 405 studies were identified. After applying inclusion and exclusion criteria, 31 articles were included for review. RESULTS A total of 14 studies evaluated 2-gland injections, and 17 studies evaluated 4-gland injections. Of the 31 studies included, one study assessed incobotulinumtoxinA (Xeomin®) the remaining all used onabotulinumtoxinA (Botox®). For 2-gland injection studies, a combined total of 899 participants were reviewed, where 602 participants received 50 units into their submandibular glands, while 262 participants received 30 to 50 units. Among 4-gland injection studies, there was a combined total of 388 participants, with the most prevalent dosage utilized being 60 to 100 units in 230 participants, followed by 100 units total in 77 participants. The most common adverse event was dysphagia which resolved in nearly all cases. Three studies aimed to examine 2-gland versus 4-gland injections, with 2 of the studies concluding 4-gland injection was superior. CONCLUSIONS The strength of evidence suggests that the dosing of 50 units total of onabotulinumtoxinA to the submandibular glands is safe and effective in the pediatric population. For 4-gland injections, bilateral submandibular and parotid gland injections of 60 to 100 units total is the safe and effective dosage. There is no substantial evidence comparing 4-gland injections to 2-gland injections, but research thus far suggests 4-gland injections to be superior. Future study is needed to evaluate incobotulinumtoxinA and abobotulinumtoxinA dosages in the pediatric population.
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Affiliation(s)
- Tiffany Heikel
- Department of Otolaryngology—Head and
Neck Surgery, The Pennsylvania State University, Milton S. Hershey Medical Center,
Hershey, PA, USA
| | - Shivam Patel
- The Pennsylvania State University,
College of Medicine, Hershey, PA, USA
| | - Kasra Ziai
- Department of Otolaryngology—Head and
Neck Surgery, The Pennsylvania State University, Milton S. Hershey Medical Center,
Hershey, PA, USA
| | - Sejal J. Shah
- Department of Anesthesiology and
Perioperative Medicine, The Pennsylvania State University, Milton S. Hershey Medical
Center, Hershey, PA, USA
| | - Jessyka G. Lighthall
- Facial Plastic and Reconstructive
Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State
University, Milton S. Hershey Medical Center, Hershey, PA, USA
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Hung SA, Liao CL, Lin WP, Hsu JC, Guo YH, Lin YC. Botulinum Toxin Injections for Treatment of Drooling in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121089. [PMID: 34943284 PMCID: PMC8700360 DOI: 10.3390/children8121089] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/06/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
Abstract
Background: We aimed to review and analyse the effectiveness and safety of botulinum toxin type A (BoNT-A) injections for drooling in children with cerebral palsy. Data sources: We searched the EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) databases from inception to January 2020. Methods: We included randomized controlled trials and observational studies which (1) involved children with cerebral palsy, (2) used BoNT-A for control of drooling, and (3) provided quantitative evaluations of drooling before and after intervention with BoNT-A. Results: Twenty-one trials met the inclusion criteria. Most studies showed that BoNT-A injections are safe and efficacious as a treatment for drooling in children with cerebral palsy. Four trials had sufficient data to pool the results for the meta-analysis. Both the drooling quotient (p = 0.002) and drooling Ffrequency and severity scale (p = 0.004) supported this conclusion. Conclusion: BoNT-A injections are a safe, reversible, effective treatment for drooling control in children with cerebral palsy that can offer effectiveness for more than 3 months with few side effects. The dosage of BoNT-A should not exceed 4 units/kg. Further studies are required to determine the optimal dosage and target glands.
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Affiliation(s)
- Shang-An Hung
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (S.-A.H.); (W.-P.L.); (Y.-H.G.)
| | - Chung-Lun Liao
- School of Medicine, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan;
| | - Wei-Pin Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (S.-A.H.); (W.-P.L.); (Y.-H.G.)
| | - Jason C. Hsu
- International Ph.D. Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei 110, Taiwan;
| | - Yao-Hong Guo
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (S.-A.H.); (W.-P.L.); (Y.-H.G.)
| | - Yu-Ching Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (S.-A.H.); (W.-P.L.); (Y.-H.G.)
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Correspondence:
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Berweck S, Bonikowski M, Kim H, Althaus M, Flatau-Baqué B, Mueller D, Banach MD. Placebo-Controlled Clinical Trial of IncobotulinumtoxinA for Sialorrhea in Children: SIPEXI. Neurology 2021; 97:e1425-e1436. [PMID: 34341153 PMCID: PMC8520391 DOI: 10.1212/wnl.0000000000012573] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 07/06/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate the efficacy and safety of repeated injections of incobotulinumtoxinA (incoBoNT/A) for treatment of chronic sialorrhea (drooling) associated with neurologic disorders (e.g., cerebral palsy, traumatic brain injury) or intellectual disability in children and adolescents in a prospective phase III study (SIPEXI [Sialorrhea Pediatric Xeomin Investigation]). METHODS The study enrolled 2- to 17-year-old patients with sialorrhea due to neurologic disorders or intellectual disability. Patients received body weight-dependent doses of incoBoNT/A (20-75 U). A main period with 1 injection cycle (placebo-controlled, double-blind, 6- to 17-year-olds) was followed by an open-label extension with up to 3 further cycles. An additional cohort of 2- to 5-year-olds received active treatment throughout the study. Coprimary endpoints were the change in unstimulated salivary flow rate (uSFR) from baseline to week 4 and the carers' Global Impression of Change Scale (GICS) rating at week 4. Adverse events were recorded. RESULTS In the main period, 220 patients aged 6-17 years were randomized and treated (148 patients in incoBoNT/A group, 72 patients in placebo group). A total of 35 patients aged 2-5 years received incoBoNT/A (no placebo). A total of 214 patients aged 6-17 years and 33 patients aged 2-5 years continued treatment in the open-label extension period. For the 6- to 17-year-olds, a significant difference between incoBoNT/A and placebo was seen in mean uSFR decrease (difference -0.06 g/min; p = 0.0012) and the carers' GICS rating (difference 0.28 points; p = 0.032) at week 4, in favor of active treatment. The secondary endpoints consistently supported these results. A sustained benefit was observed during the extension. Incidences of adverse events were comparable between incoBoNT/A and placebo and did not increase notably with repeated injections. The most common adverse events were respiratory infections. Efficacy and safety were also favorable in the uncontrolled cohort of 2- to 5-year-olds. DISCUSSION Both co-primary efficacy endpoints were reached and superiority of incoBoNT/A over placebo was confirmed. IncoBoNT/A (up to 75 U, up to 4 cycles) is an effective and well-tolerated treatment for sialorrhea associated with neurologic disorders in children. TRIAL REGISTRATION INFORMATION Clinicaltrials.gov: NCT02270736 (clinicaltrials.gov/ct2/show/results/NCT02270736); EU Clinical Trials Register: 2013-004532-30 (clinicaltrialsregister.eu/ctr-search/search?query=2013-004532-30). CLASSIFICATION OF EVIDENCE This study provides Class I evidence that injection of incobotulinumtoxinA decreases drooling in children aged 6 to 17 years with neurologic disorders.
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Affiliation(s)
- Steffen Berweck
- From the Specialist Center for Paediatric Neurology, Neurorehabilitation and Epileptology (S.B.), Schoen Klinik, Vogtareuth; Department of Pediatric Neurology and Developmental Medicine (S.B.), LMU Center for Children with Medical Complexity-Integrated Social Pediatric Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Movement Analysis Lab, Neuro Rehabilitation Department (M.B.), Mazovian Neuropsychiatry Center LLC, Warsaw, Poland; Pediatric Rehabilitation Medicine at the Department of Rehabilitation & Regenerative Medicine (H.K.), Columbia University Irving Medical Center/New York Presbyterian Hospital, New York; Merz Pharmaceuticals GmbH (M.A., B.F.-B.), Frankfurt am Main, Germany; Kantar Health (D.M.), Munich, Germany; and Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland.
| | - Marcin Bonikowski
- From the Specialist Center for Paediatric Neurology, Neurorehabilitation and Epileptology (S.B.), Schoen Klinik, Vogtareuth; Department of Pediatric Neurology and Developmental Medicine (S.B.), LMU Center for Children with Medical Complexity-Integrated Social Pediatric Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Movement Analysis Lab, Neuro Rehabilitation Department (M.B.), Mazovian Neuropsychiatry Center LLC, Warsaw, Poland; Pediatric Rehabilitation Medicine at the Department of Rehabilitation & Regenerative Medicine (H.K.), Columbia University Irving Medical Center/New York Presbyterian Hospital, New York; Merz Pharmaceuticals GmbH (M.A., B.F.-B.), Frankfurt am Main, Germany; Kantar Health (D.M.), Munich, Germany; and Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland
| | - Heakyung Kim
- From the Specialist Center for Paediatric Neurology, Neurorehabilitation and Epileptology (S.B.), Schoen Klinik, Vogtareuth; Department of Pediatric Neurology and Developmental Medicine (S.B.), LMU Center for Children with Medical Complexity-Integrated Social Pediatric Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Movement Analysis Lab, Neuro Rehabilitation Department (M.B.), Mazovian Neuropsychiatry Center LLC, Warsaw, Poland; Pediatric Rehabilitation Medicine at the Department of Rehabilitation & Regenerative Medicine (H.K.), Columbia University Irving Medical Center/New York Presbyterian Hospital, New York; Merz Pharmaceuticals GmbH (M.A., B.F.-B.), Frankfurt am Main, Germany; Kantar Health (D.M.), Munich, Germany; and Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland
| | - Michael Althaus
- From the Specialist Center for Paediatric Neurology, Neurorehabilitation and Epileptology (S.B.), Schoen Klinik, Vogtareuth; Department of Pediatric Neurology and Developmental Medicine (S.B.), LMU Center for Children with Medical Complexity-Integrated Social Pediatric Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Movement Analysis Lab, Neuro Rehabilitation Department (M.B.), Mazovian Neuropsychiatry Center LLC, Warsaw, Poland; Pediatric Rehabilitation Medicine at the Department of Rehabilitation & Regenerative Medicine (H.K.), Columbia University Irving Medical Center/New York Presbyterian Hospital, New York; Merz Pharmaceuticals GmbH (M.A., B.F.-B.), Frankfurt am Main, Germany; Kantar Health (D.M.), Munich, Germany; and Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland
| | - Birgit Flatau-Baqué
- From the Specialist Center for Paediatric Neurology, Neurorehabilitation and Epileptology (S.B.), Schoen Klinik, Vogtareuth; Department of Pediatric Neurology and Developmental Medicine (S.B.), LMU Center for Children with Medical Complexity-Integrated Social Pediatric Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Movement Analysis Lab, Neuro Rehabilitation Department (M.B.), Mazovian Neuropsychiatry Center LLC, Warsaw, Poland; Pediatric Rehabilitation Medicine at the Department of Rehabilitation & Regenerative Medicine (H.K.), Columbia University Irving Medical Center/New York Presbyterian Hospital, New York; Merz Pharmaceuticals GmbH (M.A., B.F.-B.), Frankfurt am Main, Germany; Kantar Health (D.M.), Munich, Germany; and Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland
| | - Daniela Mueller
- From the Specialist Center for Paediatric Neurology, Neurorehabilitation and Epileptology (S.B.), Schoen Klinik, Vogtareuth; Department of Pediatric Neurology and Developmental Medicine (S.B.), LMU Center for Children with Medical Complexity-Integrated Social Pediatric Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Movement Analysis Lab, Neuro Rehabilitation Department (M.B.), Mazovian Neuropsychiatry Center LLC, Warsaw, Poland; Pediatric Rehabilitation Medicine at the Department of Rehabilitation & Regenerative Medicine (H.K.), Columbia University Irving Medical Center/New York Presbyterian Hospital, New York; Merz Pharmaceuticals GmbH (M.A., B.F.-B.), Frankfurt am Main, Germany; Kantar Health (D.M.), Munich, Germany; and Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland
| | - Marta Dagmara Banach
- From the Specialist Center for Paediatric Neurology, Neurorehabilitation and Epileptology (S.B.), Schoen Klinik, Vogtareuth; Department of Pediatric Neurology and Developmental Medicine (S.B.), LMU Center for Children with Medical Complexity-Integrated Social Pediatric Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Movement Analysis Lab, Neuro Rehabilitation Department (M.B.), Mazovian Neuropsychiatry Center LLC, Warsaw, Poland; Pediatric Rehabilitation Medicine at the Department of Rehabilitation & Regenerative Medicine (H.K.), Columbia University Irving Medical Center/New York Presbyterian Hospital, New York; Merz Pharmaceuticals GmbH (M.A., B.F.-B.), Frankfurt am Main, Germany; Kantar Health (D.M.), Munich, Germany; and Department of Neurology (M.D.B.), Jagiellonian University, Krakow, Poland
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Jeon YT, Hong MP, Lee SJ, Shin GC, Choi J, Lim JY. Efficacy and safety of intraglandular botulinum toxin injections for treatment of sialadenosis. Clin Otolaryngol 2021; 46:1131-1135. [PMID: 33904247 DOI: 10.1111/coa.13788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/31/2021] [Accepted: 04/18/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Yu Tae Jeon
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Pyo Hong
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Jin Lee
- Division of Speech Pathology and Audiology, Research Institute of Audiology and Speech Pathology, College of Natural Sciences, Hallym University, Chuncheon, Korea
| | - Geun-Cheol Shin
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jihoon Choi
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Burch E, Lubeley L, Murakami J. Percutaneous Salivary Gland Ablation using Ethanol in a Rat Model. J Oral Maxillofac Res 2018; 8:e3. [PMID: 29435205 PMCID: PMC5806040 DOI: 10.5037/jomr.2017.8403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 12/29/2017] [Indexed: 11/16/2022]
Abstract
Objectives Sialorrhea is a common health and psychosocial problem for children with neuromuscular dysfunction secondary to a variety of disorders such as cerebral palsy. Current accepted treatments include the injection of botulinum toxin into the submandibular glands for temporary symptom relief. The purpose of this study is to demonstrate the feasibility of percutaneous ethanol injection for longer lasting salivary gland ablation in an animal model. Material and Methods Twenty rats were used in this study. In each rat, 98% ethanol was injected into the right submandibular gland under ultrasound guidance. No intervention was performed on the left gland, which served as the control. Ten rats were sacrificed and glands evaluated at three weeks, with the remaining 10 rats sacrificed and evaluated at three months. Unpaired, 1-tailed T-tests were used to analyse the data. Results Ethanol injections induced a significant and sustained reduction in salivary gland size. Treated glands were 41% smaller by mass than untreated controls in the 10 rats sacrificed at three weeks (P < 0.001). Treated glands were 43% smaller by mass than untreated controls in the 10 rats sacrificed at three months (P < 0.001). Qualitative histologic analysis demonstrated extensive parenchymal damage, inflammation, and fibrosis at both three week and three month time points. Conclusions Using a rat model, we demonstrated dramatic and sustained submandibular gland damage after percutaneous injection of ethanol.
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Affiliation(s)
- Emma Burch
- Department of Radiology, Nationwide Children's Hospital, Columbus, OhioUSA
| | - Lacey Lubeley
- Department of Radiology, Nationwide Children's Hospital, Columbus, OhioUSA
| | - James Murakami
- Department of Radiology, Nationwide Children's Hospital, Columbus, OhioUSA
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Alvarenga A, Campos M, Dias M, Melão L, Estevão-Costa J. BOTOX-A injection of salivary glands for drooling. J Pediatr Surg 2017; 52:1283-1286. [PMID: 28277296 DOI: 10.1016/j.jpedsurg.2016.09.074] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/26/2016] [Accepted: 09/30/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE Drooling is a challenging entity to manage. Botulinum toxin A (BOTOX-A) infiltration of salivary glands is a promising alternative to surgical treatment. This study aims to assess the outcome of BOTOX-A salivary glands infiltration in children with drooling. METHODS Patients treated between January 2012 and March 2015 were enrolled. BOTOX-A was injected in the parotid and submandibular glands under ultrasound control and general inhalational anesthesia. The outcome was evaluated through the DSFS: Drooling Severity (1-best to 5-worst) and Frequency (1 to 4) Scale, that was applied before treatment, and 1-, 3-, and 6-month after injection. The inclusion criteria were a DSS ≥4 and/or DFS ≥3. Statistical significance was set at 5%. RESULTS There were 17 patients aged 12.1±5.1 [4-19]years, all of them with neurologic impairment. After the first injection, 13 (76.5%) patients had reduction of the severity (S) and 12 (70.6%) of the frequency (F) scale; in 6 (35.5%) patients drooling resolved completely. Pre-treatment S+F score was 8.59±0.71 [7-9]; it decreased significantly to 4.65±2.32 (p=0.001) at 1-month post-injection evaluation. At 3-month and 6-month the scores were also significantly lower than the pre-treatment one (4.00±1.96, p=0.002; 5.36±2.20, p=0.005; respectively), but there was a significant increase between the 3-month and 6-month evaluations (p=0.01). With a follow-up of 20.1±9.2 [4-38] months, 4 out of the 13 successful injections needed a second one after 7.5±3.1 [3-10] months. The patient with the longest time not requiring re-injection had 28months of follow-up. One (6%) patient presented mild dysphagia that regressed spontaneously. All but two (88%) parents/caregivers would repeat the treatment. CONCLUSIONS BOTOX-A seems to be an effective minimal invasive treatment for drooling with few complications. After 6months the need for re-injection becomes substantial but it may not be necessary for several months. Further studies are needed to establish the most effective dosage and frequency of injections. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ana Alvarenga
- Department of Pediatric Surgery, Hospital S. João, Faculty of Medicine, Porto, Portugal
| | - Miguel Campos
- Department of Pediatric Surgery, Hospital S. João, Faculty of Medicine, Porto, Portugal
| | - Mariana Dias
- Department of Pediatric Surgery, Hospital S. João, Faculty of Medicine, Porto, Portugal
| | - Lina Melão
- Department of Radiology, Hospital S. João, Porto, Portugal
| | - José Estevão-Costa
- Department of Pediatric Surgery, Hospital S. João, Faculty of Medicine, Porto, Portugal.
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