Treatment of sialorrhea in adults and children using botulinum toxin type A

Abstract

Sialorrhea is a common condition in various diseases that occur in neurological practice among adult patients and children. Excessive accumulation of saliva in the oral cavity and its release outside the oral cavity is a complex medical problem that often leads to complications of the underlying disease and requires independent treatment. Severe drooling leads to conditions that significantly limit the patient’s socialization, complicates his care, and places an additional economic burden on the patient’s family members. The range of treatment strategies aimed at reducing or eliminating sialorrhea is very wide and includes cognitive behavioral therapy, medication, botulinum toxin injections, and surgery. The choice of an available treatment option for sialorrhea is based on the severity of the underlying disease and the results of assessing the severity of saliva accumulation in the oral cavity. Drug therapy, as well as surgical treatments, are often accompanied by adverse events. A modern and safe method of treatment, with the fewest side effects, is the injection of botulinum toxin type A into the parotid and submandibular salivary glands. The absence of difficulties in using this treatment method allows it being recommended in routine medical practice by a neurologist trained in the administration of botulinum toxins. The article presents a review of the world literature over the past twenty years, as well as a standard scheme for the use of botulinum toxin type A (incobotulinumtoxinA) for the treatment of sialorrhea in adults and children, with justification for the use of the drug under mandatory ultrasound control and certain diseases under anesthesia.