The large majority of sialorrhoea (drooling) in paediatric patients is managed conservatively. However in severe cases, often where there is associated developmental delay or a motor disorder, medical and surgical techniques can be used to decrease salivary flow. Botulinum toxin injection is used increasingly for this purpose, with high efficacy and favourable side-effect profile when compared to anticholinergic medications or salivary gland excision. The authors of this case control study used ultrasound to assess the size of major salivary glands which were regularly injected with Botox (22 children), versus healthy controls (38 children). Assessment was by a blinded trained sonographer. There were no adverse events associated with Botox injection. Salivary glands that had received regular Botox injection were significantly smaller than those of normal controls, correlating with clinical outcomes. The study showed that Botox injection leads to changes in the size of the submandibular and parotid glands in a paediatric population, although it is not known what the cellular mechanism for this change is. It remains unclear whether the change is permanent or transient. The authors conclude that Botox injection is effective and safe, and should be considered first-line therapy for sialorrhoea in children, before irreversible surgical procedures are considered. 

Effect of recurrent onabotulinum toxin A injection into the salivary glands: an ultrasound measurement.
Cardona I, Saint-Martin C, Daniel SJ.
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Thomas Jacques

Royal National Throat, Nose and Ear Hospital, London, UK.

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