Jongerius P H, Rotteveel J J, van den Hoogen F, Joosten F, van Hulst K, Gabreëls F J
Department of Rehabilitation, University Hospital Nijmegen, The Netherlands.
Eur J Pediatr. 2001 Aug;160(8):509-12. doi: 10.1007/s004310100784.
Drooling beyond the age of 4 years is pathological, particularly if it occurs in children with neurological and developmental impairment and disability. Considering the therapeutic spectrum of botulinum toxin A and in view of the innervation of the salivary glands, we postulated that intraglandular injections into the submandibular glands with botulinum toxin A could reduce the secretion of saliva and consequently decrease drooling. Three patients with cerebral palsy and severe drooling were selected and evaluated over a 4-month period. Under ultrasound guidance, one dose of botulinum toxin A was injected bilaterally into the submandibular glands. Saliva secretion was measured at baseline and repeated four times during the following 4 months. In the three patients, maximal salivary flow rate of the sublingual and submandibular glands was reduced by 51% to 63%. The time of the maximal effect differed among the three children. The parents reported a satisfactory reduction of drooling throughout the whole study period. No objectionable disturbances of oral functions were observed. There was mild transient thickening of saliva in one of the patients.
The application of botulinum toxin A to the submandibular gland is a promising technique to reduce salivary flow rate and probably an alternative in the treatment of drooling in children with cerebral palsy.
4岁以后流口水属于病态，尤其是发生在患有神经和发育障碍及残疾的儿童身上。考虑到A型肉毒毒素的治疗范围，并鉴于唾液腺的神经支配情况，我们推测向颌下腺内注射A型肉毒毒素可减少唾液分泌，从而减少流口水。选取了3例患有脑瘫且流口水严重的患者，并在4个月的时间里对其进行评估。在超声引导下，双侧颌下腺各注射一剂A型肉毒毒素。在基线时测量唾液分泌情况，并在接下来的4个月内重复测量4次。3例患者舌下腺和颌下腺的最大唾液流速降低了51%至63%。3名儿童达到最大效果的时间有所不同。家长们报告称，在整个研究期间流口水情况得到了令人满意的改善。未观察到令人不适的口腔功能障碍。其中1例患者出现了唾液轻度短暂变稠的情况。
向颌下腺注射A型肉毒毒素是一种很有前景的减少唾液流速的技术，可能是治疗脑瘫儿童流口水的一种替代方法。
