Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.
Diagn Interv Radiol. 2013 Jan-Feb;19(1):56-60. doi: 10.4261/1305-3825.DIR.5940-12.1. Epub 2012 Jul 13.
We aimed to evaluate the safety and efficacy of botulinum toxin A (BTX-A) injections under ultrasonography (US) guidance for children with excessive drooling.
Between January 2006 and January 2011, 44 BTX-A injections into bilateral submandibular glands were performed in 20 children (mean age, 9.1 years; range, 3-16 years; gender, 15 boys and 5 girls) under intravenous sedation. Efficacy of the injections was evaluated 4-12 weeks after the injection. Severity of drooling was assessed using the Teacher Drooling Scale (TDS). If the patient or the patient's caregiver reported a good initial response, injections were then repeated periodically when drooling reached the preinjection score. If there was no response or suboptimal response, a booster injection of BTX-A was given after one month.
Technical success rate was 100%. No procedure-related major or minor complication was detected. One family (5%) reported intermittent problems with swallowing due to viscous saliva. A successful outcome was defined as a minimum two point reduction in TDS score. This outcome occurred for 8 of 20 patients four weeks after the first injection. After consecutive sessions, clinical success was achieved at the end of the 12 weeks for 16 patients (80%). The mean TDS score decreased from 4.75 to 2.1 at the end of the study for all patients (P < 0.05). Four patients did not respond to BTXA injection. Submandibular resection was applied to 3 of 4 unresponsive patients. Two patients had complete remission after surgery, but one patient showed excessive drooling that could not be controlled.
US-guided submandibular BTX-A injection is a safe and effective procedure in treating drooling in children. It can be performed under intravenous sedation and does not require general anesthesia.
我们旨在评估在超声（US）引导下肉毒杆菌毒素 A（BTX-A）注射治疗儿童流涎过多的安全性和疗效。
在 2006 年 1 月至 2011 年 1 月期间，在静脉镇静下对 20 名儿童（平均年龄 9.1 岁；范围 3-16 岁；性别 15 名男孩和 5 名女孩）进行了 44 次双侧下颌下腺 BTX-A 注射。注射后 4-12 周评估注射的疗效。使用教师流涎量表（TDS）评估流涎的严重程度。如果患者或其照顾者报告初始反应良好，则在流涎达到注射前评分时定期重复注射。如果没有反应或反应不佳，则在一个月后给予 BTX-A 增强注射。
技术成功率为 100%。未发现与手术相关的主要或次要并发症。有 1 个家庭（5%）报告由于粘性唾液间歇性吞咽问题。成功的结果定义为 TDS 评分至少降低 2 分。在第一次注射后 4 周，20 名患者中有 8 名出现这种结果。经过连续治疗，在 12 周结束时，16 名患者（80%）获得临床成功。所有患者的 TDS 评分平均值从研究结束时的 4.75 降至 2.1（P<0.05）。4 名患者对 BTXA 注射无反应。对 4 名无反应的患者中的 3 名应用了下颌下腺切除术。2 名患者手术后完全缓解，但 1 名患者出现无法控制的流涎过多。
US 引导下的下颌下腺 BTX-A 注射是治疗儿童流涎过多的一种安全有效的方法。它可以在静脉镇静下进行，无需全身麻醉。
