Alvarenga Ana, Campos Miguel, Dias Mariana, Melão Lina, Estevão-Costa José
Department of Pediatric Surgery, Hospital S. João, Faculty of Medicine, Porto, Portugal.
Department of Radiology, Hospital S. João, Porto, Portugal.
J Pediatr Surg. 2017 Aug;52(8):1283-1286. doi: 10.1016/j.jpedsurg.2016.09.074. Epub 2016 Oct 14.
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.
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%.
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.
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.
IV.
流涎是一种难以处理的情况。A型肉毒毒素（BOTOX-A）注射到唾液腺是一种有前景的手术治疗替代方法。本研究旨在评估BOTOX-A注射到唾液腺对流涎儿童的治疗效果。
纳入2012年1月至2015年3月期间接受治疗的患者。在超声引导和全身吸入麻醉下，将BOTOX-A注射到腮腺和下颌下腺。通过流涎严重程度评分量表（DSFS：1-最佳至5-最差）和频率（1至4）量表进行评估，在治疗前以及注射后1个月、3个月和6个月进行。纳入标准为流涎严重程度评分（DSS）≥4和/或流涎频率评分（DFS）≥3。设定统计学显著性水平为5%。
共17例患者，年龄12.1±5.1[4-19]岁，均有神经功能障碍。首次注射后，13例（76.5%）患者的严重程度评分（S）降低，12例（70.6%）患者的频率评分（F）降低；6例（35.5%）患者流涎完全消失。治疗前S+F评分为8.59±0.71[7-9]；注射后1个月评估时显著降至4.65±2.32（p=0.001）。在3个月和6个月时评分也显著低于治疗前（分别为4.00±1.96，p=0.002；5.36±2.20，p=0.005），但在3个月和6个月评估之间有显著增加（p=0.01）。随访20.1±9.2[4-38]个月，13例成功注射的患者中有4例在7.5±3.1[3-10]个月后需要再次注射。未需要再次注射时间最长的患者随访了28个月。1例（6%）患者出现轻度吞咽困难，自行缓解。除2例（88%）外，所有家长/照顾者均会再次接受该治疗。
BOTOX-A似乎是一种治疗流涎的有效微创方法，并发症少。6个月后再次注射的需求显著增加，但可能在几个月内无需再次注射。需要进一步研究以确定最有效的注射剂量和频率。
IV级。
