Abboud Waseem A, Nadel Sahar, Hassin-Baer Sharon, Arad Abigail, Dobriyan Alex, Yahalom Ran
Department of Oral and Maxillofacial Surgery, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Institute of Movement Disorders, Department of Neurology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Isr Med Assoc J. 2019 Feb;21(2):116-119.
Drooling is the unintentional loss of saliva from the mouth, usually caused by poor coordination of the swallowing mechanism. It is commonly seen in patients with chronic neurologic disorders, such as Parkinson's disease, amyotrophic lateral sclerosis (ALS), cerebral palsy, and stroke, as well as in patients with cognitive impairment and dementia.
To evaluate the efficacy and safety of ultrasound-guided botulinum toxin injections into the parotid and submandibular salivary glands for the treatment of drooling.
We conducted a retrospective analysis of the medical records of 12 consecutive patients treated with botulinum toxin injections into the parotid and submandibular glands for the first time. The primary outcome variable was the subjective improvement of drooling on a 5-point scale. Secondary outcome variables were duration of the therapeutic effect, request to undergo additional treatment, and adverse events.
Of 12 patients, 8 (67%) reported considerable improvement after treatment, 3 reported slight improvement, and 1 reported development of dry mouth. All patients stated that they felt the effects 1 week after the injections; the mean duration of the therapeutic effect was 4.5 months (range 3-9 months). One patient suffered from local hematoma and ecchymosis that did not require medical care. Another patient complained of difficulty swallowing, which did not require medical treatment and resolved spontaneously within 1 month.
Ultrasound-guided botulinum toxin injections into the parotid and submandibular glands seem to be a safe and effective therapy for the treatment of drooling. Further long-term prospective studies with varying doses are warranted.
流口水是指唾液不自主地从口腔流出，通常是由于吞咽机制协调不良所致。在患有慢性神经系统疾病的患者中较为常见，如帕金森病、肌萎缩侧索硬化症（ALS）、脑瘫和中风，以及认知障碍和痴呆患者。
评估超声引导下向腮腺和颌下唾液腺注射肉毒杆菌毒素治疗流口水的疗效和安全性。
我们对12例首次接受腮腺和颌下腺肉毒杆菌毒素注射治疗的患者的病历进行了回顾性分析。主要结局变量是用5分制评估流口水的主观改善情况。次要结局变量是治疗效果的持续时间、要求接受额外治疗的情况以及不良事件。
12例患者中，67%（8例）报告治疗后有显著改善，3例报告有轻微改善，1例报告出现口干。所有患者均表示在注射后1周感觉到了效果；治疗效果的平均持续时间为4.5个月（范围3 - 9个月）。1例患者出现局部血肿和瘀斑，无需医疗处理。另1例患者抱怨吞咽困难，无需治疗，1个月内自行缓解。
超声引导下向腮腺和颌下腺注射肉毒杆菌毒素似乎是一种安全有效的流口水治疗方法。有必要进行进一步的不同剂量的长期前瞻性研究。
