Local botulinum toxin A for treating chronic sialorrhea

Background. Sialorrhea and drooling interfere with oral communication and nutrition, posing problems for hygiene, nursing, and social interactions. Therapeutic efforts such as swallowing therapy, systemic medications, operations, and irradiation are often insufficient or accompanied by side effects. Materials and methods. Ten patients with therapy-resistant sialorrhea of various etiologies were treated between 2002 and 2007 with sonography-guided botulinum toxin A (BTA) injections into the parotid and submandibular glands bilaterally. Therapeutic success was evaluated using established symptom scores, and the glandular tissue size was sonographically measured before and 3 months after injections. Results. All 10 patients benefited from the BTA therapy, as shown by significant reduction of the troublesome sialorrhea. The effect lasted 6-28 weeks. On one occasion, transient xerostomia occurred. Sonographic measurements revealed no morphologic changes. Conclusion. BTA is an effective and safe treatment for chronic sialorrhea. The effect is reversible. It causes no sonographically detectable changes.