Ultrasound-Guided Botulinum Toxin Type A Salivary Gland Injection in Children for Refractory Sialorrhea: 10-Year Experience at a Large Tertiary Children's Hospital

Pediatr Neurol. 2016 Jan;54:70-5. doi: 10.1016/j.pediatrneurol.2015.09.014. Epub 2015 Sep 28.


Background: Sialorrhea is problematic for neurologically impaired children, and botulinum toxin A salivary gland injection has been reported as effective in reducing sialorrhea. This article assesses the success and safety of ultrasound-guided weight-based botulinum toxin A injection for the management of sialorrhea in children.

Methods: A total of 111 patients (63 males; 48 females; average age 7 years) with refractory sialorrhea were treated with ultrasound-guided botulinum toxin type A salivary gland injections (144 procedures) from July 1, 2004, to July 1, 2014, using a single weight-based protocol. Patient history, procedural records, and clinical follow-up documents were retrospectively reviewed. Clinical data were compared with reported effectiveness and complications using odds ratios.

Results: A total of 144 procedures were performed in 111 patients with refractory sialorrhea. Cerebral palsy was the most common underlying etiology for sialorrhea (29%), whereas others included encephalopathy (5%), anoxic brain injury (4%), and a variety of chromosomal anomalies (5%). There was a 100% technical success rate. Overall treatment effectiveness was 68%. Repeat injections were not associated with increased clinical success. No procedure-related deaths or major complications were identified; the minor complication rate was less than 2%.

Conclusions: The protocol used for ultrasound-guided injection of botulinum toxin A proved to be safe and effective in children suffering from sialorrhea. Image guidance technique may lead to a reduction in rates of adverse events reported in other series. Subsequent procedures do not improve upon initial efficacy.

Keywords: Botox; botulinum toxin A; pediatric; sialorrhea; ultrasound.

MeSH terms

  • Adolescent
  • Adult
  • Botulinum Toxins, Type A / administration & dosage*
  • Botulinum Toxins, Type A / adverse effects
  • Cerebral Palsy / complications*
  • Cerebral Palsy / diagnostic imaging
  • Cerebral Palsy / drug therapy
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Hospitals, Pediatric
  • Humans
  • Infant
  • Injections / adverse effects
  • Injections / methods
  • Male
  • Neurotoxins / administration & dosage*
  • Neurotoxins / adverse effects
  • Retreatment / adverse effects
  • Retrospective Studies
  • Salivary Glands / diagnostic imaging
  • Salivary Glands / drug effects*
  • Sialorrhea / diagnostic imaging
  • Sialorrhea / drug therapy*
  • Sialorrhea / etiology
  • Tertiary Care Centers
  • Treatment Outcome
  • Ultrasonography, Interventional* / adverse effects
  • Ultrasonography, Interventional* / methods
  • Young Adult


  • Neurotoxins
  • Botulinum Toxins, Type A