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  • Title: US-guided botulinum toxin injection for excessive drooling in children.
    Author: Çiftçi T, Akıncı D, Yurttutan N, Akhan O.
    Journal: Diagn Interv Radiol; 2013; 19(1):56-60. PubMed ID: 22798155.
    Abstract:
    PURPOSE: We aimed to evaluate the safety and efficacy of botulinum toxin A (BTX-A) injections under ultrasonography (US) guidance for children with excessive drooling. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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