Drooling is a normal phenomenon for children up to 4 years old. However drooling becomes a significant complication for the people with neuromuscular disorders. It causes not only social embarassment from anterior drooling but also aspiration pneumonia due to posterior drooling and significant swallowing problems. Physiatrists have become the main clinician in the management of drooling due to expertise in ultrasound, use of botulinum toxin, and familiarity with neuromuscular disorders. Botulinum toxins have been used for drooling management since 1999 for the people with neuromuscular disorders. Its effect has been significant for managing drooling and preventing aspiration pneumonia with relative minor complications. This course reviews anatomy of salivary glands and its surrounding structures, includes clinical case scenarios and presents a video demonstration on the ultrasound technique for the salivary gland injections with botulinum toxin. We will also discuss dosing of botulinum toxin, injection technique and physiology of salivary glands. We will discuss the short term and long term efficacy of this treatment, associated adverse events, and the financial advantages when frequent hospitalizations can be prevented. Attendees will be confident in botulinum toxin injections to salivary glands upon completing this course.

Learning Objectives

  • Understand physiology and anatomy of salivary glands.
  • Review current dosing of botulinum toxin A for salivary gland injections, indications for injections and injection technique.
  • Delineate the techniques of ultrasound guided botulinum toxin injections to the salivary glands.