Sialorrhea

orange salivary glands on black outline of face

Sialorrhea is characterized by excessive drooling and/or swallowing caused by a lack of oral and facial muscle control. It is seen most commonly in children with cerebral palsy and adults affected by Parkinson’s disease or strokes. Sialorrhea can cause skin irritation and odor around the mouth, as well as possible lung infections if saliva pools towards the back of the mouth. It can also damage clothing and other equipment, and can lead to social isolation. 

Botox is a neurotoxin produced by Clostridium botulinum bacteria that is commonly used to treat symptoms associated with sialorrhea. When it is injected into the salivary glands, the neurotoxin blocks the production of saliva, which decreases the amount of saliva produced. 

Did You Know?

There are three main pairs of salivary glands that normally produce about 1 quart of saliva a day. They are the parotid glands, which are located in the cheeks, the submandibular glands, which are located at the base of the mouth, and the sublingual glands, which are located underneath the tongue. 

Frequently Asked Questions: 

Am I a candidate for treating sialorrhea with Botox?

You may be a candidate for treating sialorrhea with Botox if you are experiencing excessive saliva production that results in uncontrollable drooling. However, Botox is not the first treatment option and your doctor may recommend other options, such as dental appliances or anti-cholinergic medications to reduce salivary flow before recommending Botox. 

Additionally, Botox may not be an ideal treatment for everyone, and people with additional nerve or muscle conditions, breathing-related problems, or who are on certain medications may be at an increased risk for side effects. Therefore, you will need to schedule a consultation at Premier Neurology to determine if you are an ideal candidate. 

salivary glands diagram

What can I expect when having sialorrhea treated with Botox?

All Botox injections are performed in our office with a fine needle. Additional pain medications and sedation may also be used. When having sialorrhea treated with Botox, you can expect to receive injections approximately once every 2-6 months, depending on how long the results last. In most cases, two submandibular glands and two parotid glands will be injected. Since the submandibular glands are hard to palpate, ultrasonography will likely be used to accurately locate them. After your Botox injection, you will need to schedule a follow up appointment 4-6 weeks out. This follow up appointment will allow your neurologist to evaluate your progress to determine the best course of action moving forward. 

What can I expect after having a Botox injection?

After your Botox injection, you will be able to return to your usual activities. However, if you were given sedation, you will need to have a driver and spend the day recovering from the effects of the sedation. It usually takes a few days for the Botox to have an effect, however this can vary from patient to patient. Most patients will notice a significant difference about a week after the injection, however some patients may take up to a month to feel the full effect. 

Some patients may also experience pain or soreness at the injection site. This can be resolved with over the counter medications and applying ice packs to the area. In rare cases, you may also experience side effects such as dry mouth, thickened secretions, infection of the injection site, or problems with chewing and swallowing.  

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