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Botulinum Toxin A in the Management of Pediatric Sialorrhea: A Systematic Review

OBJECTIVE: Botulinum toxin A is known to be effective and safe in managing sialorrhea in pediatric patients; however, there is no consensus on a protocol for optimal injection sites and appropriate dosing for injection. METHODS: This review was performed using the Preferred Reporting Items for Syste...

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Autores principales: Heikel, Tiffany, Patel, Shivam, Ziai, Kasra, Shah, Sejal J., Lighthall, Jessyka G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9834812/
https://www.ncbi.nlm.nih.gov/pubmed/35176902
http://dx.doi.org/10.1177/00034894221078365
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author Heikel, Tiffany
Patel, Shivam
Ziai, Kasra
Shah, Sejal J.
Lighthall, Jessyka G.
author_facet Heikel, Tiffany
Patel, Shivam
Ziai, Kasra
Shah, Sejal J.
Lighthall, Jessyka G.
author_sort Heikel, Tiffany
collection PubMed
description OBJECTIVE: Botulinum toxin A is known to be effective and safe in managing sialorrhea in pediatric patients; however, there is no consensus on a protocol for optimal injection sites and appropriate dosing for injection. METHODS: This review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. PubMed, EMBASE, and other databases were queried to identify articles that evaluated botulinum toxin type A for the treatment of sialorrhea in the pediatric population. A total of 405 studies were identified. After applying inclusion and exclusion criteria, 31 articles were included for review. RESULTS: A total of 14 studies evaluated 2-gland injections, and 17 studies evaluated 4-gland injections. Of the 31 studies included, one study assessed incobotulinumtoxinA (Xeomin(®)) the remaining all used onabotulinumtoxinA (Botox(®)). For 2-gland injection studies, a combined total of 899 participants were reviewed, where 602 participants received 50 units into their submandibular glands, while 262 participants received 30 to 50 units. Among 4-gland injection studies, there was a combined total of 388 participants, with the most prevalent dosage utilized being 60 to 100 units in 230 participants, followed by 100 units total in 77 participants. The most common adverse event was dysphagia which resolved in nearly all cases. Three studies aimed to examine 2-gland versus 4-gland injections, with 2 of the studies concluding 4-gland injection was superior. CONCLUSIONS: The strength of evidence suggests that the dosing of 50 units total of onabotulinumtoxinA to the submandibular glands is safe and effective in the pediatric population. For 4-gland injections, bilateral submandibular and parotid gland injections of 60 to 100 units total is the safe and effective dosage. There is no substantial evidence comparing 4-gland injections to 2-gland injections, but research thus far suggests 4-gland injections to be superior. Future study is needed to evaluate incobotulinumtoxinA and abobotulinumtoxinA dosages in the pediatric population.
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spelling pubmed-98348122023-01-13 Botulinum Toxin A in the Management of Pediatric Sialorrhea: A Systematic Review Heikel, Tiffany Patel, Shivam Ziai, Kasra Shah, Sejal J. Lighthall, Jessyka G. Ann Otol Rhinol Laryngol Review Articles OBJECTIVE: Botulinum toxin A is known to be effective and safe in managing sialorrhea in pediatric patients; however, there is no consensus on a protocol for optimal injection sites and appropriate dosing for injection. METHODS: This review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. PubMed, EMBASE, and other databases were queried to identify articles that evaluated botulinum toxin type A for the treatment of sialorrhea in the pediatric population. A total of 405 studies were identified. After applying inclusion and exclusion criteria, 31 articles were included for review. RESULTS: A total of 14 studies evaluated 2-gland injections, and 17 studies evaluated 4-gland injections. Of the 31 studies included, one study assessed incobotulinumtoxinA (Xeomin(®)) the remaining all used onabotulinumtoxinA (Botox(®)). For 2-gland injection studies, a combined total of 899 participants were reviewed, where 602 participants received 50 units into their submandibular glands, while 262 participants received 30 to 50 units. Among 4-gland injection studies, there was a combined total of 388 participants, with the most prevalent dosage utilized being 60 to 100 units in 230 participants, followed by 100 units total in 77 participants. The most common adverse event was dysphagia which resolved in nearly all cases. Three studies aimed to examine 2-gland versus 4-gland injections, with 2 of the studies concluding 4-gland injection was superior. CONCLUSIONS: The strength of evidence suggests that the dosing of 50 units total of onabotulinumtoxinA to the submandibular glands is safe and effective in the pediatric population. For 4-gland injections, bilateral submandibular and parotid gland injections of 60 to 100 units total is the safe and effective dosage. There is no substantial evidence comparing 4-gland injections to 2-gland injections, but research thus far suggests 4-gland injections to be superior. Future study is needed to evaluate incobotulinumtoxinA and abobotulinumtoxinA dosages in the pediatric population. SAGE Publications 2022-02-18 2023-02 /pmc/articles/PMC9834812/ /pubmed/35176902 http://dx.doi.org/10.1177/00034894221078365 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Review Articles
Heikel, Tiffany
Patel, Shivam
Ziai, Kasra
Shah, Sejal J.
Lighthall, Jessyka G.
Botulinum Toxin A in the Management of Pediatric Sialorrhea: A Systematic Review
title Botulinum Toxin A in the Management of Pediatric Sialorrhea: A Systematic Review
title_full Botulinum Toxin A in the Management of Pediatric Sialorrhea: A Systematic Review
title_fullStr Botulinum Toxin A in the Management of Pediatric Sialorrhea: A Systematic Review
title_full_unstemmed Botulinum Toxin A in the Management of Pediatric Sialorrhea: A Systematic Review
title_short Botulinum Toxin A in the Management of Pediatric Sialorrhea: A Systematic Review
title_sort botulinum toxin a in the management of pediatric sialorrhea: a systematic review
topic Review Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9834812/
https://www.ncbi.nlm.nih.gov/pubmed/35176902
http://dx.doi.org/10.1177/00034894221078365
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