Botulinum Toxin (Botox): A New Treatment for Excess Saliva
Chetan Vyas BSc (Hons), MSc The Wellington Hospital, London
Division of Psychology and Language Sciences, University College London
Email: c.vyas@ucl.ac.uk
BACKGROUND
Saliva plays a critical role in swallowing, chewing and in initial food digestion.
Normal daily salivary production is 1 to 1.5 litres.
Three major pairs of salivary glands account for 90% of daily saliva produced.
Swallowing difficulties can cause excess saliva leading to drooling, a common and disabling
condition.
In 1822, Justinus Kerner a poet and physician, noted severe dryness of mouth in patients with
Botulism and first suggested that the toxic substance might be useful in treating excess saliva1.
HOW IS BOTOX TREATMENT ADMINISTERED?
Salivary Glands
By Injection:
Injected into one or two of the major glands
Methods:
Injections performed directly into the glands2
Injections using ultra-sound guidance2
Dosages:
Varies dependent on the gland / saliva amount
Currently used to treat:
Parkinson's Disease
Cerebral Palsy
Motor Neurone Disease
POTENTIAL SIDE-EFFECTS
Botox diffusion into nearby muscles may cause:
How Botox Works 3
Dysphagia (swallowing difficulties)
Dental decay
Weak chewing
Damage to facial nerve / artery
PEOPLE’S EXPERIENCES
“Mom had a lot of excess saliva and drooling and
it was embarrassing her and making her very
unhappy. She had one shot of Botox in the neck
six months ago and has not had any drooling
problem since”.4
MY RESEARCH
Aims:
Assessing use of Botox in treating excess saliva in patients’ with a tracheostomy tube
Introducing guidelines on excess saliva management
Rationale:
Presently there is no policy or guidelines on the management of excess saliva
Botox treatment not used in patients who have a tracheostomy tube
Improve patient care and reduce costs
REFERENCES:
1. F. J. Erbguth. Botulinum toxin, a historical note. Lancet 1998; 351:1820;
2. Dr. V. Peter Misra. Advances in Clinical Neuroscience and Rehabilitation, Vol. 2, No. 5 November / December 2002
3. P. Moore & M. Naumann. Handbook of Botulinum Toxin treatment, Blackwell Publishing; 2003.
4. Parkinson’s Disease Forum: Botox helps eye, drooling, pain – Daily Strength. http://dailystrength.org/c/Parkinsons_Disease/forum/