Abstract
Background: Sialorrhea is a troublesome symptom in a variety of neurological diseases. Recently, local injection of botulinum toxin into the salivary glands was approved for treatment of sialorrhea, and injection guidance by anatomical landmarks was suggested. Objective: To compare the accuracy of ultrasound versus previously proposed anatomical landmarks for localizing the salivary glands. Methods: In a cross-sectional study in 21 adults, landmark positions (LM) of the parotid gland (PG) and the submandibular gland (SG) were identified following published recommendations. The ultrasound position (US) was defined as the position representing the maximum gland thickness. The distance between positions, gland thickness, and optimal injection depth were recorded by US. Results: Gland thickness differed significantly between LM and US positions (PG, 4 vs. 17.8 mm; P < 0.001; SG, 3.5 vs. 13.6 mm; P < 0.001). The spatial deviation between the recommended LM and identified US positions in the horizontal plane was 21 mm to the posterior direction for the PG and 19.6 mm for the SG. The deviation in vertical orientation was small for both glands; however, there was a positive correlation between the distance from the SG to the mandibular bone with age. The optimal injection depth measured by US was 11.8 mm for the PG and 13.6 mm for the SG. This showed to be positively correlated with the body mass index. Conclusions: The position of the salivary glands differs from proposed landmarks and depends on the individual age and body weight; therefore, we recommend ultrasound guidance for injection.
| Original language | English |
|---|---|
| Journal | Movement Disorders Clinical Practice |
| Volume | 7 |
| Issue number | 2 |
| Pages (from-to) | 194-198 |
| Number of pages | 5 |
| DOIs | |
| Publication status | Published - 01.02.2020 |
Funding
Sebastian Loens was, in part, employed within the “DysTract – GermanDystonia Translational Research and Therapy Consortium” funded by the Federal Ministry of Education and Research (BMBF). Norbert Brüggemann received speaker's honoraria from UCB and AbbVie. He received nonfinancial support from Bayer. N.B. is funded by the Deutsche Forschungsgemeinschaft (DFG; FOR 2488, GRK1957), the Collaborative Center for X‐linked Dystonia‐Parkinsonism, and the Else‐Kröner Fresenius‐Stiftung (HA17_2017). He is a consultant for Censa. Armin Steffen received study grants by Inspire Medicals. He received travel cost and speaker's honororia by Inspire Medical, Merz Pharmaceuticals, and Intersect. He is a consultant for Merz Pharmaceuticals. Tobias Bäumer received honiara from Pharm Allergan, Ipsen Pharma, and Merz Pharmaceuticals and is a consultant for Pharm Allergan and Merz Pharmaceuticals. He received a grant from the DFG (FG2494). Financial Disclosures for previous 12 months:
Research Areas and Centers
- Research Area: Medical Genetics
