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Background <p>Sialorrhea is a complication of several neurological disorders often encountered in the neurological intensive care unit (NICU). Current medications for the treatment of sialorrhea have limited proven efficacy and carry significant adverse effects. We sought to describe our experience with salivary gland injection of botulinum toxin (BoNT) as a novel treatment for refractory sialorrhea in patients admitted to the NICU.</p> Methods <p>We performed a retrospective case series of all patients admitted to the NICU at two tertiary medical centers from 2017 to 2023 who received intra-glandular injection of BoNT for refractory sialorrhea. We extracted baseline demographics, clinical characteristics, suctioning frequency, and antibiotic treatment before and after BoNT. We describe the procedural aspects as well as adverse events related to treatment.</p> Results <p>A total of six patients were identified; primary neurological diseases were diverse among the cohort (cardiac arrest, NMDA encephalitis, ischemic stroke, and Guillan-Barre Syndrome). Five patients had received standard anti-sialagogic treatments before injection, with three patients experiencing significant adverse events. Intraglandular BoNT was administered in the parotid gland in three cases, submandibular gland in one, and both parotid and submandibular in two cases. Among five patients with documented suctioning frequency, the average time from injection to cessation of hourly suctioning was 8.8 days, with three patients experiencing resolution of hourly suctioning within five days from injection. Recurrent pneumonia after injection occurred in 2 patients. Four patients could ultimately be liberated from the ventilator before discharge. No adverse events clearly attributable to BoNT injections were seen.</p> Conclusion <p>Intraglandular BoNT injection is a potential treatment of severe sialorrhea among intubated patients with critical neurologic illness and warrants further study in this population.</p>

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Intraglandular Botulinum Toxin Injection for Sialorrhea in the Neurologic Intensive Care Unit

  • 期刊论文

  • 发表日期：

    2026年4月29日

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  • Mohamed Ridha,
  • Safa Kaleem,
  • Hooman Kamel,
  • Shauna Linn,
  • Kaitlyn Lee,
  • Eileen Magnuski,
  • Elizabeth Hooker,
  • Jennifer I. Lee,
  • Brock Daniels,
  • Abdalla Ammar,
  • Santosh Murthy,
  • Alexander E. Merkler,
  • Sachin Agarwal,
  • Roxana Dumitru,
  • Judy H. Ch’ang

摘要

Background

Sialorrhea is a complication of several neurological disorders often encountered in the neurological intensive care unit (NICU). Current medications for the treatment of sialorrhea have limited proven efficacy and carry significant adverse effects. We sought to describe our experience with salivary gland injection of botulinum toxin (BoNT) as a novel treatment for refractory sialorrhea in patients admitted to the NICU.

Methods

We performed a retrospective case series of all patients admitted to the NICU at two tertiary medical centers from 2017 to 2023 who received intra-glandular injection of BoNT for refractory sialorrhea. We extracted baseline demographics, clinical characteristics, suctioning frequency, and antibiotic treatment before and after BoNT. We describe the procedural aspects as well as adverse events related to treatment.

Results

A total of six patients were identified; primary neurological diseases were diverse among the cohort (cardiac arrest, NMDA encephalitis, ischemic stroke, and Guillan-Barre Syndrome). Five patients had received standard anti-sialagogic treatments before injection, with three patients experiencing significant adverse events. Intraglandular BoNT was administered in the parotid gland in three cases, submandibular gland in one, and both parotid and submandibular in two cases. Among five patients with documented suctioning frequency, the average time from injection to cessation of hourly suctioning was 8.8 days, with three patients experiencing resolution of hourly suctioning within five days from injection. Recurrent pneumonia after injection occurred in 2 patients. Four patients could ultimately be liberated from the ventilator before discharge. No adverse events clearly attributable to BoNT injections were seen.

Conclusion

Intraglandular BoNT injection is a potential treatment of severe sialorrhea among intubated patients with critical neurologic illness and warrants further study in this population.