CLINICAL QUESTION
How clinically effective is onabotulinum toxin A (BoNT-A; Botox) as a treatment for sialorrhea (drooling) in children, and what are the potential adverse effects?
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July 2024BOTTOM LINE
Onabotulinum toxin A was shown effective in improving drooling severity in children with sialorrhea, and adverse effects were few, transient, and not severe.
BACKGROUND: Sialorrhea, also known as drooling, has a significant impact on the medical and psychosocial well-being of children. Clinical management of sialorrhea can be invasive or conservative. Botulinum neurotoxin is one of the primary conservative interventions for drooling, and onabotulinum toxin A is the most popular serotype used to treat children.
STUDY DESIGN: Systematic review and meta-analysis.
SETTING: Department of Otolaryngology–Head and Neck Surgery, McGill University, Montréal, Québec, Canada.
SYNOPSIS: Researchers conducted a database search for studies on the use of BoNT-A serotypes for pediatric (aged 0–21 years) sialorrhea, regardless of underlying neurological condition, and resulting treatment response and adverse effects. Twenty manuscripts representing 539 patients (52.13% male; mean age nine years, six months) were eligible for the systematic review. Cerebral palsy was found in 68.65% of patients. The average dose of BoNT-A was 1.1 unit/kg/gland. Eight studies had sufficient data for the meta-analysis. Results showed that BoNT-A significantly decreased the frequency and severity of drooling, compared with pre-injection conditions, using random-effects models. Six of 20 studies reported dysphagia as an adverse post-injection effect. Other side effects included thickness of saliva and pain at the injection site. The mean salivary pH value was significantly lower in
the BoNT-A group, underscoring a need for specialized dental care for children undergoing this treatment. Authors note the lack of worldwide consensus regarding primary assessment outcome tool, toxin dose, site of injection, and follow-up period, despite the ongoing need to quantify sialorrhea frequency and impact on children’s and caregivers’ lives. Study limitations include a small sample size.
CITATION: Oad H, Maltezeanu A, da Silva SD, et al. Onabotulinum toxin A for drooling in children: a systematic review and meta-analysis [published online ahead of print January 31, 2024]. Laryngoscope: doi.org/10.1002/lary.31277.