Medication Summary

Anticholinergic agents inhibit activation at muscarinic receptors, and at best, decrease the volume of drooling. At tolerable anticholinergic doses, drooling is unlikely to completely cease.

Botulinum toxin leads to partial or complete muscle paralysis by inhibiting acetylcholine release at the neuromuscular synaptic end plate. It also blocks the release of acetylcholine at the cholinergic synapses of the autonomic nervous system; thus, this toxin can block cholinergic parasympathetic secretomotor fibers of the salivary gland. IncobotulinumtoxinA has received FDA approval for the treatment of chronic sialorrhea.

Class Summary

Injection of incobotulinumtoxinA or rimabotulinumtoxinB into the parotid and submandibular glands has been approved by the FDA for adults with chronic sialorrhea owing to various neurologic disorders, including Parkinson disease, amyotrophic lateral sclerosis, cerebral palsy, and stroke.

IncobotulinumtoxinA (Xeomin)

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Through inhibition of acetylcholine release from peripheral cholinergic nerve endings, incobotulinumtoxinA deters cholinergic transmission at the neuromuscular junction. It is indicated for adults with chronic sialorrhea.

RimabotulinumtoxinB (Myobloc)

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Through inhibition of acetylcholine release from peripheral cholinergic nerve terminals, rimabolutinumtoxinB deters cholinergic transmission at the neuromuscular and salivary neuroglandular junction. It is indicated for treatment of chronic sialorrhea in adults.

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Media Gallery

Rhombus-shaped incision for bilateral submandibular duct transposition. Image courtesy of Dr Neeraj N Mathur.
Dissected submandibular duct with peri-stomal cuff mucosa. Image courtesy of Dr Neeraj N Mathur.
Artery passed through the submucosal tunnel opening just behind the anterior tonsillar pillar. Image courtesy of Dr Neeraj N Mathur.
Sublingual glands seen along submandibular duct and relation of duct to lingual nerve. Image courtesy of Dr Neeraj N Mathur.
Floor of mouth, as seen after bilateral submandibular duct transposition. Image courtesy of Dr Neeraj N Mathur.

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Author

Neeraj N Mathur, MBBS, MS, DNB, MAMS, FAMS Professor and Head, Department of ENT, Amrita Hospital and Amrita Institute of Medical Sciences, Faridabad, India

Neeraj N Mathur, MBBS, MS, DNB, MAMS, FAMS is a member of the following medical societies: Association of Otolaryngologists of India, Cochlear Implant Group of India, Indian Medical Association, National Academy of Medical Sciences (India), Neuro-Otological and Equilibriometric Society of India, Royal Society of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Karen H Calhoun, MD, FACS, FAAOA Professor, Department of Otolaryngology-Head and Neck Surgery, Ohio State University College of Medicine

Karen H Calhoun, MD, FACS, FAAOA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Head and Neck Society, Association for Research in Otolaryngology, Southern Medical Association, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Rhinologic Society, Society of University Otolaryngologists-Head and Neck Surgeons, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Emeritus Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Neosoma; MI10;<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10 advisor.

Additional Contributors

Jennifer P Porter, MD Assistant Professor, Department of Otorhinolaryngology, Division of Communicative Science, Chevy Chase Facial Plastic Surgery

Jennifer P Porter, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, Texas Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Karla R Brown, MD, and Traci L Vaughn, MD, to the development and writing of this article.