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