Ultrasound-Guided Salivary Gland Interventions:Clinical Application of Intraglandular Botulinum Toxin Injections
- Author:
Juntaek HONG
1
;
Dong-wook RHA
;
Jun Min CHA
Author Information
- Publication Type:Review Article
- From: Clinical Pain 2025;24(1):68-74
- CountryRepublic of Korea
- Language:English
- Abstract: Sialorrhea is a common clinical problem, particularly in patients with neurological disorders, where it can lead to significant physical and psychosocial burdens, as well as serious complications such as aspiration pneumonia. Ultrasound-guided intraglandular botulinum toxin (BTX) injection has emerged as a safe and effective treatment for sialorrhea. This technique targets the parotid and submandibular glands—responsible for the majority of salivary output—using high-resolution ultrasound to improve localization and avoid nearby vascular structures. The injection is typically performed with the patient in a hyperextended neck position and the head rotated contralaterally, using anatomical landmarks such as the tragus, mandibular angle, and chin tip to guide probe placement. A linear transducer and a 22∼25 gauge needle are recommended, with either an in-plane or out-of-plane approach employed based on operator preference and gland accessibility. While bilateral injections of both glands are common, gland selection should be individualized based on salivary physiology and therapeutic goals. The optimal dose varies by age and weight, with most studies suggesting a maximum of 4 U/kg to minimize adverse effects. Reported complications are generally mild, including transient dysphagia and xerostomia, with serious adverse events being rare.Treatment efficacy lasts up to 16 weeks and can be monitored through both caregiver-reported scales and objective methods such as ultrasound-based assessments of gland size and vascular flow. Despite variability in dosing protocols and target gland selection, this technique has shown consistent efficacy and safety across age groups, and is increasingly adopted as a standard intervention for drooling management.
