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Salivary gland Botox injection

Salivary gland botulinum toxin type A (Botox ®) injection procedure

Botulinum toxin type A (Botox) is a medication commonly used to reduce activity of muscles or glands.  Ultrasounds can be used to identify the location of a child’s salivary glands.  With direct ultrasound guidance a small needle can be placed into the salivary glands and a small amount of the botulinum medication directly injected to reduce excessive saliva production.

Conditions treated by this procedure

Children with excessive drooling as a result of neurological deficits or hypersalivation (excessive saliva production) can be at risk for aspiration (saliva going down the airway) and lung infections.  In addition excessive saliva production and drooling externally can lead to skin and dental issues around the mouth as well as social consequences.  In these circumstances Salivary Gland Botulinum Type A (Botox ®) can be performed to help control the excessive saliva production.

Procedure performance & recovery

The procedure typically requires 30 minutes to complete. Frequently, sedation or anesthesia will be used to help facilitate the successful completion of the procedure. This helps to minimize anxiety for the child and decrease risk of complications as a result of movement during the procedure.The procedure typically requires 30 minutes to complete.

Ultrasound imaging will be used to identify the location of the salivary glands. The skin surface will be cleaned to allow for a sterile skin site. As the needle used to infuse the medication (Botulinum Type A (Botox ®) is very small no local anesthetic is required. The local anesthetic needle is often larger than the needle used to inject the medication (Botulinum Type A (Botox ®). The needle is inserted into the middle of the salivary gland and confirmed with Ultrasound imaging. The medication (Botulinum Type A (Botox ®) is infused directly into the salivary gland. The puncture site is then covered with a bandage.  No sutures are required. Your child will be monitored for a short period to allow for recovery from the anesthesia or sedation

Your child may feel some soreness at the puncture site following the procedure similar to that following an immunization injection.  This should resolve with a day or two.

The full effects the medication (Botulinum Type A (Botox ®) may take several weeks and last for up to 6 months.  

Depending on the severity or the side effects of the excessive saliva production the need for repeat procedures and frequency of procedures is variable

Your child may resume normal activities immediately following the procedure.

Botulinum toxin type A (Botox) procedure benefits

The procedure is minimally invasive, reliable, and effective to reduce excessive saliva production and the potential risks associated. No surgical incision is required—only a skin puncture is required.  There is no need to have a stitch to close the skin puncture. Generally, this procedure is not painful, the recovery period is quick and can be repeated as necessary.

Botulinum toxin type A (Botox) procedure risks

Any procedure where the skin is penetrated carries a potential risk of infection. The chance of developing an infection that requires added antibiotic treatment appears to be less than one in 1,000.
If the medication (Botulinum Type A (Botox ®) disperses outside the salivary gland this can lead to localized muscle paralysis of facial muscles. Sometimes, this procedure can result in inhibition of saliva production (dry-mouth). 

Links to providers that treat that treatment

Br J Oral Maxillofac Surg. 2013 Apr;51(3):231-3. doi: 10.1016/j.bjoms.2012.07.012. Epub 2012 Aug 31. Ultrasound-guided injection of botulinum toxin A into the submandibular gland in children and young adults with sialorrhoea.

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Center of Excellence


Children's Hospital of Wisconsin's imaging department was re-designated as a Diagnostic Imaging Center of Excellence by the American College of Radiology. Our imaging department was the third children's hospital in the nation to receive this prestigious credential.