Evaluation of the efficacy and safety of botulinum toxin type A injections for the prevention of aspiration complications in patients with neurogenic dysphagia and posterior sialorrhea of various etiologies
Abstract
OBJECTIVE
To evaluate the efficacy and safety of incobotulinumtoxinA injections into the salivary glands for preventing aspiration complications in patients with neurogenic dysphagia and posterior sialorrhea of various etiologies.
MATERIAL AND METHODS
A prospective study conducted in 2024-2025 included 116 patients divided into two groups. The Main group (n=58) received ultrasound-guided chemodenervation of four salivary glands (two parotid and two submandibular) with incobotulinumtoxinA, total dose 100 U. The Control group (n=58) consisted of retrospective data from patients with similar profiles who did not receive botulinum toxin injections. All patients underwent a comprehensive diagnostic workup, including neurological assessment, instrumental methods (flexible endoscopic evaluation of swallowing, chest CT scan), and non-instrumental scales for dysphagia and cognitive function. To objectify the severity of posterior sialorrhea, the authors developed and applied a Posterior Sialorrhea Intensity Visual Scale (PSIVS). Efficacy was assessed based on the dynamics of sialorrhea intensity, changes in feeding route, the incidence of aspiration pneumonia, and the timing of tracheostomy tube decannulation.
RESULTS
In the main group, by day 28 post-injection, the vast majority of patients (54 out of 58) showed a significant reduction in sialorrhea intensity to 0-1 points on the PSIVS (compared to 2-3 points initially). Following the reduction in sialorrhea and rehabilitation, 51…
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