Effectiveness and safety of botulinum toxin in comparison with surgery for drooling in paediatric patients with neurological disorders: a systematic review

Different therapeutic methods for chronic drooling in pediatric patients with neurological problems have been described in the scientific literature. However, there is no consensus on the ideal strategy of treatment. The aim of this study was to compare botulinum toxin injection therapy and surgical modalities to control drooling in pediatric patients with neurological disorders. A systematic literature research was conducted on nine electronic databases, which were published until April 2020. Six articles were included in this systematic review. The total sample consisted of 209 patients, 67.4% (n = 141) with cerebral palsy. All studies used injections of botulinum toxin type A with the application to the submandibular and/or parotid salivary glands. The surgical treatments performed were duct ligation in parotid and/or submandibular salivary glands, duct relocation in submandibular salivary glands and glandular excision of the submandibular and sublingual salivary glands. There were complications in only 16.1% (n = 27) of the sample: 11 cases due botulinum toxin application and 16 due to surgery. The drooling control was assessed by objective measures, and subjective measures.Although surgical procedures presented higher risk of adverse effects than the botulinum toxin type A, in all studies and measurements performed, they presented larger and longer-lasting positive effect on drooling than the botulinum toxin type A injection. We suggest performing bilateral submandibular duct relocation with bilateral sublingual gland excision or isolated bilateral submandibular duct ligation, which are the surgical techniques with the largest sample in this review. Nevertheless, further studies are necessary to compare samples with botulinum toxin type A and surgical treatment.