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Non-invasive ventilation
Developing an intrasalivary gland botox service for patients receiving long-term non-invasive ventilation at home: a single-centre experience
  1. Jessica Harbottle1,
  2. Hannah Carlin2,
  3. Thomas Payne-Doris3,
  4. Hilary M I Tedd2,
  5. Anthony de Soyza4 and
  6. Ben Messer3
  1. 1School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
  2. 2Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
  3. 3North East Assisted Ventilation Service, Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
  4. 4Population Health Science Institutes, Newcastle University, Newcastle upon Tyne, UK
  1. Correspondence to Dr Ben Messer; ben.messer{at}nhs.net

Abstract

Introduction Sialorrhoea is a debilitating symptom in neurological disease and there is a growing literature for the use of intrasalivary gland Botulinum Toxin (botox) injections in its management. However, provision of intrasalivary gland botox remains inconsistent and sialorrhoea is often poorly controlled in motor neuron disease (MND).

Sialorrhoea in association with bulbar dysfunction can cause intolerance of non-invasive ventilation (NIV) and respiratory infection, so its treatment is critical within a home ventilation service (HVS).

This treatment can also be used to enable tracheostomy cuff deflation to facilitate weaning from ventilation. We report on the outcomes of intrasalivary gland botox in our HVS.

Methods In 2015, we set up an intrasalivary gland botox service for patients under our HVS. Under ultrasound guidance, we injected submandibular gland

(SMG), parotid gland (PG) or both.

Results 109 intrasalivary gland botox procedures were performed in 72 patients. Diagnostic groups included MND 32

Cerebral Palsy 8 and Weaning 14. Glands injected were, SMG (6%), PG (47%) and both (47%). The majority (84%) received the Dysport preparation with mean dose 273 units. 94% were ultrasound guided. 81% of injections resulted in a positive treatment effect, with 47% patients requesting repeat injections. Complications were angioedema (0.9%) and worsening dysphagia (3.7% following SMG injection). Mean survival following treatment was 40 months with 53% patients still alive.

Conclusions Intrasalivary gland botox appears effective across a range of neurological conditions requiring long-term NIV with few complications. Dysphagia may be an important complication of SMG injection. A randomised controlled trial may help establish the evidence base.

  • non invasive ventilation
  • assisted ventilation

Data availability statement

No data are available.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/bmjresp-2021-001188

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    Data availability statement

    No data are available.

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    Footnotes

    • Twitter @drbenmesser

    • Contributors JH and BM conceived and designed the study. JH obtained patient data. All authors undertook review and interpretation of the data. JH drafted the initial manuscript. The manuscript was revised, and the final version was approved, by all authors. BM accepts full responsibility for the work and the conduct of the study, had access to the data and controlled the decision to publish.

    • Funding Merz pharmaceuticals have agreed to pay the open access charges.

    • Competing interests BM reports speaker fees from Fisher and Paykel outside the submitted work. AdS reports grants and personal fees from AstraZeneca, Bayer, Boehringer, Chiesi, Forest labs, GSK, Grifols, Insmed, Teva, Zambon, outside the submitted work.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.