64611 Chemodenervation of parotid and submandibular salivary glands, bilateral

Name of the Procedure:

Chemodenervation of Parotid and Submandibular Salivary Glands, Bilateral
Common name: Salivary gland Botox injection

Summary

Chemodenervation of the salivary glands involves injecting botulinum toxin (Botox) into the parotid and submandibular glands on both sides of the face. This procedure helps reduce excessive saliva production.

Purpose

The procedure aims to treat sialorrhea, or excessive drooling. The goal is to decrease saliva production, improving the quality of life for patients experiencing this condition.

Indications

• Chronic sialorrhea due to neurological conditions (e.g., Parkinson's disease, cerebral palsy)
• Drooling that interferes with daily activities or causes social discomfort
• Patients who have not responded to other treatments for excessive salivation

Preparation

• Patients may be advised to avoid certain medications that could increase bleeding risk.
• Fasting may be required if sedation is used.
• Pre-procedure assessments might include imaging studies or physical examination to determine the exact injection sites.

Procedure Description

1. The patient is either seated or lying down comfortably.
2. An antiseptic solution cleans the skin over the parotid and submandibular glands.
3. Local anesthesia is sometimes used to numb the injection sites.
4. Using a fine needle, the clinician injects botulinum toxin into each parotid and submandibular gland under ultrasound guidance for precision.
5. The procedure targets the nerve endings in the salivary glands, reducing saliva production.

Duration

Typically, the procedure takes about 30 minutes to an hour.

Setting

The procedure is usually performed in an outpatient clinic or specialized medical office.

Personnel

• A neurologist, ENT (ear, nose, and throat) specialist, or other trained physician performs the injections.
• A nurse or medical assistant may assist with the procedure.
• An anesthesiologist may be present if sedation is used.

Risks and Complications

• Common: Mild pain, swelling, or bruising at injection sites
• Rare: Infection, allergic reaction, dry mouth, difficulty swallowing, unintended weakening of nearby muscles

Benefits

• Reduced saliva production
• Improved comfort and social interactions
• Benefits typically seen within a few days to a week

Recovery

• Minimal downtime; patients can usually resume normal activities immediately.
• Follow-up appointments may be scheduled to assess effectiveness and determine if additional treatments are needed.
• Patients may receive instructions on managing any mild discomfort or swelling.

Alternatives

• Surgical removal or ligation of salivary glands
• Oral medications like anticholinergics to reduce saliva production
• Speech therapy
• Pros: Non-surgical alternatives may involve fewer risks.
• Cons: Medications may have systemic side effects and may not be as effective.

Patient Experience

• Patients may feel a slight pinch during injections, with minimal discomfort due to the fine needle.
• Post-procedure mild soreness at injection sites, which can be managed with over-the-counter pain relievers.
• Most patients experience a notable reduction in drooling within a week, significantly improving daily living.