ORIGINAL ARTICLES 116 21 2019 Background: Drooling is the unintentional loss of saliva from the mouth, usually caused by poor coordination of the swallowing mechanism. It is commonly seen in patients with chronic neurologic disorders, such as Parkinson’s disease, amyotrophic lateral sclerosis (ALS), cerebral palsy, and stroke, as well as in patients with cognitive impairment and dementia. Objectives: To evaluate the efficacy and safety of ultrasound- guided botulinum toxin injections into the parotid and submandibular salivary glands for the treatment of drooling. Methods: We conducted a retrospective analysis of the medical records of 12 consecutive patients treated with botu- linum toxin injections into the parotid and submandibular glands for the first time. The primary outcome variable was the subjective improvement of drooling on a 5-point scale. Secondary outcome variables were duration of the therapeutic effect, request to undergo additional treatment, and adverse events. Results: Of 12 patients, 8 (67%) reported considerable improv- ement after treatment, 3 reported slight improvement, and 1 reported development of dry mouth. All patients stated that they felt the effects 1 week after the injections; the mean duration of the therapeutic effect was 4.5 months (range 3–9 months). One patient suffered from local hematoma and ecchymosis that did not require medical care. Another patient complained of difficulty swallowing, which did not require medical treatment and resolved spontaneously within 1 month. Conclusions: Ultrasound-guided botulinum toxin injections into the parotid and submandibular glands seem to be a safe and effective therapy for the treatment of drooling. Further long-term prospective studies with varying doses are warranted. IMAJ 2019; 21: 116–119 botulinum toxin, drooling, sialorrhea, salivary gland, ultrasound-guided injections Ultrasound-Guided Botulinum Toxin Injections into the Salivary Glands for the Treatment of Drooling Waseem A. Abboud DMD 1,2 , Sahar Nadel DMD 1 , Sharon Hassin-Baer MD 2 , Abigail Arad MD 3 , Alex Dobriyan DMD 1 and Ran Yahalom DMD 1 1 Department of Oral and Maxillofacial Surgery, and 2 Institute of Movement Disorders, Department of Neurology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 3 Section of Otolaryngology, Head and Neck Surgery, Maccabi Healthcare system, Israel ABSTRACT: KEY WORDS: S wallowing is a complex neuromuscular activity that involves the rapid coordination of structures in the oral cavity, phar- ynx, and esophagus. Te initial phase of swallowing, also called the oral phase, requires the complex neuromuscular coordina- tion of the peri-oral, masticatory, lingual, and palatal muscles. Drooling is the unintentional loss of saliva from the mouth and is usually caused by poor coordination of the swallowing mechanism and not by over-production of saliva. Patients with chronic neurologic disorders, such as Parkinson’s disease, amyotrophic lateral sclerosis (ALS), cerebral palsy, and stroke, as well as patients with cognitive impairment, dementia, facial palsy, post-laryngectomy, and post-mandibulectomy ofen suf- fer from drooling, which greatly adds to their disability, lowered self-esteem, and isolation [1]. Drooling has numerous negative sequelae afecting the psychosocial functions and physical condition of the patients. Soiling of clothes, dysfunctional eating, disturbed speech, wet- ting and damage to technical aids, peri-oral skin irritations and infections, halitosis, and aspiration-related pulmonary complications are among the complaints frequently reported by patients and caregivers [2-6]. Various therapeutic approaches exist for the treatment of drooling, the diversity of which emphasizes that no single treatment is efective in providing a satisfactory result with minimal side efects and risks. Pharmacological treatments attempt to decrease salivation by reducing cholinergic activity, and anticholinergic medications such as scopolamine, glyco- pyrrolate and benztropine are prescribed for this indication. Tese drugs, however, have many serious side efects [2-4] that may pose greater risks to the health of the patient than drool- ing itself. Many surgical techniques have been proposed to control drooling, with resection of the submandibular glands being one of the early surgical techniques described. It car- ries with it the risk of an irreversible xerostomia and paresis of the facial nerve developing [2]. Resection of the chorda tympani nerve and tympanic plexus neurectomy decrease salivary fow by interrupting the parasympathetic neural pathway. Tey carry the risk of taste loss and hearing loss and are associated with neural regrowth and waning of the efects