Name: ultrasound-guided botulinum toxin-a injections: a method of treating sialorrhea
Uploaded: 2016-11-09T12:30:00
Description: Watch this Scientific Journal Video about Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea at JoVE.com

We thank the patients who gave their consent and contributed to the publication.

在这里，我们在技术上描述用于在患者的神经系统的吞咽困难的治疗流涎的方法。我们不会集中在疗效的结果，这已先前7出版。在本文中，在结果部分，我们从连续5例治疗从2014年至2016年，这些患者被认为是代表全体人民，它由肉毒毒素的长期随访（3个疗程）显示数据圣路易吉Gonzaga大学医院的服务。该协议获得批准，是继人体实验地方的道德标准委员会的指导方针。 1.患者的招募</...

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This protocol describes US-guided BoNT-A injection in the parotid and submandibular glands for the treatment of moderate to severe sialorrhea. Sialorrhea secondary to dysphagia is a frequent complication of the advanced stages of different neurological diseases, and when pharmacological therapy with anticholinergic agents demonstrates scarce efficacy or tolerability, salivary gland BoNT injection represents a useful therapeutic option2,7. However, salivary gland BoNT injection guided by anatomical landmarks ma...

流涎是唾液代表几个神经病症，包括中风，脑性麻痹，多发性硬化，和神经变性疾病1的共同和禁用并发症的过度流动。患者中度至严重流涎患有生命的质量受损，常由相关的并发症，如吸入性肺炎，口腔感染，龋齿，和浸软的皮肤2的恶化。各种治疗方法可用于治疗流涎，范围从手术药物治疗，以减少唾液分泌的目的。 手术选择包括去神经，唾液腺的切除和换位或结扎涎管3,4。然而，尽管其疗效，手术是通过定义与潜在的严重的不良事件，诸如唾液瘘和囊肿形成，感染，丧失侵入性手术味觉，听觉，构音障碍的损失，并在唾液腺生产3不可逆转的影响。此外，已经观察到该过程2,5后的唾液腺两年或两年以上手术方法可以仅具有临时有效性由于神经支配恢复。对于严重流涎更常见，微创治疗是采用全身用药与抗胆碱能性。然而，长期使用抗胆碱能药的通常与全身的副作用，如混乱，记忆问题，嗜睡，尿潴留，和麻痹性肠梗阻2,5相关联。 肉毒毒素（肉毒毒素）唾液喷射为用于流涎一个新兴的治疗选择。的BoNT是蛋白酶（七从A到G），由细菌肉毒梭菌产生，其能够从神经肌肉接头的突触前神经末梢制止乙酰胆碱释放，阻断肌肉收缩和腺活动在orthosympathetic和副交感神经节后突触。肉毒毒素A型（肉毒毒素-A）和B型（肉毒毒素-B）通常用于肌张力障碍和痉挛6的治疗管理。最近，由于缺乏疗效或显著副作用2,7,8存在下被证明是一个有用的治疗选择在中度至其他医学治疗不理想的反应严重流涎大唾液腺中的BoNT注射。 人类唾液腺分为两类：主要和次要。大唾液腺包括一对腮腺，一对颌下腺，和一对舌下腺的;小唾液腺包括口腔9的子黏膜内扩散约1000小腺体。大约0.5升唾液是每天分泌。三对主要唾液腺负责的唾液产生的90％以上，约划分如下：20％F或腮腺，65％为颌下腺和5％，舌下腺9。腮腺是最大的之一，位于外耳道下方，下颌骨和胸锁乳突肌之间;它向前突出咬肌10的表面上。重要结构穿过压盖，如面神经，颈外动脉，和下颌后静脉等几个重要的神经血管结构是靠近压盖。颌下腺是浆粘液腺位于后面，下颌骨升支的下方，在颌下三角的区域，二腹肌的前部和后部的肚子之间和周围的肌肉下颌舌骨11的后缘。 的BoNT唾液腺注射是有潜力的本地处理以避免不适和/或全身性的副作用与其他疗法，如口服，TR相关ansdermal和手术方式的选择。在这里，我们展现出可靠的，容易复制的方法，以获得令人满意的和持久的减少流口水的同时，极力限制严重发生的治疗下，超声在腮腺肉毒毒素-A注射和颌下腺流涎（美国）指导不良事件。在流口水在没有美国的指导对肉毒毒素-A注射疗效的数据文献报道12;然而，腺体和其周围组织的超声引导标识，与针位置的实时可视化一起允许在不利事件的降低和更精确的注射，导致增加的疗效和结果再现性7,13。

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		<tr>
			<td>abobotulinumtoxinA (Dysport)&#160;</td>
			<td>&#160;IpsenBiopharm, Wrexham, UK</td>
			<td></td>
			<td>Delivered drug</td>
		</tr>
		<tr>
			<td>MyLab &#160;Twice&#160;</td>
			<td>Esaote</td>
			<td></td>
			<td>Ultraonograph</td>
		</tr>
		<tr>
			<td>LA523 5&#8211;10 MHz&#160;</td>
			<td>Esaote</td>
			<td></td>
			<td>Linear transducer</td>
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	</tbody>
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ultrasound-guided botulinum toxin-a injections: a method of treating sialorrhea

Neurological diseases can be complicated by sialorrhea, an excessive flow of saliva. Patients suffering from moderate to severe sialorrhea have an impaired quality of life, often worsened by correlated complications such as aspiration pneumonia, oral infections, dental caries, and maceration of the skin. Diverse therapeutic approaches have been proposed for the treatment of sialorrhea, including surgery and the use of anticholinergic agents, with limited results and the possible occurrence of serious adverse events. Recently, botulinum toxin (BoNT) injection within the major salivary glands has been proposed in patients refractory to anticholinergic therapy, with the aim of inhibiting local acetylcholine release and gland activity. 
In order to obtain a better outcome in terms of reduction of saliva production, efficacy, duration, and avoidance of major adverse events, we developed an ultrasound-guided BoNT-type A injection technique accurately described in the text. Here we present a method of treating sialorrhea with bilateral parotid and submandibular gland BoNT-type A injections under ultrasound guidance. Four quadrants of the parotid gland and two quadrants of the submandibular gland are visualized and injected using two accesses and one access, respectively. 
The ultrasound-guided procedure provides a simple, non-invasive, real-time visualization of the muscular and glandular tissues and their surrounding structures, optimizing treatment efficacy and safety.

在超声引导下注射是获得实时的和精确的针可视化在唾液腺的BoNT施用一种有效的技术。这种方法提供了可靠的流涎处理，具有延长的疗效和没有严重不良事件。事实上，腺体，并通过本文提出的超声引导下的做法提供的针入度的可视化允许肉毒毒素A的有显著而持久的成果大唾液腺内的一种普遍的管理。流口水减少可通过唾液吸引容易观察1瓦特处理后通过DFSS和增值业务的...

Watch this Scientific Journal Video about Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea at JoVE.com

Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea

Botulinum toxin is injected into the salivary glands for the treatment of sialorrhea. The ultrasound-guided botulinum toxin injection in both the parotid and submandibular glands demonstrates a sustained efficacy and the absence of serious side effects.

超声引导下肉毒毒素-A注射液：治疗流涎的一种方法

Neurological diseases can be complicated by sialorrhea, an excessive flow of saliva. Patients suffering from moderate to severe sialorrhea have an ...

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