Ann Rehabil Med.  2017 Feb;41(1):51-57. 10.5535/arm.2017.41.1.51.

Accuracy of Ultrasound-Guided and Non-ultrasound-Guided Botulinum Toxin Injection Into Cadaver Salivary Glands

• So JI
• Song DH
• Park JH
• Choi E
• Yoon JY
• Yoo Y
• Chung ME

• KMID: 2383677
• DOI: http://doi.org/10.5535/arm.2017.41.1.51

Abstract

OBJECTIVE
To compare the accuracy of ultrasound (US)-guided and non-US-guided botulinum toxin (BTX) injection into the salivary glands (parotid and submandibular glands) of cadavers.
METHODS
Two rehabilitation physician injected dye into three sites in the salivary glands (two sites in the parotid gland and one site in the submandibular gland) on one side of each cadaver (one was injected on the right side, while the other was injected on the left side), using either a non-US-guided injection procedure based on superficial landmarks or a US-guided procedure. Orange dye was used for the US-guided procedure, and green dye was used for the blind procedure. Two physicians uninvolved with the injection procedures and who were blinded to the method of injection dissected the cadavers to identify whether the dye was accurately injected into each target site.
RESULTS
The accuracies of the blind and US-guided injections into the parotid gland were 79.17% and 95.83%, respectively. In the submandibular gland, the accuracies of the blind and US-guided injections were 50.00% and 91.67%, respectively. The difference in accuracy between the two procedures was statistically significant only in the submandibular gland (p=0.025). There were no significant differences in the accuracy of US-guided and non-US-guided injections between the two physicians for the two sites in the parotid gland (p=0.278 and p=0.146, respectively).
CONCLUSION
US-guided BTX injection into the submandibular gland offers significantly greater accuracy over blind injection. For the treatment of drooling by injecting BTX into the submandibular gland, clinicians should consider using US guidance for improved accuracy.

Keyword

Sialorrhea; Botulinum toxins; Ultrasonography

MeSH Terms

Botulinum Toxins*
Cadaver*
Citrus sinensis
Methods
Parotid Gland
Rehabilitation
Salivary Glands*
Sialorrhea
Submandibular Gland
Ultrasonography
Botulinum Toxins

Figure

• 

  Fig. 1 Locations of the non-ultrasound-guided parotid gland injections (A) and submandibular gland injections (B). Injection points were marked with blue dots and squares, respectively. M, mandible; MP, mastoid process; MAS, masseter muscle; SCM, sternocleidomastoid muscle; G, gnathion; DM, digastric muscle; MA, mandibular angle.

• 

  Fig. 2 Ultrasound-guided dye injection into the salivary gland: (A) parotid gland (PG) and (B) submandibular gland (SMG). Intraglandular injectate (arrow head) and needle placement (arrow) are shown in this figure.

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  Fig. 3 Dissected cadaver with non-ultrasound-guided injection (green dye, arrow head) and ultrasound-guided injection (orange, arrow): (A) parotid gland (PG) and (B) submandibular gland (SMG). Non-ultrasound-guided injection that was incorrectly placed into the subcutaneous fat tissue (B).

• 

  Fig. 4 Extracted submandibular gland. We determined whether the dye was located in the intraglandular area by incising the gland.

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