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Botulinum Toxin in the Management of Hyperhidrosis and Other Salivary Conditions

  • Use of Botulinum Toxin in Otorhinolaryngology (A D’Souza and CL Ng, Section Editors)
  • Published:
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Abstract

Purpose of Review

The aim of this review is to summarise the most up-to-date literature on the application of botulinum toxin in hyperhidrosis and other salivary conditions, including sialorrhea, salivary leak and Frey’s syndrome. Surgeons performing this procedure should stay updated with the most recent evidence of its effectiveness for appropriate treatment planning and patient consultation.

Recent Findings

The use of botulinum toxin in hyperhidrosis provides symptom relief in most patients, with satisfaction rates of 80–100% in the majority of patients. Accidental infiltration of local musculature is the most common complication, providing a transient paralysis which is reversible. There has been an increasing body of evidence on the effectiveness of botulinum toxin in salivary gland conditions. This has been able to confirm and quantify its utility as a temporary symptom relief treatment, with minimal complications. For both conditions examined, there is a lack of literature comparing the effect of botulinum toxin to other treatment modalities.

Summary

Botulinum toxin has a growing body of evidence in hyperhidrosis and other salivary conditions. Overall, it is a very safe treatment which provides symptom relief and increased patient satisfaction in most patients. During consultations, surgeons should highlight the need of recurrent applications and the risk of diminishing efficacy with continuous use.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Pirazzini M, Rossetto O, Eleopra R, Montecucco C. Botulinum neurotoxins: biology, pharmacology, and toxicology. Pharmacol Rev. 2017;69(2):200–35.

    PubMed  PubMed Central  CAS  Google Scholar 

  2. Dutta SR, Passi D, Singh M, Singh P, Sharma S, Sharma A. Botulinum toxin the poison that heals: a brief review. Nat J Maxillofac Surg. 2016;7(1):10–6.

    Google Scholar 

  3. Münchau A, Bhatia KP. Uses of botulinum toxin injection in medicine today. Bmj. 2000;320(7228):161–5.

    PubMed  PubMed Central  Google Scholar 

  4. Persaud R, Garas G, Silva S, Stamatoglou C, Chatrath P, Patel K. An evidence-based review of botulinum toxin (Botox) applications in non-cosmetic head and neck conditions. JRSM short reports. 2013;4(2):1–9.

    Google Scholar 

  5. Nigam PK, Nigam A. Botulinum toxin. Indian J Dermatol. 2010;55(1):8–14.

    PubMed  PubMed Central  CAS  Google Scholar 

  6. Ohshima Y, Tamada Y. Classification of systemic and localized sweating disorders. InPerspiration research 2016 (Vol. 51, pp. 7-10). Karger Publishers.

  7. Augustin M, Radtke MA, Herberger K, Kornek T, Heigel H, Schaefer I. Prevalence and disease burden of hyperhidrosis in the adult population. Dermatology. 2013;227(1):10–3. https://doi.org/10.1159/000351292.

    Article  PubMed  CAS  Google Scholar 

  8. Jabbari B, Lakraj AAD, Moghimi N. Hyperhidrosis: anatomy, pathophysiology and treatment with emphasis on the role of botulinum toxins. Toxins. 2013;5(4):821–40. https://doi.org/10.3390/toxins5040821.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Naumann MK, Hamm H, Lowe NJ. Effect of botulinum toxin type a on quality of life measures in patients with excessive axillary sweating: a randomized controlled trial. Br J Dermatol. 2002;147(6):1218–26. https://doi.org/10.1046/j.1365-2133.2002.05059.x.

    Article  PubMed  CAS  Google Scholar 

  10. • Cruddas L, Baker DM. Treatment of primary hyperhidrosis with oral anticholinergic medications: a systematic review. J Eur Acad Dermatol Venereol. 2017;31(6):952–63. https://doi.org/10.1111/jdv.14081This systematic review shows that although anticholinergic therapy is successful in treating hyperhidrosis the side effect profile is both very common (73% of patients experiencing dry mouth) with a mean of 10.9% of patients stopping treatment as a result.

    Article  PubMed  CAS  Google Scholar 

  11. Stolman LP. Treatment of excess sweating of the palms by Iontophoresis. Arch Dermatol. 1987;123(7):893–6. https://doi.org/10.1001/archderm.1987.01660310061015.

    Article  PubMed  CAS  Google Scholar 

  12. Montaser-Kouhsari L, Zartab H, Fanian F, Noorian N, Sadr B, Nassiri-Kashani M, et al. Comparison of intradermal injection with iontophoresis of abobotulinum toxin a for the treatment of primary axillary hyperhidrosis: a randomized, controlled trial. J Dermatol Treat. 2014;25(4):337–41. https://doi.org/10.3109/09546634.2012.739679.

    Article  CAS  Google Scholar 

  13. Krasna MJ (2011). The role of surgical treatment of hyperhidrosis. In Mayo Clinic Proceedings (Vol. 86, issue 8, pp. 717–718). Elsevier ltd. https://doi.org/10.4065/mcp.2011.0401.

  14. Lin TS, Fang HY. Transthoracic endoscopic sympathectomy in the treatment of palmar hyperhidrosis - with emphasis on perioperative management (1,360 case analyses). Surg Neurol. 1999;52(5):453–7. https://doi.org/10.1016/S0090-3019(99)00111-1.

    Article  PubMed  CAS  Google Scholar 

  15. Stashak AB, & Brewer JD (2014). Management of hyperhidrosis. In Clinical, Cosmetic and Investigational Dermatology (Vol. 7, pp. 285–299). Dove medical press ltd. https://doi.org/10.2147/CCID.S53119.

  16. Saenz JW, Sams RW, Jamieson B. FPIN’s clinical inquiries. Treatment of hyperhidrosis. Am Fam Physician. 2011;83(4):465–6 http://www.ncbi.nlm.nih.gov/pubmed/21322524. Accessed 14 May 2020.

  17. Lowe NJ, Glaser DA, Eadie N, Daggett S, Kowalski JW, Lai PY. Botulinum toxin type a in the treatment of primary axillary hyperhidrosis: a 52-week multicenter double-blind, randomized, placebo-controlled study of efficacy and safety. J Am Acad Dermatol. 2007;56(4):604–11. https://doi.org/10.1016/j.jaad.2007.01.009.

    Article  PubMed  Google Scholar 

  18. Eisenach JH, Atkinson JLD, & Fealey RD (2005). Hyperhidrosis: evolving therapies for a well-established phenomenon. In Mayo Clinic Proceedings (Vol. 80, issue 5, pp. 657–666). Elsevier Ltd. https://doi.org/10.4065/80.5.657.

  19. Heckmann M, Ceballos-Baumann AO, Plewig G. Botulinum toxin a for axillary hyperhidrosis (excessive sweating). N Engl J Med. 2001;344(7):488–93. https://doi.org/10.1056/NEJM200102153440704.

    Article  PubMed  CAS  Google Scholar 

  20. Swartling C, Naver H, Pihl-Lundin I, Hagforsen E, Vahlquist A. Sweat gland morphology and periglandular innervation in essential palmar hyperhidrosis before and after treatment with intradermal botulinum toxin. J Am Acad Dermatol. 2004;51(5):739–45. https://doi.org/10.1016/j.jaad.2004.07.030.

    Article  PubMed  Google Scholar 

  21. Weinberg T, Solish N, & Murray C (2014). Botulinum neurotoxin treatment of palmar and plantar hyperhidrosis. In Dermatologic Clinics (Vol. 32, issue 4, pp. 505–515). W.B. Saunders. https://doi.org/10.1016/j.det.2014.06.012.

  22. Scamoni S, Valdatta L, Frigo C, Maggiulli F, Cherubino M. Treatment of primary axillary hyperhidrosis with Botulinum toxin type a: our experience in 50 patients from 2007 to 2010. ISRN Dermatology. 2012;2012:702714–5. https://doi.org/10.5402/2012/702714.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Nicholas R, Quddus A, & Baker D M (2015). Treatment of primary craniofacial hyperhidrosis: a systematic review. In American Journal of Clinical Dermatology (Vol. 16, issue 5, pp. 361–370). Springer International Publishing https://doi.org/10.1007/s40257-015-0136-6, 2015.

  24. Swartling C, Färnstrand C, Abt G, Stålberg E, Naver H. Side-effects of intradermal injections of botulinum a toxin in the treatment of palmar hyperhidrosis: a neurophysiological study. Eur J Neurol. 2001;8(5):451–6. https://doi.org/10.1046/j.1468-1331.2001.00261.x.

    Article  PubMed  CAS  Google Scholar 

  25. Ekedahl C. Surgical treatment of drooling. Acta Otolaryngol. 1974;77(1–6):215–20.

    PubMed  CAS  Google Scholar 

  26. Van De Heyning Marquet JF, Creten WL. Drooling in children with cerebral palsy. Acta Otorhinolaryngol Belg. 1980;34(6):691–705.

    Google Scholar 

  27. Syeda F, Ahsan F, Nunez D. Quality of life outcome analysis in patients undergoing submandibular duct repositioning surgery for sialorrhoea. J Laryngol Otol. 2007;121(6):555–8.

    PubMed  CAS  Google Scholar 

  28. Tahmassebi J, Curzon M. Prevalence of drooling in children with cerebral palsy attending special schools. Dev Med Child Neurol. 2003;45(9):613–7.

    PubMed  CAS  Google Scholar 

  29. Hyson H, Johnson A, Jog M. Survey of sialorrhea in parkinsonian patients in southwestern Ontario. Can J Neurol Sci. 2001;28:S46–7.

    Google Scholar 

  30. NICE. Hypersalivation: Oral glycopyrronium bromide. https://www.nice.org.uk/advice/esuom15/chapter/Intervention-and-alternatives. Updated 2017. Accessed 05/01, 2020.

  31. NICE. Xeomin (botulinum neurotoxin type A) for treating chronic sialorrhoea. https://www.nice.org.uk/guidance/TA605/chapter/1-Recommendations. Updated 2019. Accessed 05/01, 2020.

  32. Regueira LS, Baratella-Evêncio L, de Oliveira JB, et al. Effects of chronic treatment with botulinum toxin type a in salivary glands of rats: histological and immunohistochemical analyses. J Oral Pathol Med. 2019;48(8):728–34.

    PubMed  CAS  Google Scholar 

  33. • Sridharan K, Sivaramakrishnan G. Pharmacological interventions for treating sialorrhea associated with neurological disorders: a mixed treatment network meta-analysis of randomized controlled trials. J Clin Neurosci. 2018;51:12 This review provided empirical evidence that Botulinum toxins effectively reduce sialorrhea compared to placebo. The relative efficacies of anticholinergics compared to placebo are also reported.

    PubMed  CAS  Google Scholar 

  34. Squires N, Humberstone M, Wills A, Arthur A. The use of botulinum toxin injections to manage drooling in amyotrophic lateral sclerosis/motor neurone disease: a systematic review. Dysphagia. 2014;29(4):500–8.

    PubMed  Google Scholar 

  35. Stone CA, O'Leary N. Systematic review of the effectiveness of botulinum toxin or radiotherapy for sialorrhea in patients with amyotrophic lateral sclerosis. J Pain Symptom Manag. 2009;37(2):246–58.

    CAS  Google Scholar 

  36. Jongerius PH, van der Hoogen F, van Limbeek J, et al. Effect of botulinum toxin in the treatment of drooling: a controlled clinical trial. Pediatrics. 2004;114:620–7.

    PubMed  Google Scholar 

  37. Vaile L, Finlay F. Is injection of botulinum toxin type A effective in the treatment of drooling in children with cerebral palsy? Arch Dis Child. 2006 Oct 1;91(10):862–3.

    PubMed  PubMed Central  CAS  Google Scholar 

  38. Suskind DL, Tilton A. Clinical study of botulinum-A toxin in the treatment of sialorrhea in children with cerebral palsy. Laryngoscope. 2002 Jan;112(1):73–81.

    PubMed  CAS  Google Scholar 

  39. van der Waal I. Diseases of the salivary glands including dry mouth and Sjögren's syndrome: diagnosis and treatment. Springer Sci Bus Media. 2012:152–3.

  40. Parekh D, Glezerson G, Stewart M, Esser J, Lawson HH. Post-traumatic parotid fistulae and sialoceles. A prospective study of conservative management in 51 cases. Ann Surg. 1989;209(1):105–11.

    PubMed  PubMed Central  CAS  Google Scholar 

  41. Naragund AI, Halli VB, Mudhol RS, Sonoli SS. Parotid fistula secondary to suppurative parotitis in a 13-year-old girl: a case report. J Med Case Rep. 2010;4(1):249.

    PubMed  PubMed Central  Google Scholar 

  42. Marchese-Ragona R, De Filippis C, Marioni G, Staffieri A. Treatment of complications of parotid gland surgery. Acta Otorhinolaryngol Ital. 2005;25(3):174–8.

    PubMed  PubMed Central  CAS  Google Scholar 

  43. Rao JK, Gehlot N, Laxmy V, Siwach V. Management of parotid fistula using hypertonic saline. Natl J Maxillofac Surg. 2011;2(2):177–80.

    PubMed  PubMed Central  CAS  Google Scholar 

  44. Srinidhi D, Singh M, Rangaswamy S, Choudry S. Parotid sialocele and fistulae: current treatment options. Int J Contemp Dent. 2011;2(1).

  45. Graillon N, Le Roux M, Chossegros C, Haen P, Lutz J, Foletti J. Botulinum toxin for ductal stenosis and fistulas of the main salivary glands. Int J Oral Maxillofac Surg. 2019;48(11):1411–4.

    PubMed  CAS  Google Scholar 

  46. Costan V, Dabija MG, Ciofu ML, Sulea D, Popescu E, Boisteanu O. A functional approach to posttraumatic salivary fistula treatment: the use of botulinum toxin. J Craniofac Surg. 2019;30(3):871–5.

    PubMed  Google Scholar 

  47. • Send T, Bertlich M, Eichhorn KW, Bootz F, Jakob M. Management and follow-up results of salivary fistulas treated with botulinum toxin. Laryngoscope. 2019;129(2):403–8 This is the largest available case series available in the literature and demonstrates the ability of Botulinum toxin to give rise to salivary fistula healing and quantifies the number of injections needed for healing.

    PubMed  CAS  Google Scholar 

  48. Laskawi R, Winterhoff J, Köhler S, Kottwitz L, Matthias C. Botulinum toxin treatment of salivary fistulas following parotidectomy: follow-up results. Oral Maxillofac Surg. 2013;17(4):281–5.

    PubMed  Google Scholar 

  49. von Lindern JJ, Niederhagen B, Appel T, Bergé S, Reich RH. New prospects in the treatment of traumatic and postoperative parotid fistulas with type A botulinum toxin. Plast Reconstr Surg. 2002;109(7):2443–5.

    Google Scholar 

  50. Guntinas-Lichius O, Sittel C. Treatment of postparotidectomy salivary fistula with botulinum toxin. Ann Otol Rhinol Laryngol. 2001;110(12):1162–4.

    PubMed  CAS  Google Scholar 

  51. Marchese-Ragona R, De Filippis C, Staffieri A, Tugnoli V, Restivo D. Parotid gland fistula: treatment with botulinum toxin. Plast Reconstr Surg. 2001;107(3):886–7.

    PubMed  CAS  Google Scholar 

  52. Lovato A, Restivo DA, Ottaviano G, Marioni G, Marchese-Ragona R. Botulinum toxin therapy: functional silencing of salivary disorders. Acta Otorhinolaryngol Ital. 2017;37(2):168–71.

    PubMed  PubMed Central  CAS  Google Scholar 

  53. Linder TE, Huber A, Schmid S. Frey's syndrome after parotidectomy: a retrospective and prospective analysis. Laryngoscope. 1997;107(11):1496–501.

    PubMed  CAS  Google Scholar 

  54. Freni F, Gazia F, d’Alcontres FS, Galletti B, Galletti F. Use of botulinum toxin in Frey's syndrome. Clinical case reports. 2019;7(3):482–5.

    PubMed  PubMed Central  Google Scholar 

  55. Motz KM, Kim YJ. Auriculotemporal syndrome (Frey syndrome). Otolaryngol Clin N Am. 2016;49(2):501–9.

    Google Scholar 

  56. Xie S, Wang K, Xu T, Guo XS, Shan XF, Cai ZG. Efficacy and safety of botulinum toxin type a for treatment of Frey's syndrome: evidence from 22 published articles. Cancer Med. 2015;4(11):1639–50.

    PubMed  PubMed Central  Google Scholar 

  57. Eckardt A, Kuettner C. Treatment of gustatory sweating (Frey's syndrome) with botulinum toxin a. Head Neck: Journal for the Sciences and Specialties of the Head and Neck. 2003;25(8):624–8.

    Google Scholar 

  58. Steffen A, Rotter N, König IR, Wollenberg B. Botulinum toxin for Frey's syndrome: a closer look at different treatment responses. J Laryngol Otol. 2012;126(2):185–9.

    PubMed  CAS  Google Scholar 

  59. Gross KM, Schote AB, Schneider KK, Schulz A, Meyer J. Elevated social stress levels and depressive symptoms in primary hyperhidrosis. PLoS One. 2014;9(3):e92412. https://doi.org/10.1371/journal.pone.0092412.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  60. Li C, Wu F, Zhang Q, Gao Q, Shi Z, Li L. Interventions for the treatment of Frey's syndrome. Cochrane Database Syst Rev 2015(3).

  61. Ribeiro LB, Xerez DR, Maliska C, de Souza SAL, Costa MMB. Qualitative and quantitative scintigraphy in sialorrhea before and after botulinum toxin injection. Laryngoscope. 2019;129(11):2521–6.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Lewisham and Greenwich NHS Trust, Lewisham High Street, London, SE 13 6LH, UK

    Angelos Mantelakis & Anil Joshi

  2. St Georges Hospital, London Borough of Wandsworth, UK

    Harry Spencer

  3. Addenbrookes Hospital, Cambridge, UK

    Jean-Luc Duval

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  1. Angelos Mantelakis
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Correspondence to Angelos Mantelakis.

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Mantelakis, A., Spencer, H., Duval, JL. et al. Botulinum Toxin in the Management of Hyperhidrosis and Other Salivary Conditions. Curr Otorhinolaryngol Rep 8, 358–363 (2020). https://doi.org/10.1007/s40136-020-00304-8

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