[Evaluation of the efficacy and safety of botulinum toxin type A injections for the prevention of aspiration complications in patients with neurogenic dysphagia and posterior sialorrhea of various etiologies].

[OBJECTIVE] To evaluate the efficacy and safety of incobotulinumtoxinA injections into the salivary glands for preventing aspiration complications in patients with neurogenic dysphagia and posterior sialorrhea of various etiologies.

[MATERIAL AND METHODS] A prospective study conducted in 2024-2025 included 116 patients divided into two groups. The Main group (=58) received ultrasound-guided chemodenervation of four salivary glands (two parotid and two submandibular) with incobotulinumtoxinA, total dose 100 U. The Control group (=58) consisted of retrospective data from patients with similar profiles who did not receive botulinum toxin injections. All patients underwent a comprehensive diagnostic workup, including neurological assessment, instrumental methods (flexible endoscopic evaluation of swallowing, chest CT scan), and non-instrumental scales for dysphagia and cognitive function. To objectify the severity of posterior sialorrhea, the authors developed and applied a Posterior Sialorrhea Intensity Visual Scale (PSIVS). Efficacy was assessed based on the dynamics of sialorrhea intensity, changes in feeding route, the incidence of aspiration pneumonia, and the timing of tracheostomy tube decannulation.

[RESULTS] In the main group, by day 28 post-injection, the vast majority of patients (54 out of 58) showed a significant reduction in sialorrhea intensity to 0-1 points on the PSIVS (compared to 2-3 points initially). Following the reduction in sialorrhea and rehabilitation, 51 patients improved their feeding route (transitioning from tube/gastrostomy to oral or combined feeding) and decannulation was successfully performed in 14 patients. Three cases of aspiration pneumonia (5.2%) were recorded in the main group, compared to 12 cases (20.7%) in the control group. No serious adverse events were reported. Two patients experienced mild dry mouth, which resolved within one month.

[CONCLUSION] Incorporating salivary gland chemodenervation with incobotulinumtoxinA (100 U) into the diagnostic and treatment algorithm for neurogenic dysphagia and posterior sialorrhea is an effective and safe method for preventing aspiration complications. This technique significantly reduces sialorrhea intensity and the incidence of aspiration pneumonia, improves swallowing function, facilitates patient care, and enhances the rehabilitation prognosis for severe neurological patients, starting from the acute disease phase. Implementing this method into the routine practice of rehabilitation facilities is advisable to reduce mortality, disability, and the financial burden on the healthcare system.