儿科前流口水对儿童和护理人员的日常生活有重大影响。A型肉毒神经毒素(BoNT-A)注射被认为是减少流口水的有效治疗方法。然而,对于应注射哪些主要唾液腺以获得最佳治疗效果,同时将副作用的风险降至最低,国际上尚无共识。这项范围审查旨在探索颌下注射BoNT-A和同时进行颌下和腮腺(即四腺)注射的证据,分别,并评估是否可以在不同研究中比较结局,以改善关于儿科前流口性最佳初始BoNT-A治疗方法的决策。PubMed,Embase,搜索和WebofScience以确定有关颌下或四腺注射BoNT-A治疗神经发育障碍儿童前流口性的相关研究(直到2023年10月1日)。治疗上的异同,病人,结果,并评估随访特征。确定了28篇论文;7例报告了颌下注射,21例报告了四腺注射。没有发现治疗程序或随访时间的重大差异。然而,患者特征报告不佳,结果测量有很大的变化,副作用的评估没有明确描述.结论:这篇综述强调了儿科BoNT-A注射研究中结局指标和患者人群描述符的异质性,限制了在颌下注射和四腺注射之间比较治疗效果的能力。这些发现强调需要更广泛和统一的患者特征报告和实施核心结果测量集,以允许比较研究之间的结果并促进临床实践指南的优化。已知:•关于最初注射BoNT-A治疗小儿流口水的唾液腺没有国际共识。新内容:•基于文献得出最佳初始BoNT-A治疗的结论目前是不可行的。用于量化前流口水的结果指标存在相当大的异质性。通常没有足够的报道和接受腺内BoNT-A治疗的儿童的临床特征。•应制定和实施基于共识的结果测量和患者特征集。
Paediatric anterior drooling has a major impact on the daily lives of children and caregivers. Intraglandular botulinum neurotoxin type-A (BoNT-A) injections are considered an effective treatment to diminish drooling. However, there is no international consensus on which major salivary glands should be injected to obtain optimal treatment effect while minimizing the risk of side effects. This scoping
review aimed to explore the evidence for submandibular BoNT-A injections and concurrent submandibular and parotid (i.e. four-gland) injections, respectively, and assess whether outcomes could be compared across studies to improve decision making regarding the optimal initial BoNT-A treatment approach for paediatric anterior drooling. PubMed, Embase, and Web of Science were searched to identify relevant studies (until October 1, 2023) on submandibular or four-gland BoNT-A injections for the treatment of anterior drooling in children with neurodevelopmental disabilities. Similarities and differences in treatment, patient, outcome, and follow-up characteristics were assessed. Twenty-eight papers were identified; 7 reporting on submandibular injections and 21 on four-gland injections. No major differences in treatment procedures or timing of follow-up were found. However, patient characteristics were poorly reported, there was great variety in outcome measurement, and the assessment of side effects was not clearly described. Conclusion: This
review highlights heterogeneity in outcome measures and patient population descriptors among studies on paediatric BoNT-A injections, limiting the ability to compare treatment effectiveness between submandibular and four-gland injections. These findings emphasize the need for more extensive and uniform reporting of patient characteristics and the implementation of a core outcome measurement set to allow for comparison of results between studies and facilitate the optimization of clinical practice guidelines. What is Known: • There is no international consensus on which salivary glands to initially inject with BoNT-A to treat paediatric drooling. What is New: • Concluding on the optimal initial BoNT-A treatment based on literature is currently infeasible. There is considerable heterogeneity in outcome measures used to quantify anterior drooling.and clinical characteristics of children treated with intraglandular BoNT-A are generally insufficiently reported. • Consensus-based sets of outcome measures and patient characteristics should be developed and implemented.