This technique video focuses
on the treatment of adults
with chronic sialorrhea using XEOMIN® (incobotulinumtoxinA).
Treatment of chronic sialorrhea involves
the identification of specific anatomic areas,
which can be identified by using anatomic landmarks
or through use of ultrasound guidance.
This video will demonstrate
how to identify each injection site
using ultrasound guidance.
Once the gland is located,
XEOMIN is administered to each injection site
for the treatment of chronic sialorrhea in an adult patient.
Please see the end of the video
for Important Safety Information, including BOXED WARNING.
XEOMIN is injected into the parotid
and submandibular glands on both sides of the face.
This is accomplished through 4 identified
injection sites per treatment session.
The total FDA-approved dose
per treatment session is 100 Units.
The total 100 U dose is divided with a ratio of 3:2
between the parotid gland and the submandibular gland.
30 Units are injected to the parotid gland on each side
and 20 Units are injected
to the submandibular gland on each side.
Please note for these demonstration purposes,
the individual is not a real patient
and is injected with saline.
The model has been properly consented,
pre-treatment photographs have been obtained
and the skin in the treatment areas
has already been prepped.
While care has been taken to confirm the accuracy
of the information presented in this video
and consistency with the FDA-approved use of XEOMIN
in the treatment of an adult with chronic sialorrhea,
all information provided is necessarily generic in nature
and does not constitute continuing
medical education or medical advice.
The parotid glands are superficial
structures and readily amenable
to high-resolution ultrasound examination.
The normal parotid gland appears homogenous
and has increased echogenicity relative
to the adjacent muscles on ultrasound.
This increased echogenicity is related
to the fatty glandular tissue composition of the parotid.
To identify the injection site of the parotid gland,
find the midpoint on the line connecting
the tragus and mandible angle,
approximately at the height of the ear lobe,
one fingerbreadth anterior to this.
A single injection site
in the middle of the gland is required, and in general,
the injection depth should be no more
than 0.5 to 1.0 centimeters,
depending on the thickness of the tissue.
Tissue thickness can vary from patient to patient,
secondary to the patient's nutritional status.
Upon insertion, the needle cannot be readily visualized.
However, the injection volume can be seen
with weak echoing as a black fluid within the gland.
(upbeat music)
The same procedure should be followed
on the patient's contralateral side.
(upbeat music)
The normal submandibular gland shows homogenous echotexture
and fine soft-tissue echogenicity.
It is hypoechoic as compared to the surrounding tissue
and is similar to the echogenicity of muscle.
The submandibular gland shows almost the same texture
and echogenicity of the parotid gland.
The border between the glands can be clearly seen as conjunctive tissues
and more echogenic than glandular tissue.
To determine the injection site for the submandibular gland,
locate the midpoint between the angle of the mandible
and the tip of the chin.
Deliver the injection 1 fingerbreadth medial
to the inferior surface of the mandible at this site.
The needle is inserted upwards and forward
in the direction of the mouth floor
in a 70- to 90-degree angle to the mandibular arch.
A single injection site
in the middle of the gland is required, and in general,
the injection depth should be no more than 0.5 to 1.0 centimeters,
depending on the thickness of the tissue.
Tissue thickness can vary from patient to patient
secondary to the patient's nutritional status.
Upon insertion, the needle cannot be readily visualized.
However, the injection volume can be visualized
with weak echoing as black fluid within the gland.
The same procedure should be followed
on the patient's contralateral side.
(upbeat music)