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 anatomic landmark 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 gland is superficially located
and can be easily palpated.
Its location is inferior anterior
to the external acoustic meatus
and it lies posterior to the mandibular ramus.
The parotid gland also lies anterior
to the mastoid process of the temporal bone.
The parotid gland appears wedge-shaped
when visualized superficially and on horizontal sections.
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.
The injection site is to be marked
1 fingerbreadth anterior to this site.
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.
The same procedure should be performed on the contralateral side.
(upbeat music)
The submandibular gland is located
beneath the floor of the mouth
and, generally, its shape in the longitudinal
and transverse sections is that of a triangle.
This gland is comprised of superficial and deep lobes.
The superficial portion fills the digastric triangle
and is much larger than the deep portion.
It extends upward deep to the mandible
and up to the mylohyoid muscle.
The deep portion lies deep to the mylohyoid muscle
and superficial to the hyoglossus and styloglossus muscles.
The submandibular gland is not palpable,
but its anatomical position is well-defined.
To identify the injection site of 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.
It is important to note that the needle is inserted upwards
and forward in the direction of the mouth floor
and in a 70- to 90-degree angle to the mandibular arch.
This will be demonstrated in the treatment portion of this video.
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.
The same procedure should be performed
on the contralateral side.
(upbeat music)