WEBVTT

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This technique video focuses
on the treatment of adults

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with chronic sialorrhea using XEOMIN®
(incobotulinumtoxinA).

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Treatment of chronic sialorrhea involves

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the identification of specific
anatomic areas,

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which can be identified by using
anatomic landmarks

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or through use of ultrasound guidance.

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This video will demonstrate
how to identify each injection site

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using anatomic landmark guidance.

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Once the gland is located,

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XEOMIN is administered to
each injection site

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for the treatment of chronic sialorrhea
in an adult patient.

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Please see the end of the video

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for Important Safety Information,
including BOXED WARNING.

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XEOMIN is injected into the parotid

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and submandibular glands on both
sides of the face.

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This is accomplished through 4 identified

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injection sites per treatment session.

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The total FDA-approved dose

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per treatment session is 100 Units.

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The total 100 U dose is divided
with a ratio of 3:2

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between the parotid gland and
the submandibular gland.

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30 Units are injected to the
parotid gland on each side,

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and 20 Units are injected

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to the submandibular gland on each side.

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Please note for these
demonstration purposes,

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the individual is not a real patient

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and is injected with saline.

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The model has been properly consented,

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pre-treatment photographs
have been obtained

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and the skin in the treatment areas

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has already been prepped.

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While care has been taken to
confirm the accuracy

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of the information presented in this video

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and consistency with the FDA-approved
use of XEOMIN

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in the treatment of an adult with
chronic sialorrhea,

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all information provided is necessarily
generic in nature

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and does not constitute continuing

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medical education or medical advice.

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The parotid gland is superficially located

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and can be easily palpated.

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Its location is inferior anterior

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to the external acoustic meatus

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and it lies posterior to
the mandibular ramus.

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The parotid gland also lies anterior

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to the mastoid process of
the temporal bone.

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The parotid gland appears wedge-shaped

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when visualized superficially and
on horizontal sections.

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To identify the injection site
of the parotid gland,

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find the midpoint on the line
connecting the tragus

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and mandible angle approximately
at the height of the ear lobe.

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The injection site is to be marked

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1 fingerbreadth anterior to this site.

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A single injection site in the middle

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of the gland is required, and in general,

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the injection depth should be no more
than 0.5 to 1.0 centimeters,

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depending on the thickness of the tissue.

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Tissue thickness can vary from
patient to patient

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secondary to the patient's
nutritional status.

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The same procedure should be performed
on the contralateral side.

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(upbeat music)

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The submandibular gland is located

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beneath the floor of the mouth

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and, generally, its shape in the longitudinal

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and transverse sections is
that of a triangle.

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This gland is comprised of
superficial and deep lobes.

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The superficial portion fills the
digastric triangle

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and is much larger than the deep portion.

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It extends upward deep to the mandible

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and up to the mylohyoid muscle.

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The deep portion lies deep to
the mylohyoid muscle

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and superficial to the hyoglossus
and styloglossus muscles.

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The submandibular gland is not palpable,

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but its anatomical position
is well-defined.

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To identify the injection site
of the submandibular gland,

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locate the midpoint between
the angle of the mandible

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and the tip of the chin.

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Deliver the injection 1
fingerbreadth medial

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to the inferior surface of
the mandible at this site.

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It is important to note that the
needle is inserted upwards

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and forward in the direction
of the mouth floor

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and in a 70- to 90-degree angle
to the mandibular arch.

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This will be demonstrated
in the treatment portion of this video.

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A single injection site
in the middle of the gland is required

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and in general, the injection depth
should be no more

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than 0.5 to 1.0 centimeters,

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depending on the thickness of the tissue.

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Tissue thickness can vary from
patient to patient

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secondary to the patient's
nutritional status.

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The same procedure should be performed

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on the contralateral side.

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(upbeat music)