WEBVTT

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This technique video focuses

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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

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how to identify each injection site

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using ultrasound 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 glands are superficial

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structures and readily amenable

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to high-resolution ultrasound examination.

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The normal parotid gland appears homogenous

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and has increased echogenicity relative

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to the adjacent muscles on ultrasound.

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This increased echogenicity is related

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to the fatty glandular tissue
composition of the parotid.

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To identify the injection site of
the parotid gland,

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find the midpoint on the line connecting

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the tragus and mandible angle,

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approximately at the height of the ear lobe,

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one fingerbreadth anterior to this.

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A single injection site

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in the middle of the gland is required,
and in general,

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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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Upon insertion, the needle cannot be
readily visualized.

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However, the injection volume can be seen

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with weak echoing as a black fluid
within the gland.

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(upbeat music)

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The same procedure should be followed

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on the patient's contralateral side.

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(upbeat music)

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The normal submandibular gland shows
homogenous echotexture

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and fine soft-tissue echogenicity.

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It is hypoechoic as compared to
the surrounding tissue

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and is similar to the echogenicity
of muscle.

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The submandibular gland shows
almost the same texture

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and echogenicity of the parotid gland.

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The border between the glands can be
clearly seen as conjunctive tissues

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and more echogenic than glandular tissue.

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To determine the injection site for 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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The needle is inserted upwards and forward

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in the direction of the mouth floor

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

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A single injection site

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in the middle 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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Upon insertion, the needle cannot be
readily visualized.

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However, the injection volume
can be visualized

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with weak echoing as black fluid
within the gland.

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The same procedure should be followed

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on the patient's contralateral side.

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(upbeat music)