WEBVTT

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This technique video focuses on the

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treatment of adults with chronic

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sialorrhea using

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Xeomin(incubotulinumtoxinA).

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Treatment of chronic sialorrhea

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involves the identification of

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specific anatomic areas, which

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can be identified by using anatomic

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landmarks or through use of

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ultrasound guidance.

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This video will demonstrate how to

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identify each injection site using

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anatomic landmark guidance.

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Once the gland is located.

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XEOMIN is administered to each

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injection site for the treatment of

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chronic sialorrhea in an adult

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patient.

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Please see the end of the video for

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important safety information,

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including boxed warning.

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XEOMIN is injected into the parotid

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and submandibular glands on both

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sides of the face.

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This is accomplished through four

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identified injection sites per

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treatment session.

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The total FDA approved dose per

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treatment session is 100 units.

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The total 100 U dose is divided

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with a ratio of three to two between

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the parotid gland and the

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submandibular gland.

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30 units are injected to the parotid

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gland on each side and 20 units

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are injected to submandibular gland

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on the each side.

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Please note for these demonstration

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purposes, the individual is

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not a real patient and is injected

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with saline.

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The model has been properly

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consented, pre-treatment photographs

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have been obtained and the skin in

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the treatment areas has already been

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prepped.

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While care has been taken to confirm

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the accuracy of the information

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presented in this video and

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consistency with the FDA approved

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use of XEOMIN in the treatment of

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an adult with chronic sialorrhea,

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all information provided is

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necessarily generic in nature and

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does not constitute continuing

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medical education or medical advice.

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The parotid gland is superficially

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located 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

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the mandibular ramus.

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The parotid gland also lies anterior

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to mastoid process of the temporal

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bone.

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The parotic gland appears

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wedge-shaped when visualized

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superficially and on horizontal

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sections.

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To identify the injection site of

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the parotid gland, find the

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mid-point on the line connecting the

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tragus and mandible angle

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approximately at the height of the

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earlobe.

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The injection site is to be marked

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one finger breadth anterior to this

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site. A single injection site

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in the middle of the gland is

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required and in general, the

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injection depth should be no more

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than 0.5 to 1.0

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centimeters, depending on the

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thickness of the tissue.

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Tissue thickness can vary from

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patient to patient, secondary to

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the patient's nutritional status.

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The same procedure should be

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performed on the contralateral side.

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The submandibular gland is located

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beneath the floor of the mouth and

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generally, its shape in the

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longitudinal and transverse sections

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is that of a triangle.

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This gland is comprised of

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superficial and deep lobes.

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The superficial portion fills the

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digastric triangle and is much

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larger than the deep portion.

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It extends upward deep to the

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mandible and up to the mylohyoid

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muscle.

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The deep portion lies deep to

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mylohyoid muscle and superficial

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to the hyoglossus and styloglossus

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muscles.

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The submandibular gland is not

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palpable, but its anatomical

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position is well defined.

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To identify the injection site of

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the submandibular gland, locate

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the midpoint between the angle of

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the mandible and the tip of the

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chin. Deliver the injection one

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finger breadth medial to the

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inferior surface of the mandible at

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this site.

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It is important to note that the

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needle is inserted upwards and

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forward in the direction of the

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mouth floor and in a 70 to

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90 degree angle to the mandibular

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arch. This will be demonstrated

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in the treatment portion of this

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video.

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A single injection site in the

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middle of the gland is required,

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and in general, the injection depth

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should be no more than 0.5

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to 1.0 centimeters,

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depending on the thickness of the

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tissue.

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Tissue thickness can vary from

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patient to patient, secondary to

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the patient's nutritional status.

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The same procedure should be

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performed on the contralateral side.