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Video of onabotulinumtoxinA (Botox) infusion into left parotid gland with 25 gauge Chiba needle

return to: Botox injection to salivary glands for hypersalivation

Modified Operative Note

Procedure: Ultrasound-guided Botox injection to the submandibular glands bilaterally (25 units in 1.0 cc to each) and to the parotid glands bilaterally (25 units in 1. cc to each) to a total of 100 units delivered

Preop Diagnosis: Sialorrhea associated with ALS

Anesthesia: None

Description of Procedure: Following identification the patient informed consent and a brief timeout in the minor room using the Toshiba Aplio 500 ultrasound unit with the 14 to 5 MHz probe Botox was reconstituted with 4 cc of preservative-free saline added to a 100 unit vial of on a botulinum toxin yielding 25 units/cc loaded then with the same 5 cc syringe into short IV tubing fixed to a 25-gauge Chiba ultrasound needle.
 
The ultrasound was initially used to identify the right tail of parotid and submandibular gland and then positioned over the anterior aspect of the right submandibular gland with gel removed with a sterile 4 x 4 and then further sterilized with an alcohol swab allowing for placement of the Chiba needle into the substance of the submandibular gland with ultrasound confirmation directing 1 cc to be delivered (25 units).  An identical procedure was done on the contralateral left submandibular gland also delivering 25 units (1 cc).
 
Attention then was directed to the right parotid gland with an oblique orientation of the ultrasound probe allowing for visualization of the tail in large part of the body with similar cleaning of gel with sterile 4 x 4 followed by alcohol swab and placement of the Chiba needle with ultrasound documentation of appropriate location delivering 1 cc (25 units).  An identical procedure was done the contralateral left side also delivering 25 units (1 cc).
 
She was observed in clinic and had no complications no bleeding with ultrasound evaluation of each of the injection sites done immediately after the injection showing no hematoma