[Endoscopic diagnosis of neurogenic dysphagia and quantitative visual scale assessment of posterior sialorrhea for the prevention of aspiration events in adults].

Abstract

Objective: This study aimed to evaluate the efficacy and safety of intrasalivary injections of incobotulinumtoxinA for the prevention of aspiration complications in patients with neurogenic dysphagia and posterior sialorrhea of various etiologies.

Material and methods: This prospective study, conducted from 2024 to 2025, included 116 patients divided into two groups. The Main group (n=58) received ultrasound-guided chemodenervation of four salivary glands (two parotid and two submandibular) with incobotulinumtoxinA at a total dose of 100 U. The Control group (n=58) comprised retrospective data from patients with similar clinical profiles who did not receive botulinum toxin injections. All participants underwent a comprehensive diagnostic evaluation, including neurological assessment, instrumental methods such as a videofluoroscopic swallow study (VFSS) and a chest computed tomography (CT) scan, and non-instrumental scales for dysphagia and cognitive function. To quantify the severity of posterior sialorrhea, a Posterior Sialorrhea Intensity Visual Scale (PSIVS) ranging from 0 to 3 points was developed and applied. Efficacy was evaluated based on changes in sialorrhea intensity, feeding route, aspiration pneumonia incidence, and timing of tracheostomy decannulation.

Results: By day 28 post-injection, the majority of patients in the Main group (54 out of 58) demonstrated a significant reduction in sialorrhea intensity to 0-1 points on the PSIVS, compared to 2-3 points at baseline. Following the reduction in sialorrhea and subsequent rehabilitation, 51 patients improved their feeding route, transitioning from tube or gastrostomy to oral or combined feeding. Decannulation was successfully performed in 14 patients. The incidence of aspiration pneumonia was 5.2% (3 cases) in the Main group, compared to 20.7% (12 cases) in the Control group. No serious adverse events were observed. Two patients experienced mild dry mouth, which resolved within one month.

Conclusion: The integration of salivary gland chemodenervation with incobotulinumtoxinA (100 U) into the diagnostic and therapeutic algorithm for neurogenic dysphagia and posterior sialorrhea represents an effective and safe strategy for preventing aspiration complications. This intervention significantly reduces sialorrhea intensity and the incidence of aspiration pneumonia, enhances swallowing function, facilitates patient care, and improves rehabilitation outcomes for patients with severe neurological disorders, beginning in the acute phase. Adoption of this method in routine rehabilitation practice is recommended to decrease mortality and disability rates and to alleviate the financial burden on the healthcare system.