Botulinum Toxin for Sialorrhea in Bilateral Accessory Submandibular Glands: A Case Report

Thursday, October 23, 2025

5:00 PM - 6:30 PM MT

Location: Open Kiosks

Has Audio

Primary Author(s)

Panayotis Jusakos, MD

Resident Physician
One Brooklyn Health System/Kingsbrook Jewish Medical Center PM&R Program
Brooklyn, New York

Co-Author(s)

MS

Michael Sposito, MD

Resident Physician
One Brooklyn Health System/Kingsbrook Jewish Medical Center PM&R Program
Latham, New York
CC

Charlene Canales, DO

Resident physician
One Brooklyn Health System/Kingsbrook Jewish Medical Center PM&R Program
Brooklyn, New York
DS

Daniel Sanchez, MD

Resident
One Brooklyn Health System/Kingsbrook Jewish Medical Center PM&R Program
Brooklyn, New York
Suha Qasem, MD

Resident physician
One Brooklyn Health System/Kingsbrook Jewish Medical Center PM&R Program
Brooklyn, New York
MR

Marc Ross, MD

Chair Department of physical medicine and rehabilitation
One Brooklyn Health
New York, New York
YA

Yaacov Anziska, MD

Associate Professor of Neurology
SUNY-Downstate Medical Center
Brooklyn, New York

Disclosure(s):

Panayotis Jusakos, MD: No financial relationships to disclose

Suha Qasem, MD: No financial relationships to disclose

Case Diagnosis: Bilateral Accessory Submandibular Glands with Functional Sialorrhea

Case Description or Program Description: A 55-year-old female with hypertension, gastric bypass, gastric ulcer, and COPD presented with a six-week history of progressive, non-tender submental swelling. She reported excessive salivation, chronic coughing, throat clearing, globus pharyngeus, and intermittent hoarseness, which impaired phonation and airway clearance. Contrast-enhanced CT demonstrated bilaterally enlarged submandibular glands with ovoid soft tissue structures anterior to each gland, consistent with chronic bilateral accessory salivary glands. No cervical lymphadenopathy was identified.

Setting: Outpatient with interventional ultrasound-guided treatment.

Assessment/Results: The patient underwent ultrasound-guided botulinum toxin injections (100 units diluted in 1 mL normal saline) into the bilateral parotid, submandibular, and accessory glands. The procedure was uneventful, with no post-injection complications. At a one-month follow-up, the patient reported significant improvement in phonatory effort, reduction in sialorrhea, and improved airway protection, with decreased frequency of throat clearing and aspiration events.

Discussion (relevance): Bilateral accessory submandibular glands are an uncommon anatomical variation that can contribute to functional sialorrhea, impairing airway protection, swallowing, and vocal function. While accessory parotid glands are well documented, submandibular variants are rare. This case supports the therapeutic efficacy of botulinum toxin in modulating autonomic control of salivary secretion, reducing secretion burden, and improving functional outcomes. Botox injection has been widely used in neurological and musculoskeletal rehabilitation for spasticity and dystonia, and its application in salivary dysfunction represents an emerging therapeutic modality within rehabilitative medicine. This case adds to the growing body of evidence supporting its role in managing sialorrhea in rare salivary gland anomalies.

Conclusions: Botulinum toxin injections provided effective symptomatic relief in this patient with bilateral accessory submandibular glands, reducing sialorrhea and improving airway protection and phonation. This case underscores the role of Botox as a non-invasive rehabilitative intervention for salivary dysfunction, expanding its application within musculoskeletal and neurological rehabilitation paradigms.