Salivary-Gland Injections for Drooling: The Referral and Review Plan

After salivary-gland botulinum toxin injections, significant swallowing, speech or breathing difficulties need immediate medical attention. If severe, call your local emergency number. Dudley’s leaflet identifies these problems as requiring urgent action.¹

Dudley describes this treatment for referred adults with chronic neurological sialorrhoea. Botulinum toxin temporarily reduces salivary secretions. This referral does not establish that injections are suitable for every person who drools.¹

Before the visit: return to the referral question

Tell the referring team if your symptoms have changed since referral so it can review whether the injection remains suitable. Dudley specifically asks patients to report such changes.¹

Write down what has changed and what you want reviewed. Ask the team to connect the proposed injection with the assessment already underway, including alternatives discussed and the expected benefit in your circumstances.

Confirm which service arranges the appointment and whom you should contact with a question before the day. If you need assistance with mobility or communication, explain that when booking. Ask how a companion can help and where they may wait during the procedure.

Preparation: get directions for your own medicines

Send the service your current medicine list, including blood thinners, and ask for written preparation instructions. Do not pause an anticoagulant or another medicine based on a general article. Have the treating team and prescriber resolve any unclear or conflicting direction before the appointment.

Ask what time to arrive, how long to allow and what arrangements you need afterward. Keep those answers with the appointment letter so someone helping with transport can use the same information.

During the visit: ultrasound guides the injection

A radiologist uses ultrasound to determine the injection site. The salivary glands are injected through the skin. Dudley describes discussion and consent before the procedure.¹

Ask which glands are being treated and why. Have the clinician explain the intended benefit, risks and alternatives before you consent. You can also ask how staff will help if you find injections difficult or want another explanation during the visit.

Before leaving, get the instructions that apply to your procedure and the contact to use if a concern develops. Do not borrow another person’s observation period or aftercare schedule as your own.

Afterward: keep symptom changes with the review plan

Dudley advises contact with the referring doctor or specialist nurse if treatment causes thick saliva or dry mouth. The duration of improvement varies between people.¹

Ask when the team wants to review the effect and which changes to report sooner. Describe what has improved, what remains difficult and any new concern using the team’s reporting instructions. Keep the urgent warning above separate from questions that can wait for routine review.

Confirm who decides whether further treatment is appropriate and how that discussion will be arranged. If the agreed review has not arrived, contact the service rather than assuming a repeat visit is automatic.

Is It My Breath? includes a red-flag list and visit script. Use the script to organize the referral question and your team’s follow-up instructions. Explore the breath and mouth playbook.