In what clinical situation do you use Botox in patients with increased salivation?

Botulinum toxin injections are considered first-line pharmacologic management for sialorrhea due to their safety and efficacy with appropriate patient selection. It can be considered for patients who have increased aspiration risk, skin breakdown from drooling, or experience social effects like embarrassment. Often, these are patients with cerebral palsy, ALS, and chronic strokes.