Hypersalivation

Sialorrhea

1. hypersalivation Ade Wijaya, MD – October 2018

2. Introduction = sialorrhea = drooling Common in neurological diseases Definition: Saliva beyond the margin of the lip . This condition is normal in infants but usually stops by 15 to 18 months of age . Sialorrhea after four years of age generally is considered to be pathologic. Hockstein NG, Samadi DS, Gendron K, Handler SD. Sialorrhea: a management challenge. American family physician. 2004 Jun 1;69(11).

3. Anatomy & Physiology Saliva is secreted by the six major salivary glands (two parotid, two submandibular, and two sublingual) and several hundred minor salivary glands . The major salivary glands produce 90 percent of the approximately 1.5 L of saliva that are secreted per day . In the unstimulated (basal) state, 70 percent of saliva is secreted by the submandibular and sublingual glands . When stimulated, salivary flow increases by five times, with the parotid glands providing the preponderance of the saliva. Stuchell RN, Mandel ID. Salivary gland dysfunction and swallowing disorders.  Otolaryngol Clin North Am . 1988;21:649–61.

4. Function of saliva Mechanical cleansing of the mouth Oral homeostasis Regulate oral pH Bacteriostatic and bacteriocidal L ubrication of food boluses The amylase in saliva begins the digestion of starches Hockstein NG, Samadi DS, Gendron K, Handler SD. Sialorrhea: a management challenge. American family physician. 2004 Jun 1;69(11).

5. Innervation Hornibrook J, Cochrane N. Contemporary surgical management of severe sialorrhea in children. ISRN pediatrics. 2012 Mar 28;2012.

6. ETIO-mechanism Hockstein NG, Samadi DS, Gendron K, Handler SD. Sialorrhea: a management challenge. American family physician. 2004 Jun 1;69(11).

7. Neuromuscular/sensory dysfunction Mental retardation Cerebral Palsy Parkinson’s disease Pseudobulbar Bulbar palsy Stroke Hockstein NG, Samadi DS, Gendron K, Handler SD. Sialorrhea: a management challenge. American family physician. 2004 Jun 1;69(11).

8. Hypersecretion Inflammation – infection Medication side effects (tranquilizers, anticonvulsants) Gastroesophageal reflux Toxin exposure (mercury vapor) Hockstein NG, Samadi DS, Gendron K, Handler SD. Sialorrhea: a management challenge. American family physician. 2004 Jun 1;69(11).

9. Anatomic Macroglossia Oral incompetence Dental malocclusion Orthodontic problems Head and neck surgical defects (i.e. Andy Gump deformity) Hockstein NG, Samadi DS, Gendron K, Handler SD. Sialorrhea: a management challenge. American family physician. 2004 Jun 1;69(11).

10. Assestment Thomas-Stonell N, Greenberg J. Three treatment approaches and clinical factors in the reduction of drooling. Dysphagia 1988;3:75

11. complication H ypersalivation causes a range of physical and psychosocial complications , including: Perioral chapping Dehydration Odor Social stigmatization that can be devastating for patients and their families. Hockstein NG, Samadi DS, Gendron K, Handler SD. Sialorrhea: a management challenge. American family physician. 2004 Jun 1;69(11).

12. management Multidisciplinary approach: Primary care physicians Speech pathologists and occupational therapists   Dentists or orthodontists Neurologists Otorhinolaringologists Hockstein NG, Samadi DS, Gendron K, Handler SD. Sialorrhea: a management challenge. American family physician. 2004 Jun 1;69(11).

13. Management Observation Feeding program Biofeedback and automatic cueing techniques Acupuncture Orthodontic appliances If sialorrhea continues to interfere with the patient's health and quality of life after non-invasive measures have been tried, medication, radiation, and surgical therapy should be considered. Hockstein NG, Samadi DS, Gendron K, Handler SD. Sialorrhea: a management challenge. American family physician. 2004 Jun 1;69(11).

14. medications Blasco PA, Stansbury JC. Glycopyrrolate treatment of chronic drooling.  Arch Pediatr Adolesc Med . 1996;150:932–5. Mier RJ, Bachrach SJ, Lakin RC, Barker T, Childs J, Moran M. Treatment of sialorrhea with glycopyrrolate: a double-blind, dose-ranging study.  Arch Pediatr Adolesc Med . 2000;154:1214–8. Talmi YP, Finkelstein Y, Zohar Y. Reduction of salivary flow with transdermal scopolamine: a four-year experience.  Otolaryngol Head Neck Surg . 1990;103:615–8. Lewis DW, Fontana C, Mehallick LK, Everett Y. Transdermal scopolamine for reduction of drooling in developmentally delayed children.  Dev Med Child Neurol . 1994;36:484–6. Porta M, Gamba M, Bertacchi G, Vaj P. Treatment of sialorrhoea with ultrasound guided botulinum toxin type A injection in patients with neurological disorders.  J Neurol Neurosurg Psychiatry . 2001;70:538–40.

15. surgical Hockstein NG, Samadi DS, Gendron K, Handler SD. Sialorrhea: a management challenge. American family physician. 2004 Jun 1;69(11).

16. Summary Common problem in neurological diseases Physical and psychosocial complications Multidisciplinary Approach

17. THANK YOU