Treatment of patients with sialorrhea. A systematic review
Keywords:
Drooling, sialorrhea, botulinum toxin, salivary duct ligation, salivary duct relocation, salivary gland resectionAbstract
Introduction: Sialorrhea, defined as the unintentional and passive loss of saliva from the oral cavity due to a dysfunction in the coordination of the swallowing mechanism, is a relevant medical problem that generates important disability and negative effects on the physical health and quality of life of patients with chronic neurological disabilities. Various approaches have been described to manage this condition, including oral motor therapy, behavior modification with biofeedback, drug therapy with anticholinergic medications or botulinum toxin, and a wide range of surgical treatments. Objective: To provide a thorough overview of sialorrhea and its different treatment modalities. Methods: We analyzed by PubMed, MD consult, and Ovid-SP
data bases. Discussion: We describe the initial evaluation of the patient with sialorrhea and
the subjective and objective methods to evaluate its severity. The diverse treatment modalities for this pathology as well as their results are described. Conclusions: Sialorrhea is a complex pathology that requires a multidisciplinary management. Multiple treatment modalities exist
and they should be considered according to the severity of the problem. Oral motor training should be considered as the first line of treatment. Botulinum toxin is effective in cases in which conservative measures are not sufficient. Surgical treatment is the last resource; diverse effective surgical techniques have been developed.
References
Blasco PA, Allaire JH. Drooling in the developmentally
disabled: management practices and recommendations.
Consortium on drooling. Dev Med Child Neurol. 1992;
(19): 849-862
LalD,HotalingAJ.Drooling.CurrOpinOtolaryngolHea
Neck Surg. 2006; 14 (6): 381-386.
Crysdale WS. The management of drooling. In:
Bluestone CD, Stool SE, Alper CM, editors. Pediatric otolaryngology. 4th ed. Philadelphia: Saunders; 2002. pp. 1138-1148.
Tahmassebi JF, Curzon ME. Prevalence of drooling in children with cerebral palsy attending special schools. Dev Med Child Neurol. 2003; 45: 613-617.
Sullivan PB, Lambert B, Rose M, Ford-Adams M, Johnson A, Griffiths P. Prevalence and severity of feeding and nutritional problems in children with neurological impairment: Oxford Feeding Study. Dev Med Child Neurol. 2000; 42: 674-680.
Fairhurst CB, Cockerill H. Management of drooling in children. Arch Dis Child Educ Pract Ed. 2011; 96: 25-30. 7. Reddihough D, Johnson H, Ferguson E. The role of a saliva control clinic in the management of drooling. J
Paediatr Child Health. 1992; 28: 395-397.
Walker PJ, Hutchinson J, Cant R, Parmenter R, Knox G. Chronic drooling: a multidisciplinary approach to assessment and management. Aust J Otolaryng. 1994;
: 542-545.
Crysdale W. Drooling. Experience with team assessment
and management. Clinical Pediatrics. 1992; 31 (2): 77-80. 10. Meningaud JP, Pitak-Arnnop P, Chikhani L, Bertrand JC. Drooling of saliva: a review of the etiology and management options. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod. 2006; 101 (1): 48-57.
Thomas-Stonell N, Greenberg S. Three treatment approaches and clinical factors in the reduction of
drooling. Dysphagia. 1988; 3 (2): 73-78.
JongeriusPH,vanLimbeekJ,RotteveelJJ.Assessment of salivary flow rate: biologic variation and measure
error. Laryngoscope 2004; 114: 1801-1804.
Jongerius PH, van den Hoogen FJ, van Limbeek J, Gabreëls FJ, van Hulst K, Rotteveel JJ. Effect of botulinum toxin in the treatment of drooling: a controlled
clinical trial. Pediatrics. 2004; 114: 620-627.
WilkieTF,BrodyGS.Thesurgicaltreatmentofdrooling.A 10-year review. Plast Reconstr Surg. 1977; 59: 791-797. 15. Jongerius PH, van Tiel P, van Limbeek J, Gabreëls FJ, Rotteveel JJ. A systematic review for evidence of efficacy of anticholinergic drugs to treat drooling. Arch
Dis Child. 2003; 88: 911-914.
SavareseR,DiamondM,ElovicE,MillisSR.Intraparotid
injection of botulinum toxin A as a treatment to control sialorrhea in children with cerebral palsy. Am J Phys Med Rehabil. 2004; 83 (4): 304-311; quiz 312-314, 336.
Jongerius PH, Joosten F, Hoogen FJ, Gabreels FJ, Rotteveel JJ. The treatment of drooling by ultrasound-guided intraglandular injections of botulinum toxin type A into the salivary glands. Laryngoscope. 2003; 113 (1): 107-111.
Dressler D, Saberi FA, Barbosa ER. Botulinum toxin: mechanisms of action. Arq Neuropsych. 2005; 63: 180-185.
Dressler D, Saberi FA. Botulinum toxin: mechanisms of action. Eur. Neurol. 2005; 53: 3-9
Nashida T, Imai A, Shimomura H. Relation of Rab26 to
the amylase release from rat parotid acinar cells. Arch
Oral Biol. 2006; 51: 89-95.
Popoff MR. Ecology of neurotoxigenic strains of
clostridia. Curr Top Microbiol Immunol. 1995; 195: 1-29. 22. Imai A, Nashida T, Yoshie S, Shimomura H. Intracellular localization of SNARE proteins in rat parotid acinar cells: SNARE complexes on the apical plasma membrane.
Arch Oral Biol. 2003; 48: 597-604.
Takuma T, Arakawa T, Tajima Y. Interaction of SNARE proteins in rat parotid acinar cells. Arch Oral Biol. 2000; 45: 369-375.
Bushara KO. Sialorrhea in amyotrophic lateral sclerosis: a hypothesis of a new treatment botulinum toxin A injections of the parotid glands. Med Hypotheses. 1997; 48: 337-339.
Kim H, Lee Y, Weiner D, et al. Botulinum toxin type A injections to salivary glands: combination with single event multilevel chemoneurolysis in 2 children with severe spastic quadriplegic cerebral palsy. Arch Phys Med Rehabil 2006; 87: 141-144.
Jongerius PH, Rotteveel JJ, van den Hoogen F, Joosten F, van Hulst K, Gabreëls FJ. Botulinum toxin A: a new option for treatment of drooling in children with cerebral palsy. Presentation of a case series. Eur J Pediatr. 2001; 160: 509-512.
Suskind DL, Tilton A. Clinical study of botulinum-A toxin in the treatment of sialorrhea in children with cerebral palsy. Laryngoscope. 2002; 112: 73-81.
Jeung IS, Lee S, Kim HS, Yeo CK. Effect of botulinum toxin a injection into the salivary glands for sialorrhea in children with neurologic disorders. Ann Rehabil Med. 2012; 36 (3): 340-346.
Breheret R, Bizon A, Jeufroy C, Laccourreye L. Ultrasound-guided botulinum toxin injections for treatment of drooling. Eur Ann Otorhinolaryngol Head Neck Dis. 2011; 128 (5): 224-229.
Hassin-Baer S, Scheuer E, Buchman AS, et al. Botulinum toxin injections for children with excessive drooling. J Child Neurol 2005; 20: 120-123.
Ellies M, Laskawi R, Götz W, Arglebe C, Tormählen G. Immunohistochemical and morphometric investigations of the influence of botulinum toxin on the submandibular gland of the rat. Eur Eur Arch Otorhinolaryngol. 1999; 256 (3): 148-152.
Ellies M, Laskawi R, Schütz S, Quondamatteo F. Immunohistochemical evidence of nNOS and changes after intraglandular application of botulinum toxin A in cephalic salivary glands of adult rats. J Otorhinolaryngol Relat Spec. 2003; 65 (3): 140-143.
Ellies M, Schütz S, Quondamatteo F, Laskawi R. The effect of local injection of botulinum toxin A on the immunoreactivity of nNOS in the rat submandibular gland: an immunohistochemical study. Int J Pediatr Otorhinolaryngol. 2006; 70 (1): 59-63.
Yuan F, Hou Y, Wen W. Immunohistochemical and
morphological investigations of the influence of
botulinum toxin type A on the submandibular gland of
the rats. Lin Chuang Er Bi Yan Hou Ke Za Zhi. 2004;
(9): 558-560.
Coskun BU, Savk H, Cicek ED, Basak T, Basak M, Dadas
B. Histopathological and radiological investigations of the influence of botulinum toxin on the submandibular gland of the rat. Eur Arch Otorhinolaryngol. 2007; 264 (7): 783-787.
Teymoortash A, Sommer F, Mandic R. Intraglandular application of botulinum toxin leads to structural and
functional changes in rat acinar cells. Br J Pharmacol.
; 152 (1): 161-167.
Lee ZI, Cho DH, Choi WD, Park DH, Byun SD. Effect of
botulinum toxin type A on morphology of salivary glands in patients with cerebral palsy. Ann Rehabil Med. 2011; 35: 636-640.
Erasmus CE, Van Hulst K, Van Den Hoogen FJ, Van Limbeek J, Roeleveld N, Veerman EC et al. Thickened saliva after effective management of drooling with botulinum toxin A. Dev Med Child Neurol. 2010; 52 (6): e114-e118.
Møller E, Karlsborg M, Bardow A, Lykkeaa J, Nissen FH, Bakke M. Treatment of severe drooling with botulinum toxin in amyotrophic lateral sclerosis and Parkinson’s disease: efficacy and possible mechanisms. Acta Odontol Scand. 2011; 69 (3): 151-157.
Greensmith AL, Johnstone BR, Reid SM, Hazard CJ, Johnson HM, Reddihough DS. Prospective analysis of the outcome of surgical management of drooling in the pediatric population: a 10-year experience. Plast Reconstr Surg. 2005; 116 (5): 1233-1242.
Crysdale WS. Surgery for drooling. In: Bluestone CD, Rosenfeld RM. Surgical atlas of pediatric otolaryngology. Chapter 19. Canada: BC Decker; 2002. pp. 427-440.
Uppal HS, De R, D’Souza AR, Pearman K, Proops DW. Bilateral submandibular duct relocation for drooling: an evaluation of results for the Birmingham Children’s Hospital. Eur Arch Otorhinolaryngol. 2003; 260 (1): 48-51.
Shirley WP, Hill JS, Woolley AL, Wiatrak BJ. Success and complications of four-duct ligation for sialorrhea. Int J Pediatr Otorhinolaryngol. 2003; 67 (1): 1-6.
Klem C, Mair EA. Four-duct ligation: a simple and effective treatment for chronic aspiration from sialorrhea. Arch Otolaryngol Head Neck Surg. 1999; 125: 796-800.
Cotton RT, Richardson MA. The effect of submandibular duct rerouting in the treatment of sialorrhea in children. Otolaryngol Head Neck Surg. 1981; 89 (4): 535-541.
Shott SR, Myer CM 3rd, Cotton RT. Surgical management of sialorrhea. Otolaryngol Head Neck Surg. 1989; 101 (1): 47-50.
Crysdale WS, Raveh E, McCann C, Roske L, Kotler A. Management of drooling in individuals with neurodisability: a surgical experience. Dev Med Child Neurol. 2001; 43 (6): 379-383.
Crysdale WS, Greenberg J, Koheil R, Moran R. The
drooling patient: team evaluation and management. Int
J Pediatr Otorhinolaryngol. 1985; 9 (3): 241-248.
Dundas DF, Peterson RA. Surgical treatment of drooling by bilateral parotid duct ligation and submandibular gland resection. Plast Reconstr Surg. 1979; 64 (1): 47-51.
Reed J, Mans CK, Brietzke SE. Surgical management of drooling: a meta-analysis. Arch Otolaryngol Head Neck Surg. 2009; 135 (9): 924-931.
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