Saliva Management

  • Charley CoffeyEmail author


Neuromuscular and neurodegenerative disease can result in significant risk of aspiration of saliva and respiratory secretions. Inability to adequately clear saliva can also result in problematic drooling, throat clearing, and cough, with significant quality of life implications. A variety of techniques may be employed to address sialorrhea and drooling, with treatment selection dictated by severity of symptoms, tolerability of side effects, individual preference, and availability of techniques. Behavioral approaches focus on improving salivary clearance and can be employed in conjunction with broader efforts to improve swallowing function. Pharmacologic treatment focuses on reducing salivary production and includes a range of oral, topical, transdermal, or injectable options. Anticholinergic medications can prove effective, but are characterized by parasympathetic side effects that frequently limit tolerance. Central anticholinergic effects may also preclude use in patients with dementia or cognitive impairment. Botulinum neurotoxin (BoNT) injection directly into major salivary glands offers an effective longer term means of reducing saliva production with minimal adverse effects. BoNT injection can be performed in a clinic setting with ultrasound guidance to aid precision injection and can be repeated as needed for durable benefit. Surgical options such as ductal ligation or re-routing may offer permanent solutions for patients unable or unwilling to undergo serial BoNT injections. External beam radiation therapy targeting major salivary glands can reduce saliva production in selected patients who fail other treatments, though acute toxicities and long-term risks preclude widespread use. Successful approaches may vary significantly across patients and may require changing strategies based upon disease progression.


Saliva Drooling Secretions Sialorrhea Botulinum Neuromuscular Neurodegenerative Swallowing Parasympathetic Anticholinergic 


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Division of Otolaryngology–Head & Neck Surgery, Department of SurgeryUniversity of California San DiegoLa JollaUSA

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