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Surgical Options for Sialorrhea Management in Children with Cerebral Palsy

  • Christopher Tsang
  • Steven Cook
  • Udayan Shah
Living reference work entry

Abstract

Sialorrhea is a condition that affects many children with cerebral palsy. It can lead to a myriad of problems, ranging from irritation of the peri-oral skin to recurrent aspiration causing respiratory compromise. There exist several medical and surgical options for the treatment of this condition. Behavioral and physical therapy can help in milder cases, especially in children with better neurocognitive ability. Botulinum toxin injections have been shown to be helpful in decreasing salivary gland output. Surgical interventions include salivary duct diversion, salivary duct ligation, salivary gland removal, or a combination of the aforementioned procedures. The most refractory cases involving recurrent aspiration may necessitate a tracheostomy for pulmonary hygiene, or a laryngotracheal separation, which physically separates the airway from the digestive tract. No one treatment is guaranteed to work, and proper management requires tailoring the therapy to the individual child.

Keywords

Sialorrhea Salivary Drooling Aspiration 

References

  1. Bushara KO (1997) Sialorrhea in amyotrophic lateral sclerosis: a hypothesis of a new treatment: botulinum toxin a injections of the parotid glands. Med Hypotheses 48(4):337–339CrossRefPubMedGoogle Scholar
  2. Celet Ozden B, Aydin A, Kuvat SV et al (2012) Quadruple salivary duct diversion for drooling in cerebral palsy. J Craniofac Surg 23(3):738–741CrossRefPubMedGoogle Scholar
  3. Cook SP (2009) Laryngotracheal separation in neurologically impaired children: long-term results. Laryngoscope 119(2):390–395CrossRefPubMedGoogle Scholar
  4. Crysdale WS, McCann C, Roske L et al (2006) Saliva control issues in the neurologically challenged: a 30-year experience in team management. Int J Pediatr Otorhinolaryngol 70(3):519–527CrossRefPubMedGoogle Scholar
  5. Daniel SJ, Kanaan AA (2015) Chapter 201: salivary gland disease in children. In: Flint et al (eds) Cummings Otolaryngology – Head & Neck Surgery, 5th edn. Elsevier Saunders, Philadelphia, pp 3117–3118Google Scholar
  6. Eiland LS (2012) Glycopyrrolate for chronic drooling in children. Clin Ther 34(4):735–742CrossRefPubMedGoogle Scholar
  7. Fairhurst CBR, Cockerill H (2011) Management of drooling in children. Arch Dis Child Educ Pract Ed 96(1):25–30CrossRefPubMedGoogle Scholar
  8. Garnock-Jones KP (2012) Glycopyrrolate oral solution: for chronic, severe drooling in pediatric patients with neurologic conditions. Paediatr Drugs 14(4):263–269CrossRefPubMedGoogle Scholar
  9. Greensmith AL, Johnstone BR, Redi SM et al (2005) Prospective analysis of the outcome of surgical management of drooling in the pediatric population. Plast Reconstr Surg 116(5):1233–1242CrossRefPubMedGoogle Scholar
  10. Hara H, Hori T, Sugahara K et al (2014) Effectiveness of laryngotracheal separation in neurologically impaired pediatric patients. Acta Otolaryngol 134(6):626–630CrossRefPubMedGoogle Scholar
  11. Hong KH, Yang YS (2008) Surgical results of the intraoral removal of the submandibular gland. Otolaryngol Head Neck Surg 139(4):530–534CrossRefPubMedGoogle Scholar
  12. Inga CJ, Reddy AK, Richardson SA et al (2001) Appliance for chronic drooling in cerebral palsy patients. Pediatr Dent 23(3):241–242PubMedGoogle Scholar
  13. Jongerius PH, van den Hoogen FJ, van Limbeck J et al (2004) Effect of botulinum toxin in the treatment of drooling: a controlled clinical trial. Pediatrics 114(3):620–627CrossRefPubMedGoogle Scholar
  14. Kitsko DJ, Mehta D (2014) Chapter 72: The management of drooling (sialorrhea). In: Bluestone et al (eds) Bluestone & Stool’s Pediatric Otolaryngology, 5th edn. People’s Medical Publishing House, Shelton, pp 1289–1296Google Scholar
  15. Lungren MP, Halula S, Coyne S et al (2016) Ultrasound-guided botulinum toxin type a salivary gland injection in children for refractory sialorrhea: 10-year experience at a large tertiary children's hospital. Pediatr Neurol 54:70–75CrossRefPubMedGoogle Scholar
  16. Mier RJ, Bachrach SJ, Lakin RC et al (2000) Treatment of sialorrhea with glycopyrrolate: a double-blind, dose-ranging study. Arch Pediatr Adolesc Med 154(12):1214–1218CrossRefPubMedGoogle Scholar
  17. Montgomery J, McCusker S, Lang K et al (2016) Managing children with sialorrhoea (drooling): experience from the first 301 children in our saliva control clinic. Int J Pediatr Otorhinolaryngol 85:33–39CrossRefPubMedGoogle Scholar
  18. Mullins WM, Gross CW, Moore JM (1979) Long-term follow-up of tympanic neurectomy for sialorrhea. Laryngoscope 89(8):1219–1223CrossRefPubMedGoogle Scholar
  19. Norderyd J, Graf J, Marcusson A et al (2017) Sublingual administration of atropine eyedrops in children with excessive drooling – a pilot study. Int J Paediatr Dent 27(1):22–29CrossRefPubMedGoogle Scholar
  20. Porte M, Chaléat-Valayer E, Patte K et al (2014) Relevance of intraglandular injections of botulinum toxin for the treatment of sialorrhea in children with cerebral palsy: a review. Eur J Paediatr Neurol 18(6):649–657CrossRefPubMedGoogle Scholar
  21. Rapoport A (2010) Sublingual atropine drops for the treatment of pediatric sialorrhea. J Pain Symptom Manag 40:783–788CrossRefGoogle Scholar
  22. Reed J, Mans CK, Brietzke SE (2009) Surgical management of drooling: a meta-analysis. Arch Otolaryngol Head Neck Surg 135(9):924–931CrossRefPubMedGoogle Scholar
  23. Reid SM, Johnson HM, Reddihough DS (2010) The drooling impact scale: a measure of the impact of drooling in children with developmental disabilities. Dev Med Child Neurol 52(2):e23–e28CrossRefPubMedGoogle Scholar
  24. Reid SM, McCutcheon J, Reddihough DS, Johnson H (2012) Prevalence and predictors of drooling in 7- to 14-year-old children with cerebral palsy: a population study. Dev Med Child Neurol 54(11):1032–1036CrossRefPubMedGoogle Scholar
  25. Stern Y, Feinmesser R, Collins M et al (2002) Bilateral submandibular gland excision with parotid duct ligation for treatment of sialorrhea in children: long term results. Arch Otolaryngol Head Neck Surg 128(7):801–803CrossRefPubMedGoogle Scholar
  26. Takano K, Kurose M, Mitsuzawa H et al (2015) Clinical outcomes of tracheoesophageal diversion and laryngotracheal separation for aspiration in patients with severe motor and intellectual disability. Acta Otolaryngol 135(12):1304–1310CrossRefPubMedGoogle Scholar
  27. Webb K, Reddihough DS, Johnson H (1995) Long-term outcome of saliva-control surgery. Dev Med Child Neurol 37(9):755–762CrossRefPubMedGoogle Scholar
  28. Young CA, Ellis C, Johnson J et al (2012) Treatment for sialorrhea (excessive saliva) in people with motor neuron disease/amyotrophic lateral sclerosis. Cochrane Database Syst Rev 11(5):CD006981Google Scholar
  29. Zeller RS, Lee HM, Cavanaugh PF et al (2012) Randomized phase III evaluation of the efficacy and safety of a novel glycopyrrolate oral solution for the management of chronic severe drooling in children with cerebral palsy or other neurologic conditions. Ther Clin Risk Manag 8:15–23CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Christopher Tsang
    • 1
  • Steven Cook
    • 1
    • 3
  • Udayan Shah
    • 1
    • 2
    • 3
  1. 1.Division of Pediatric Otolaryngology, Department of SurgeryNemours Alfred I. DuPont Hospital for ChildrenWilmingtonUSA
  2. 2.Department of Otolaryngology - Head and Neck Surgery and PediatricsWilmingtonUSA
  3. 3.Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaUSA

Section editors and affiliations

  • Freeman Miller
    • 1
  • Steven Bachrach
    • 2
  1. 1.AI DuPont Hospital for ChildrenWilmingtonUSA
  2. 2.Al duPont Hospital for ChildrenWilmingtonUSA

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