ABSTRACT
Hypersalivation describes a relatively excessive salivary flow, which wets the patient himself and his surroundings. It may result because of insufficient oro-motor function, dysphagia, decreased central control and coordination. This reduces social interaction chances and burdens daily care. Multidisciplinary diagnostic and treatment evaluation is recommended already at early stage and focus on dysphagia, and saliva aspiration. Therefore, a multidisciplinary S2k guideline was developed. Diagnostic tools such as fiberoptic endoscopic evaluation of swallowing and videofluoroscopic swallowing studies generate important data on therapy selection and control. Especially traumatic and oncologic cases profit from swallowing therapy programmes in order to activate compensation mechanisms. In children with hypotonic oral muscles, oralstimulation plates can induce a relevant symptom release because of the improved lip closure. In acute hypersalivation, the pharmacologic treatment with glycopyrrolate and scopolamine in various applications is useful but its value in long-term usage critical. The injection of botulinum toxin into the salivary glands has shown safe and effective results with long lasting saliva reduction. Surgical treatment should be reserved for isolated cases. External radiation is judged as ultima ratio. Therapy effects and symptom severity has to be followed, especially in neurodegenerative cases. The resulting xerostomia should be critically evaluated by the responsible physician regarding oral and dental hygiene.
Subject(s)
Sialorrhea/etiology , Sialorrhea/therapy , Adult , Behavior Therapy , Botulinum Toxins, Type A/adverse effects , Botulinum Toxins, Type A/therapeutic use , Child , Combined Modality Therapy , Cooperative Behavior , Deglutition Disorders/diagnosis , Deglutition Disorders/etiology , Deglutition Disorders/therapy , Evidence-Based Medicine , Exercise Therapy , Germany , Glycopyrrolate/adverse effects , Glycopyrrolate/therapeutic use , Humans , Interdisciplinary Communication , Orthodontics , Pneumonia, Aspiration/diagnosis , Pneumonia, Aspiration/etiology , Pneumonia, Aspiration/prevention & control , Scopolamine/adverse effects , Scopolamine/therapeutic use , Sialorrhea/diagnosisABSTRACT
Drooling is both a clinical sign for the diminished control of saliva and oral motor function and a heavy social burden for patients. We report a case in which drooling deteriorated after radiotherapy of the head and neck region as the primary treatment for hypopharyngeal cancer, although radiotherapy of the salivary glands is known to be an effective treatment option for drooling. In this particular case, injection of botulinum toxin in the parotid and submandibular glands significantly reduced drooling. The excellent response to botulinum toxin is of great clinical interest for similar RT non-responders.