DROOLING

• A/K/A  sialorrhoea
• Physiological in early life: usually resolves by 2-4 years of age
• Can occur in relation to:

1. Teething
2. Oropharyngeal ulceration
3. URTI
4. Upper aerodigestive tract infection
5. Cerebral palsy or severe neurological impairment (10%)

HOW WILL YOU EVALUATE A DROOLING CHILD?

• Ask how many times are changes of clothes required per day?
• Are quilted bibs required for the management?
• Is the condition adding difficulty in peer acceptance?
• Look for dermatological condition around the mouth and along the line of gravity.
• General examination and full ENT examination (specially nasal obstruction and oropharyngeal ulceration).
• Neurological examination.

MANAGEMENT

If minimal: simple reassuarance.

If Excessive:

• Nonsurgical management are often disappointing which includes:

1. Anticholinergic: less tolerable due to nausea and ocular side effects.
2. Speech and swallowing therapy for 6 months
3. Botulinum toxin injection directly to glands may reduce flow but still under study.

• Surgical treatments:

1. Neurectomy: division of anterior branch of tympanic plexus for parotid and chorda tympani for submandibular used to be done but no longer recommended.
2. Mechanical diversion or obstruction of salivary flow: best outcomes and usually 50% gland atrophies.
3. Transposition of submandibular duct to tonsillar fossae is a recent choice of procedure which also includes excision of sublingual salivary gland and tonsillectomy.