- A/K/A sialorrhoea
- Physiological in early life: usually resolves by 2-4 years of age
- Can occur in relation to:
- Teething
- Oropharyngeal ulceration
- URTI
- Upper aerodigestive tract infection
- 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:
- Anticholinergic: less tolerable due to nausea and ocular side effects.
- Speech and swallowing therapy for 6 months
- Botulinum toxin injection directly to glands may reduce flow but still under study.
- Surgical treatments:
- Neurectomy: division of anterior branch of tympanic plexus for parotid and chorda tympani for submandibular used to be done but no longer recommended.
- Mechanical diversion or obstruction of salivary flow: best outcomes and usually 50% gland atrophies.
- Transposition of submandibular duct to tonsillar fossae is a recent choice of procedure which also includes excision of sublingual salivary gland and tonsillectomy.
