What is the best intervention for management of pediatric sialorrhea?

Submitted by:

Rene’ Kronlage
University of Florida College of Medicine

Presenter(s):

Rene’ Kronlage
Angela Fadil

Abstract

Background. Sialorrhea, also known as excessive salivation, is considered abnormal beyond four years of age. Sialorrhea severity is best measured using a combination of quantitative and qualitative metrics to guide clinical decision making. Severe cases warrant intervention to improve patient quality of life and reduce caretaker burden.

Objective. The primary aim of this study is to review the five major forms of sialorrhea management ranging from least-to-most invasive: oral-motor therapy, anticholinergic medications, botulinum neurotoxin, sialendoscopy sclerotherapy, and surgical intervention.

Data Sources and Review Methods. An electronic literature review identified articles through a comprehensive search of sialorrhea management in pediatric patients in Cambridge Scientific Abstracts, EMBASE, PubMed, and Web of Science.

Conclusions and Implications for Practice. Sialorrhea management starts with more conservative approaches. Viable candidates begin with oral-motor therapy. Anticholinergic medications can decrease saliva production, but adverse side effects may outweigh benefits. Botulinum neurotoxin injection of the salivary glands decreases salivary flow rate; however, relief is transient and thus requires multiple treatments. Sialendoscopy sclerotherapy is the latest treatment option that shows promising results. Surgical intervention is reserved as a treatment option of last resort for patients who suffer from severe sialorrhea due to potential adverse consequences, which include airway swelling/obstruction, facial nerve paralysis, postoperative hemorrhage, and xerostomia with its downstream effects. In conclusion, this review found that the underlying cause and severity of sialorrhea dictate the approach to management.

Objectives

Explain what sialorrhea is, how severity can be measured, and how it impacts patients.

Explain what the different sialorrhea management options are, along with pertinent side effects and risks.

Discuss the five major methods of sialorrhea management and their implications for practice.