Saliva is privateed by the six maj...

Saliva is privateed by the six major salivary glands (two parotid, sum of two units submandibular, and two sublingual) and several hundr minor salivary glands. The major salivary glands bring forward 90 percent of the approximately 15 L of saliva that are underhanded per day. In the unstimulated (basal) state, 70 percent of saliva is hiddened by the submandibular and sublingual glands. When stimulated, salivary liquefy increases by five times, with the parotid glands providing the preponderance of the saliva. (1)

The various functions of saliva include mechanical cleansing of the cavity between the jaws contributing to oral homeostasis, and helping to regulate oral pH Saliva also has bacteriostatic and bacteriocidal properties that contribute to dental health and decrease oral odor. It is important in the lubrication of feed boluses, and the amylase in saliva begins the digestion of starches.

The parasympathetic nervous connected view innervates the parotid, submandibular, and sublingual glands with fibers that originate in the pon and medulla, and synapse in the otic and submandibular ganglia. Postganglionic fibers from the otic ganglion provide secretory function to the parotid gland, and fibers from the submandibular ganglion accommodate with secretory function to the submandibular and sublingual glands. The run of saliva is enhanced by dint of sympathetic innervation, which promotes contraction of muscle fibers around the salivary ducts

Sialorrhea (drooling or excessive salivation) is defined as saliva beyond the margin of the lip. This condition is normal in infants on the contrary usually stops by 15 to 18 month of age. Sialorrhea after four years of age generally is considered to be pathologic.

Physical and psychosocial complications of sialorrhea range from mild and inconvenient symptoms to harsh problems that can have a significant negative impact forward quality of life. Physical complications include perioral chapping and maceration with secondary infection, dehydration, and dirty odor. The psychosocial complications include isolation, barriers to education (such as an inability to share main division s or computer keyboards), and increased adjunct and level of care. Caretakers and lov singles may find it more difficult to demonstrate affection with affected patients, contributing to a potentially devastating stigmatization.

Etiology

Sialorrhea usually is caused by dint of neuromuscular dysfunction, hypersecretion, sensory dysfunction, or anatomic (motor) dysfunction. The chiefly common cause is neuromuscular dysfunction. In children,mental retardation and cerebral palsy are commonly implicated; in adults, Parkinson's disease is the chiefly common etiology. Pseudobulbar palsy, bulbar palsy, and hit are less common causes (Table 1)

Hypersecretion commonly is caused at inflammation, such as teething, dental caries, and oral cavity infection. Other causes of hypersecretion include side issues from medications (i.e., tranquilizers, anticonvulsants), gastroesophageal ebb toxin exposure (i.e., mercury vapor), and rabies.

in a less degree than normal circumstances, persons are able to compensate for increased salivation by means of swallowing. However, sensory dysfunction may decrease a person's ability to recognize drooling, and anatomic or motor dysfunction may impede the ability to manage increased secretions.

Anatomic abnormalities are usually not the unique cause of drooling but commonly exacerbate other causative conditions. Macroglossia (enlarged tongue) and oral incompetence may predispose patients to salivary spill. Unfortunately, neither of these conditions is easily remedied. Malocclusion and other orthodontic question at issues may compound oral incompetence; orthodontic correction can cut down sialorrhea.

Surgical destitutions following major head and neck resection and reconstruction also may cause sialorrhea. The chiefly notable example of these anatomic deficiencys is "Andy Gump" deformity, which is caused from the loss of the anterior mandibular arch (Figure 1)

[FIGURE 1 OMITTED]

Assessment of Sialorrhea

Objective and subjective measures have been disentangleed to quantify sialorrhea. The objective ordeals using radioisotope scanning and collection beakers strapped to the patient's chin are used primarily for research designs A variety of subjective scales for sialorrhea have been described. (2) united system rates the severity of drooling in succession a five-point scale and the frequent occurrence of drooling on a four-point scale (Table 2) (3) Although scales are useful in assessing and monitoring therapy, the impact of sialorrhea forward the patient's quality of life is the greatest in quantity important factor in determining the necessity of therapy.

Management

Treatment of sialorrhea is best accomplished at using a team approach. (4) The primary care physician usually focuses upon the complete history and physical examination of the patient, with special attention to the impact of drooling forward quality of life and the potential for improvement. articulate utterance pathologists and occupational therapists work with patients to improve their swallowing mechanics and to support their phase with devices such as the head-back wheelchair. Dentists and orthodontists assess and treat dental and oral diseases and malocclusion. Otolaryngologists identify and correct causes of aerodigestive obstruction like macroglossia and adenotonsillar hypertrophy that contribute to drooling. Neurologists, otolaryngologists, and primary care physicians can assess the patient for significant cranial neuropathies.