7: Drooling and sialorrhoea

Drooling and sialorrhoea

INCIDENCE

People at the extremes of age, the chronically debilitated, or those in chronic care facilities, especially when associated with cerebrovascular events and oesophageal cancer, are especially affected by drooling. True sialorrhoea is rare.

AETIOLOGY AND PATHOGENESIS

Drooling is caused either by increased saliva flow (sialorrhoea) that cannot be compensated for by swallowing, or by poor oral and facial muscle control in patients with swallowing dysfunction (secondary sialorrhoea), or by anatomic or neuromuscular anomalies (Table 7.1).

Table 7.1

Causes of drooling

Excessive saliva production (sialorrhoea) Decreased swallowing Anatomic abnormalities Neuromuscular diseases
Oral lesions or foreign bodies
Neurologic disorders (especially Riley–Day syndrome, Ch. 56)
Otolaryngologic diseases Pregnancy
Gastrointestinal causes
Liver disease
Drugs and poisons
parathion, strychnine, (Table 54.6)
Oropharyngeal infections and obstruction Macroglossia or tongue thrusting
Surgical defects following major head and neck surgery
Parkinson disease, cerebral palsy, intellectual impairment, stroke, pseudobulbar palsy, bulbar palsy, anterior opercular syndrome (Foix–Chavany–Marie syndrome, Ch. 56)
Rabies

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DIAGNOSIS

History helps assess the severity and frequency of drooling, and the effect on the quality of life of patient and family. Quantitative measurements can be helpful for guiding treatment decisions (Table 7.2): counting the number of bibs or items of clothing soiled each day provides a subjective estimate. Examination should include:

Table 7.2

Quantitation of drooling

Condition Description
Dry Never drools
Mild Only lips wet
Occasional drooling – not every day
Moderate frequent drooling Lips and chin wet – every day
Constant drooling Severe – clothing soiled
Profuse – hands moist and wet

Jan 9, 2015 | Posted by in Oral and Maxillofacial Pathology | Comments Off on 7: Drooling and sialorrhoea
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