Surgical Treatment of Drooling, 1/1996

The September 1995 issue of the journal Developmental Medicine and Child Neurology included a report of an Australian study on the "Long Term Outcome of Saliva-control Surgery" by K. Webb et al (Vol. 37/ No.9, Pgs. 755-762). The following summarizes and comments on some of the highlights of that report.

When present, drooling is a difficult problem in persons with developmental brain disorders. Drooling is normal in infancy but usually subsides around 18 months of age. Persistence beyond four years of age is not considered normal (Crysdale 1989). It is generally accepted that drooling occurs because of a defect in the oral or voluntary phase of swallowing, resulting in an overflow of secretions which builds up in the front of the mouth (Shott et al. 1989).

Any treatment which reduces the amount of drooling must also consider the several important functions of saliva; these include lubrication of the material being swallowed, the digestion of starch, oral hygiene and dental protection. It is important that the benefits of therapy outweigh its disadvantages, particularly for the long run.

Treatments proposed for saliva control and drooling include behavioral conditioning, oromotor training, drug therapy and several types of surgical procedures. Behavioral and oromotor training have been reported to give modest improvement but usually, these procedures do not provide long term beneficial results. Drug therapies are generally directed at decreasing the amount of saliva and usually result in an unacceptable dry mouth with resultant swallowing difficulties and poor oral hygiene.

There are a number of surgical procedures which have been used for the treatment of drooling; most have not been found to be satisfactory. The recent study describes the results of a surgical procedure which involves the redirection of flow from some salivary ducts (the submandibular ducts) and closing of one salivary duct (a paroted duct). Unfortunately, there was only a superficially favorable outcome. The authors report that a significant proportion of persons or their caregivers did not find the surgery helpful, generally because they found the complications unacceptable.

Comment
At this time there is no single acceptable treatment for drooling. A combination of approaches is usually necessary and benefits of therapy need to be considered in respect to complications. The fundamental issue is we don't really understand the neurological and neuromuscular mechanisms responsible for drooling. Until we do, it will continue to be "hit and miss". Drooling is one of the research areas identified for Research Foundation support. So far, we have had very few research grant requests.