Therapy | Mechanism | How to use | Side effects and cautions | Respiratory issues |
---|---|---|---|---|
Conservative therapy | ||||
Positioning | Position slightly reclined in wheelchair, saliva less likely to leak from mouth | Be vigilant for pooling of secretions in oropharynx which may be aspirated | ||
Dental review | Caries or malocclusion may exacerbate drooling | |||
Medication | ||||
Hyoscine hydrobromide transdermal patches | Inhibit parasympathetic stimulation of saliva production through antimuscarinic effect | 1 month–3 years: ¼ patch 3–10 years: ½ patch 10–18 years: 1 patch Apply patch to hairless area of skin behind ear. Change patch every 72 h | Constipation, urinary retention, dilated pupils, loss of accommodation, rarely angle closure glaucoma Local skin reaction with hyoscine patch Dental caries more likely if saliva reduced by any method | Be vigilant for thick secretions which may be hard to clear and cause mucous plugging |
Glycopyrrolate | 1 month–18 years: 40–100 μg/kg (max 2 mg) 3–4 times a day | |||
Botulinum toxin A | Inhibit release of acetylcholine at neuromuscular junction and reduce saliva production | Ultrasound guided injection Can often be done under local anaesthetic Repeat every 3–6 months | Trauma at injection site, dysphagia, dry mouth Maximum safe dose not established May need a general anaesthetic | |
Surgery | ||||
Salivary gland duct ligation | Blocks salivary flow and induces atrophy of glands Safest surgical modality | Note that re-routing salivary glands is not recommended in children with severe neurological impairment, because it may increase the risk of aspiration | Salivary gland stones | Reduces incidence of pneumonia |
Salivary gland excision | Glands surgically removed | External scarring, dry mouth, facial and hypoglossal nerve injury | ||
Laryngotracheal separation | Upper and lower airways completely separated Tracheostomy formed | Will lose ability to phonate Side effects of general anaesthetic, transient fistula formation | Definitive control of salivary aspiration Reduces incidence of pneumonia |