The control of saliva may be impaired in children with severe spastic quadriplegia. Poor head control and oromotor deficits are the cause. With the head held flexed or to the side, there may be pooling of oral secretions in the anterior portion of the oral cavity. If bolus formation is not initiated, these secretions will spill over the lips and onto the face and body. Although primarily thought of as a social or cosmetic issue, drooling may lead to skin problems such as chapping on the face. Families and physicians have used a variety of techniques to stem the drooling when it persists in childhood and is perceived as a problem. As a side effect, some common medications are noted to decrease secretions. These drugs, including scopolamine, atropine, imipramine, trihexyphenidyl hydrochloride (Artane), glycopyrrolate (Robinal), benztropine mesylate (Cogentin), and antihistamines, have been used with limited success. 3 Side effects of these medications, toxicity (if the family should give multiple doses), and possible drug interactions are of concern in the emergency setting. Surgery also has been used for severe drooling. Salivary duct rerouting is the most commonly used procedure at this time.4 Following surgery, cheek swelling and swallowing dysfunction have been noted. In a small number of patients, ranula formation was noted. In the past, xerostoma has been reported after surgical removal of salivary glands with resulting lesions of the oral mucosa and increased dental caries. None of these issues needs to be handled on an emergent basis and should be referred to the ENT service for long-term management on an outpatient basis.
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