Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0043352 (xerostomia)
 4,250 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study is a long-term follow up of 17 patients surgically treated for uncontrolled drooling, by retroposition of the ducts from the submandibular glands. Mean age was 16.8 years (range 7-31), with an average postoperation time of 9.2 years (range 1-18). Clinically, no subject revealed an impression of an extremely dry mouth, but most patients showed obvious permanent decrease in drooling after the surgical treatment. They had a highly significant increase in caries prevalence of the mandibular incisal and canine area, and this caries prevalence was related to the severity of cerebral palsy.
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PMID:Caries prevalence after submandibular duct retroposition in drooling children with neurological disorders. 215 58

Sialorrhea (drooling) is most commonly seen in children with cerebral palsy or mental retardation. Surgical procedures for the control of sialorrhea include salivary gland excision, parasympathetic nerve section, and salivary duct ligation and/or rerouting. Eighteen children between the ages of 5 and 17 years underwent bilateral submandibular gland excision and rerouting of Stensen's duct (Wilkie procedure). All children had severe drooling associated with cerebral palsy or mental retardation. Follow-up at 7 years showed satisfactory control of sialorrhea in 16 of 18 patients (89%). There was one major complication: xerostomia. Our results indicate that submandibular gland excision together with parotid duct retropositioning provides effective control of sialorrhea in most cases. Unfavorable head and mandibular posturing seemed to cause persistent sialorrhea in one case.
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PMID:Experience with the Wilkie procedure for sialorrhea. 239 10

Sialorrhea is a distressing problem in children with cerebral palsy, in children with other neurologic disorders, and in normal children. The constant need for clothing or bib changes in handicapped patients frequently results in further social isolation and causes normal children to be viewed as "impaired." The surgical treatment of sialorrhea at Children's Hospital Medical Center, Cincinnati, Ohio, has evolved over the past 5 years. Since 1981, 70 surgical procedures have been performed for drooling at this institution; follow-up information is available on 52 patients. The surgical procedures performed included submandibular rerouting alone, submandibular duct rerouting with bilateral tympanic neurectomy with bilateral submandibular gland excision, and bilateral submandibular gland excision with bilateral parotid duct ligation. Our review indicates that bilateral submandibular gland excision with parotid duct ligation is the only procedure in which consistent control of sialorrhea can be expected. Postoperative complications after this procedure were minimal and only one parent complained that the child had a dry mouth after the procedure. Postoperative hospitalization after bilateral submandibular gland excision and bilateral parotid duct ligation was not significantly different from that required after any of the other procedures. In conclusion, this surgical procedure appears to be the most effective surgical treatment for sialorrhea and precludes the need for multiple operative procedures for this problem.
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PMID:Surgical management of sialorrhea. 212 33

This study assessed the efficacy of synthetic anticholinergic benztropine and incidence of side-effects in 20 developmentally-disabled patients with severe drooling. The double-blind, placebo-controlled, crossover protocol included one-week baseline, two-week placebo and two-week benztropine conditions (mean dose 3.8 mg). A significant decrease in drooling during the benztropine condition relative to placebo was demonstrated and conservative response rates (calculated by deleting placebo responders), ranged up to 65 to 70 per cent. For patients completing the protocol the incidence of side-effects did not differ across conditions and minor problems such as a dry mouth were eliminated by small dose adjustments. More serious cholinergic side-effects, which resolved within 24 to 48 hours, necessitated discontinuation of the drug in three patients. This study demonstrates that synthetic anticholinergics can provide an important therapeutic alternative to surgical and behavioral therapies for drooling.
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PMID:Efficacy of benztropine therapy for drooling. 266 5

Drooling is a common stigmatizing problem necessitating increased care in the neurologically damaged child or adult. Appropriate physiotherapy frequently reduces drooling but rarely eliminates it. The goal of surgical therapy is to minimize drooling while specifically avoiding the complication of xerostomia. During the past 4 years, 37 of 46 patients assessed have undergone surgery specifically intended to reduce drooling. Good results have been obtained with bilateral transtympanic neurectomy procedures; it is the surgical procedure of choice in the more retarded patient. Encouraging results have been obtained in six patients with bilateral submandibular duct relocation; because of increased operative morbidity, it is the procedure of choice in the less retarded child.
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PMID:The drooling patient: evaluation and current surgical options. 737 7

Thirty-nine patients who had undergone transposition of the submandibular ducts and unilateral ligation of a parotid duct for saliva control were followed up six years after surgery. Overall improvement was documented according to a drooling quotient, drooling severity and drooling frequency measures. Despite this superficially favourable outcome, a significant proportion of patients (39 per cent) or their caregivers had not found the surgery helpful. Complications included ranula formation, complaints of dry mouth, difficulty with swallowing, and changes in the consistency of oral secretions. More knowledge is needed of the likely outcomes of this procedure in individual patients, so that appropriate advice can be given and complications minimised.
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PMID:Long-term outcome of saliva-control surgery. 758 58

Fifty-four parents/caretakers of children with cerebral palsy were surveyed regarding their use of antisialorrheic medication for excessive drooling. Glycopyrrolate was used by 37 of 41 respondents, with significant improvement in drooling noted in the vast majority (95%) of cases as indicated by a five-point rating scale. Side effects (dry mouth, thick secretions, urinary retention, or flushing) surfaced in almost half (44%) of the patients but necessitated discontinuation of pharmacologic treatment in less than a third. While larger clinical studies are needed, our preliminary data indicate a trial of glycopyrrolate should be considered in children with cerebral palsy where drooling is a significant problem.
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PMID:Use of glycopyrrolate and other anticholinergic medications for sialorrhea in children with cerebral palsy. 972 4

Patients with cerebral palsy who experience drooling are often isolated from social interaction. Surgical treatment is effective in reducing abnormal, profuse drooling in patients who have low cognitive function, but it has a risk of complications. In this study, a new, simple procedure using laser intervention that minimizes surgical complications is described. Forty-eight patients with cerebral palsy and persistent drooling after more than 6 months of conservative treatment were enrolled in this study. An Nd:YAG laser (1064 nm) was used for intraductal laser photocoagulation of the bilateral parotid ducts at 7 to 10 W for 10 seconds. The outcome was evaluated by questionnaire-based, semiquantitative assessments of drooling severity and frequency, collection and measurement of stimulated saliva, and salivary amylase measurement. The entire procedure was completed in 25 to 65 minutes, with a mean duration of 38.4 minutes. Early complications included transient facial swelling in all patients. Swelling persisted for 6 to 37 days (mean, 11 days). One hematoma (2.1 percent of patients), two infections (4.2 percent of patients), and two cystic formations (4.2 percent of patients) also occurred. No obvious xerostomia or visible scar was noted after the procedure. In the final assessment, a significant improvement in drooling severity (p < 0.05) and frequency (p < 0.05) was noted in the majority of cases. Forty patients (83.3 percent) demonstrated remarkable improvement in drooling severity, seven patients (14.6 percent) showed significant improvement, and one patient (2.1 percent), who was also autistic, continued to experience severe drooling after the laser procedure. The decrease in the amount of saliva produced ranged from 20 to 60 percent at 12 weeks after surgery. The decrease in the amount of salivary amylase measured ranged from 4 to 97 percent at 12 weeks after surgery (p < 0.05). In conclusion, the intraductal laser photocoagulation of bilateral parotid ducts is a simple, effective procedure for reducing drooling in patients who have cerebral palsy. This procedure minimizes risks and complications, compared with those associated with conventional surgery.
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PMID:Intraductal laser photocoagulation of the bilateral parotid ducts for reduction of drooling in patients with cerebral palsy. 1125 81

The parotid glands and part of the submandibular glands were irradiated in 18 amyotrophic lateral sclerosis patients with very advanced disease and severe drooling problems. In a prospective study, a single dosage of 7.0-7.5 Gy was administered bilateral to the larger part of the parotid glands and the posterior parts of the submandibular glands. Salivary secretion rate was assayed before and after radiotherapy. Sixteen out of eighteen patients reported satisfactory to good reduction in drooling lasting up to 4-6 months, 1/18 developed xerostomia and needed saliva substitutes, and 1/18 reported no effect. Caregivers reported positive effect in all patients. The procedure was well tolerated with few side effects. Low dosage external radiotherapy of the salivary glands is effective in reducing drooling satisfactorily in ALS patients, especially in well-hydrated patients.
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PMID:External radiation of the parotid glands significantly reduces drooling in patients with motor neurone disease with bulbar paresis. 1167

Hypersialorrhea is a common phenomenon in Parkinson disease (PD). The objective of this study was to determine whether patients with PD had an abnormally increased production of saliva and whether the production of saliva could be associated to factors related to either the disease characteristics or to its treatment. A total of 83 patients with PD and 55 control subjects participated in this study. Because of the age difference between the two groups, comparisons were made on a +/-2-year age-matched sample of 44 PD patients and 44 control subjects. PD patients produced significantly less saliva than control subjects. Correlations were obtained with the 83 PD patients between unstimulated salivary flow and patients characteristics. When controlling for age, sex, and Hoehn and Yahr scale, decreased production of saliva correlated significantly with the dose of levodopa and the symptoms of xerostomia. When controlling for medications, there was no relationship between the production of saliva and the evolution of the disease. This study shows that patients with PD produce less saliva than normal. Factors influencing the production of saliva include the use of levodopa and female gender. Our results may have implications for the treatment of drooling in PD.
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PMID:Salivary production in Parkinson's disease. 1538 96


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