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1.
Background: Salivary secretory disorders can be the result of a wide range of factors. Their prevalence and negative effects on the patient''s quality of life oblige the clinician to confront the issue.Aim: To review the salivary secretory disorders, inducing drugs and their clinical management.Methods: In this article, a literature search of these dysfunctions was conducted with the assistance of a research librarian in the MEDLINE/PubMed Database.Results: Xerostomia, or dry mouth syndrome, can be caused by medication, systemic diseases such as Sjögren''s Syndrome, glandular pathologies, and radiotherapy of the head and neck. Treatment of dry mouth is aimed at both minimizing its symptoms and preventing oral complications with the employment of sialogogues and topical acting substances. Sialorrhea and drooling, are mainly due to medication or neurological systemic disease. There are various therapeutic, pharmacologic, and surgical alternatives for its management. The pharmacology of most of the substances employed for the treatment of salivary disorders is well-known. Nevertheless, in some cases a significant improvement in salivary function has not been observed after their administration.Conclusion: At present, there are numerous frequently prescribed drugs whose unwanted effects include some kind of salivary disorder. In addition, the differing pathologic mechanisms, and the great variety of existing treatments hinder the clinical management of these patients.The authors have designed an algorithm to facilitate the decision making process when physicians, oral surgeons, or dentists face these salivary dysfunctions.  相似文献   
2.
Botulinum toxin injections are useful in patients with refractory sialorrhoea although the optimum treatment protocol and its efficacy over a long period of follow up are controversial. The aim of our prospective study was to examine the efficacy and complications of a protocol of repeated ultrasound-guided botulinum toxin injections of fixed doses at a tertiary children’s hospital. A total of 79 procedures were done in 34 patients who were followed up for two years. The overall complication rate was 3%. The outcome measures considered included the Drooling Frequency Severity Scale (DFSS), visual analogue scale (VAS), and carers’ assessments of the reduction in drooling. Our study highlighted two types on non-responders (primary and secondary) of which 3/34 required definitive surgical management. In summary, this study shows that a protocol of repeated injections of fixed doses of botulinum toxin A, while not beneficial in all cases, is a potentially valuable option for the safe and effective treatment of sialorrhoea in children.  相似文献   
3.
目的 探讨不同类型脑瘫患儿流涎症的发生率、严重程度及其与口运动评分、吞咽障碍评分及粗大运动功能分级间的关系。 方法 采用流涎严重程度评估量表对2013年7月至2016年7月期间在青岛市妇女儿童医院康复中心门诊及住院治疗的100例脑瘫患儿及在本院健康查体的50例正常儿童进行流涎评估,同时对脑瘫患儿进行口运动评估、吞咽障碍评分(DDS)及粗大运动功能分级(GMFCS)评估,分析不同类型脑瘫患儿流涎严重程度与其口运动评分、吞咽障碍评分及GMFCS分级水平的关系。 结果 本研究入选脑瘫患儿流涎症(流涎Ⅱ级~Ⅴ级)发生率为32%,明显高于正常对照组流涎症发生率(P<0.01),脑瘫流涎严重程度分级情况如下:Ⅰ级68例,Ⅱ级8例,Ⅲ级16例,Ⅳ级8例,Ⅴ级0例。不同类型脑瘫患儿其流涎严重程度间存在显著差异,痉挛型四肢瘫、不随意运动型和混合型脑瘫患儿流涎程度较严重,其次是痉挛型双瘫和共济失调型患儿,偏瘫患儿无流涎发生。脑瘫患儿流涎严重程度分级与口运动评分呈显著负相关(r=-0.764,P<0.01),而与DDS评分(r=0.772,P<0.01)及GMFCS分级(r=0.788,P<0.01)呈正相关。 结论 约1/3脑瘫患儿并发流涎症,其流涎严重程度与脑瘫类型、口运动障碍、吞咽障碍及粗大运动障碍程度密切相关。  相似文献   
4.
The objectives were to obtain rough estimates of the number of bacteria in an edentulous mouth and the mean turnover time of the oral mucosa and the conditions under which the salivary phase in the mouth might act as a bacterial continuous culture system. The premise was that at steady state in vivo, the rates of loss of bacteria and epithelial cells in saliva must be equal to their rates of proliferation. Drooled saliva was collected from 17 subjects and the number of epithelial cells per millilitre was determined in a Coulter Counter. The numbers of adherent bacteria per epithelial cell were counted on cells stained with Toluidine Blue. For 10 subjects, salivary bacterial counts were obtained after saliva had been diluted in Reduced Transport Fluid and grown anaerobically on Blood Agar for 5 days. From the known surface areas of the oral mucosa and individual epithelial cells and the rate of loss of epithelial cells into saliva, the surface layer of epithelial cells was calculated to be replaced every 2.7h. From the calculated number of epithelial cells lining the oral mucosa, the number of bacteria per epithelial cell, and the rate of swallowing of the bacteria in saliva, the number of bacteria in an edentulous mouth was calculated to be about 1.58 x 10(9) and the mean time between bacterial cell divisions to be 1.38h. Given a residual volume of 0.8ml and a maximal bacterial division rate of 3h(-1), the salivary phase in the mouth could act as a continuous culture system for certain fast-growing bacteria only if the maximum flow rate were <0.04ml/min.  相似文献   
5.
ObjectiveTo determine the effectiveness of submandibular salivary gland Botulinum Toxin Type-A (BTX-A) injection in the treatment of drooling in children with varying degrees of neurological dysfunction.MethodsA retrospective review of pre- and post-procedure drooling frequency and severity scores of patients receiving BTX-A between January 2008 and January 2013. Stratification to different subgroups of neurological impairment was performed according to Gross Motor Function Classification System (GMFCS) score. Drooling severity was assessed using Thomas-Stonell and Greenberg symptom questionnaires administered at time of initial consultation and 3 months after treatment.Results48 sets of BTX-A injections in 26 patients with an average age of 9.45 years (range 7 months–18 years) were included in the study. Marked improvement in drooling was seen in 60.4% of patients, a marginal or brief improvement was seen in 20.8% and there was no improvement in 18.8%. No adverse events were reported following any of the BTX-A injections. BTX-A was safe and effective in the eight patients with pre-existing swallowing dysfunction. Subsequent drooling surgery was performed in 15 (57.7%) of the cohort, all 15 patients responded to BTX-A injections.In patients with Cerebral Palsy, there was no correlation between the severity of the neurological dysfunction as measured by the Gross Motor Function Classification System (GMFCS) score and the response to BTX-A treatment.ConclusionsInjection of BTX-A to the submandibular glands of children with neurological disorders is a safe procedure and results in a reduction in drooling in the majority of patients. Children with severe neurological dysfunction respond to BTX-A injections as effectively as their less impaired peers and the degree of response does not appear to be associated with the severity of neurological disability. BTX-A injection is a good initial procedure when drooling surgery is being considered.  相似文献   
6.
7.
The aim of this audit was to assess the effectiveness of botulinum toxin B (NeuroBloc®, Eisai Ltd.) in the treatment of drooling. Over a period of 18 months patients treated with NeuroBloc® botulinum toxin (BTX) for serious drooling (drooling score more than 7) were invited to complete a questionnaire on their experience of drooling and the impact of treatment. A total of 170 questionnaires were given to consecutive patients or carers and 145 (85%) responded. Of these, 128 (88%) reported that symptoms had improved by 6/10 or more on a visual analogue scale (VAS), and 54 (37%) reported compete resolution of drooling (10/10 VAS). A total of 139 (96%) would recommend the treatment to others.  相似文献   
8.
PurposeMoebius Syndrome is a rare congenital neurological condition often characterized by multiple cranial nerve involvement. This case study presents an eight-year old girl with Moebius Syndrome (MC) who received 30 sessions of speech therapy. This occurred after presenting to clinic 11 months after left facial reanimation with gracilis thigh muscle transfer surgery. On examination, only flickers of left facial movement were observed. There was no movement on the right side of the face. As a consequence of the minimal movement, MC presented with drooling and unintelligible speech. The purpose of speech therapy was three fold: minimise the pooling of saliva, improve the placement of the articulators so that articulation of speech sounds would be more accurate, and gain advances in overall intelligibility.MethodsTherapy focussed on speech, facial movement and saliva management using a combination of speech drills, evidence-based articulation therapies, facial exercises with surface electromyography biofeedback, self-awareness training and compensatory saliva management strategies.ResultsAfter a course of 30 one-hour speech therapy sessions, substantial improvements were seen in speech sound accuracy, overall intelligibility, facial movement and saliva control.ConclusionsThe combination of surgery and speech therapy led to functional gains that surgery alone did not achieve. The impact of speech therapy on surgical outcomes in individuals with Moebius syndrome deserves further investigation.  相似文献   
9.
Familial dysautonomia is a rare disease affecting the nervous system. Symptoms include speech and movement problems, anterior sialorrhea (drooling) due to hypersalivation as a consequence of poor oropharyngeal coordination; dysphagia and aspiration pneumonia secondary to recurrent posterior sialorrhea. The treatment for sialorrhea in this population is very challenging. Traditional drugs carry a number of side-effects that are difficult to control in this disease. We report the first documented case series of 3 patients with this condition that successfully responded to Onabotulinum toxin A injection into their salivary glands. This is an innovative, safe method for drooling control in this population.  相似文献   
10.
《The Laryngoscope》2017,127(7):1604-1607
We performed endoscopic transoral neurectomy of the submandibular and sublingual glands to treat drooling. We bilaterally operated two adult cases with treatment‐resistant drooling. In these patients, conventional treatment had failed. Repeated botilinum toxin type A (BOTOX®, Abdi Ibrahim Pharmaceutical Company, Istanbul, Turkey) injections had been effective but were becoming less so. The patients benefited from surgery in that their saliva scores decreased. No issue emerged over 6 months of follow‐up. Endoscopic transoral neurectomy of the submandibular and sublingual glands reduces saliva production and allows management of drooling in treatment‐resistant patients. Laryngoscope , 127:1604–1607, 2017  相似文献   
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