Table 7

Sialorrhoea interventions

InterventionAdvantagesDisadvantagesCommon side effects/cautionsNotes
Non-pharmacological interventions
Behavioural interventions, oral motor therapy and oral appliances288Non-invasive.Intensive.
Requires careful patient selection.
Weak evidence base for benefit.289
Contraindicated in posterior drooling.290
Medication
Hyoscine transdermal patchPatch change every 72 hours.
Shown to be equally as efficacious as glycopyrronium in treating sialorrhoea in CYP with CP.291
Dose titration challenging.
Local skin irritation.
Overly dry mouth, blurred vision, constipation, urinary retention, skin flushing or dryness.Anticholinergic medications reduce saliva production either through direct or systemic route. Recommended as first-line therapy for sialorrhoea in CYP and adults.290 292
Can cause thick, difficult to clear secretions or mucous plugging resulting in CAP.
Glycopyrronium liquidDose titration.
Side effects less frequent than with hyoscine hydrobromide.291
Typical dosing schedule three times per day.
Inhaled ipratropium bromideCan be a useful adjunct to other medications listed.
Less systemic absorption.
Facemask and spacer may be poorly tolerated.
Efficacy evidence base lacking.
AtropineCan be administered sublingually as drops.
No reliance on gut absorption.293
Typical dosing 3–4 times per day.
Difficult to deliver accurate dosing.
Salivary gland botulinum A toxin injectionOften done under local anaesthetic with ultrasound guidance.294 295
Can be repeated every 3–6 months
Invasive.
Repeated injections likely to be required.
Trauma at injection site, EDS difficulties, dry mouth.Cohort study evidence of reduced incidence of pneumonia following injection in CYP with neurological impairment.296 297
Surgical
Salivary gland duct ligationResults in the atrophy in salivary glands and subsequent reduction in saliva production.298Invasive.
Irreversible.
Requires general anaesthetic.
Salivary gland stones.Some cohort study evidence of reduced incidence of CAP and hospitalisations in CYP with neurological impairment.299 300
Salivary gland excisionHighly effective.298Invasive.
Irreversible.
Requires general anaesthetic.
External scarring.
Dry mouth.
Facial and hypoglossal nerve damage.
  • CAP, community-acquired pneumonia; CP, cerebral palsy; CYP, children and young people; EDS, eating, drinking and swallowing.