Surgical Options for Sialorrhea Management in Children with Cerebral Palsy

Abstract

Sialorrhea is a condition that affects many children with cerebral palsy. It can lead to a myriad of problems, ranging from irritation of the peri-oral skin to recurrent aspiration causing respiratory compromise. There exist several medical and surgical options for the treatment of this condition. Behavioral and physical therapy can help in milder cases, especially in children with better neurocognitive ability. Botulinum toxin injections have been shown to be helpful in decreasing salivary gland output. Surgical interventions include salivary duct diversion, salivary duct ligation, salivary gland removal, or a combination of the aforementioned procedures. The most refractory cases involving recurrent aspiration may necessitate a tracheostomy for pulmonary hygiene, or a laryngotracheal separation, which physically separates the airway from the digestive tract. No one treatment is guaranteed to work, and proper management requires tailoring the therapy to the individual child.