title: Saliva control issues in the neurologically challenged. A 30 year experience in team management.
abstract: OBJECTIVE
  The objective of this paper is to report the experience of a multidisciplinary team (otolaryngologist, speech-language pathologists, pediatric dentist, and social worker) functioning at a pediatric rehabilitation center have had in the management of 1487 neurologically challenged individuals with saliva control issues assessed from 1976 to the end of 2004.
  
  
  METHODS
  The role of each team member is outlined. Management decisions have consisted of no treatment, utilization of oral-motor training program, elimination of contributing situational factors, utilization of medication, surgery and Botox injections of the major salivary glands.
  
  
  RESULTS
  Oral-motor programs to improve oral-motor function is essential initially if there is patient compliance. Surgery was recommended in the majority of patients. Submandibular duct relocation with simultaneous sublingual gland excision remains the procedure of first choice for persistent significant drooling. Aspiration is much less common than drooling and is more problematic to treat. Simultaneous ligation of the submandibular and parotid ducts (aka 4-duct ligation) is promising. A recent initiative to inject the major salivary glands with Botox is being evaluated.
  
  
  CONCLUSIONS
  Team evaluation with consensus decision making has worked well in this patient population with complex medical conditions.
authors.affiliation: Department of Otolaryngology & Head and Neck Surgery, Hospital for Sick Children, 555 University Avenue, Toronto, Ont., Canada M4W1X8. william.crysdale@sickkids.ca
authors.forename: William S
authors.initials: WS
authors.lastname: Crysdale
authors.forename: Catherine
authors.initials: C
authors.lastname: McCann
authors.forename: Lisa
authors.initials: L
authors.lastname: Roske
authors.forename: Melissa
authors.initials: M
authors.lastname: Joseph
authors.forename: Dan
authors.initials: D
authors.lastname: Semenuk
authors.forename: Peter
authors.initials: P
authors.lastname: Chait
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D001927:Brain Diseases / Q000453:epidemiology* / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D032921:Consensus; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D033183:Interdisciplinary Communication; D009465:Neuromuscular Agents / Q000627:therapeutic use; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010348:Patient Care Team; D012463:Saliva / Q000187:drug effects; D012798:Sialorrhea / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D013070:Speech Therapy / Q000379:methods
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A