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Drooling and aspiration


Normal saliva flow


Under normal conditions the mouth produces a teaspoon of saliva every five minutes. Saliva keeps the mouth moist, initiates food digestion, and helps fight infections. Saliva is produced by four large glands and hundreds of small glands located throughout the lining of the mouth. Two of the large glands, the parotid glands, are located in front of the ears, in the soft tissues of the cheek. The other two large glands, the submandibular glands, are located in the neck, on either side of the chin. The saliva produced by the glands empties into the mouth by the way of a duct or tube. The parotid and submandibular glands produce most of the saliva generated in the mouth. The small glands, or minor salivary glands, located through out the lining of the mouth is responsible or generating a small fraction of the total saliva.


What is drooling?


Saliva is swallowed periodically and unconsciously, so that this fluid does not accumulate in the mouth. However, saliva can accumulate in the mouth if the glands produce too much, or if the saliva is not periodically swallowed. When saliva accumulates in the mouth, it eventually spills over the lips and onto the chin. This is defined as drooling. 


Who suffers from aspiration?

Children with neurological problems are often unable to periodically swallow their saliva, and in these kids drooling becomes a chronic problem. The excess saliva can even drain down the back of the tongue into the airway and lungs, instead of the stomach, causing a continuous cough and recurrent chest infections which may result in permanent lung damage.


The treatment for drooling and saliva aspiration is to reduce the amount of saliva produced. This is accomplished by removing the submandibular glands from the neck through a small incision on either side of the chin or sewing closed the ducts that drain saliva form these glands (through the mouth). Additionally, the duct emptying the saliva from the parotid glands, found easily on the inside of the mouth next to the molars, is sewn closed. This operation successfully reduces drooling in the majority of children. Botox injections into the salivary glands may also temporarily accomplish the same thing.

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