The causes of severe sialorrhea (drooling) are reviewed, and in particular in children in whom it can become a life-long disability. The history of medical and surgical treatments is discussed. A major advance has been the surgical relocation of the submandibular gland ducts with removal of sublingual glands. The results of this operation, technical considerations, and its outcomes in 16 children are presented. There were no significant complications. Caregivers judged the efficacy with a median score of “75%” improvement. The technique has become the most logical and reliable surgical treatment for drooling, with very good control in most cases. In contrast to “Botox” its effects are permanent. 1. Introduction An adult produces about 1.2 litres of saliva a day, mainly from three pairs of major salivary glands and from minor glands in the oral cavity and palate. The relative contributions to volume are minor glands 5%, sublingual glands 5%, parotids 30%, and submandibular glands 70%. The parasympathetic nerve supply to the salivary glands is illustrated in Figure 1. Saliva lubricates food to assist in chewing, and the swallowing process contains digestive enzymes and has a role in dental health. Figure 1: Parasympathetic innervation of the salivary glands. Otological access is to the chorda tympanic nerve for the submandibular and sublingual glands and the tympanic plexus for the parotid gland. Sialorrhea (“drooling”, “dribbling”, and “drivelling”) is the involuntary escape of saliva from the mouth. In contrast to excess saliva production (salivation) it implies an inability to retain saliva due to lip incontinence, or to decreased oral sensation, a defective oral stage of swallowing, an open bite, poor posture and neck flexion, or a combination of those factors. Minor “normal” drooling is not uncommon in normal children (usually boys) up to the age of five. In contrast, pathological drooling is a major cause of poor quality of life in individuals with major neurological disability. Strokes, Parkinson’s disease, and motor neurone disease can be a cause of sialorrhea in late adult life. Of greater significance is that drooling can be a major and potential life-long disability in physically and intellectually impaired children. Between 10% and 37% of children with cerebral palsy display pathological drooling [1]. The cause is not overproduction of saliva [2] but impaired lip control, causing a delay between the suction and propelling stages of the oral phase of swallowing [3]. Consequently, saliva from the sublingual and submandibular glands pools in the
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