Sialorrhea

SIALORRHEA, synonyms: salivation (from Latin saliva-saliva), sialosis, sialorrhea (from Greek sialon-saliva and rheo-flow), polysialia, ptyalism, a pathological increase in the secretion of saliva, a symptom of many, very different in their nature, localization, and origin, pathological processes. In the basis of S. can lie both local influences on the tissue of the salivary glands (for example, influence on it of mercury released with saliva during mercury treatment), and central influences as a result of various pathological processes in the central nervous system (for example, in bulbar paralysis, in arteriosclerotic pseudobulbar paralysis, in cerebral hemiplegia, in certain psychoses, etc.) and finally reflex influences, coming from the most various organs, especially from individual segments of the digestive tract, in particular from the side of the oral cavity (in stomatitis, especially aphthous and ulcerative, in children constantly during teething), from the side of the esophagus {in chronic spastic its narrowings, especially near cardia), from the side of the stomach [in hypersecretion and, hyperaciditas, and according to Boas {Boas) and in achylia gastrica], from the side of the intestine [often in worms, according to Moynihan {Moyni-han) often in ulcus duodeni], sometimes in diseases of the pancreas; finally reflex S. can take place in diseases of the uterus, nose, less often kidneys and other organs. If in local influences on the salivary glands themselves the mechanism of development of S. is understandable, then in central and reflex S. this mechanism is still not established with certainty; while Bekhterev and Mislavsky, Bari and some others assume the existence of a special cortical salivary center, irritation of which leads to sialorrhea, Boschfontaine, Eckardt, Tikhomirov and others deny its existence, considering only the presence of a salivary center in the medulla oblongata {see Salivation) to be established. Besides the above-mentioned pathological processes S. can be observed in intoxications Br, J, C1, Cu, Sn, H₂S, Hg, pilocarpine, in toxicosis of pregnancy (see.) (more often in its first months), in uremia, often in vagotonia, various neuroses, in hysteria, sometimes in chorea minor, in eclampsia, tabes dorsalis, often in rabies, Parkinson's syndrome; in tremor paralysis S. is an early symptom, sometimes preceding the development of tremor phenomena. S. is often observed in children, especially in idiocy and cretinism, sometimes in congenital mental deficiency; S. is constantly observed in damage to the tympanic cavity with involvement in the process of chorda tympani. S. is characteristic in trigeminal neuritis. Clinically S. in individual diseases differs by some features; so, in reflex S. as a result of diseases of internal organs, nose, etc., it is observed only during the day, moreover mainly at certain hours; in worms and, according to Boas, in achylia gastrica, mainly at night, moreover in the latter case first often nausea appears, after which in large quantities begins to be released watery transparent S; in toxicosis of pregnancy S. is observed mainly in the mornings, but can be continuous throughout the day, causing sometimes distressing insomnia and general exhaustion; in certain psychoses it occurs only periodically; in tabes dorsalis sometimes appears in the form of crises. In stomatitis with involvement in the process of salivary ducts the character of saliva changes in the sense that saliva becomes more viscous and is released more slowly: such more viscous (so-called sympathetic) saliva is often observed, according to Nothnagel {Nothnagel), also in cerebral hemiplegia. The amount of saliva released during S. can reach 3-5 and even 10-12 liters per day (norm-1¹/₂ l); patients are forced to swallow saliva very often - sometimes to exhaustion, some spit it out all the time, in part of patients it constantly flows from the mouth, causing often accompanying skin lesions. Mixing of S. with the discharge of saliva accumulating in the mouth in connection with a violation of the act of swallowing (for example, in anginas) is possible. Partially due to a violation of the act of swallowing one should attribute the discharge of saliva in patients with Parkinson's syndrome (for example, in encephalitis epide-mica in its chronic stage, where this is also promoted by the half-open position of the patient's mouth) and in rabies. Inadequate closing of lips in paralysis of the facial nerve or their destruction (for example, in tuberculous lupus) can also contribute to the discharge of saliva, although in part of these cases we also have true increase in salivation. Causal treatment consists in treating the main ailment; symptomatically give atropine (0.5-2.0 mg per day), opium (0.02 several times a day), nervina; sometimes care for the oral cavity, in particular rinsing with an infusion of sage or chamomile, in individual cases gives effect the conduct of a course of treatment with arsenic. In smegma on the basis of a disease of the nervous system (especially in hysteria) it is expedient to try psychotherapy. Sialorrhea during pregnancy see Pregnancy.