Hypersalivation – Ersterstellung der S2k-Leitlinie (AWMF) in gekürzter Darstellung

Zusammenfassung

Hypersalivation bezeichnet einen übermäßigen Speichelfluss, der durch insuffiziente oromotorische Fähigkeiten, verminderte zentralnervöse Kontrolle und Koordination oder gestörte Schluckabläufe zu einem Benässen des Betroffenen und seiner Umgebung führen kann. Dieses reduziert die sozialen Interaktionsmöglichkeiten und erhöht den Pflegeaufwand. Die Diagnostik und Therapie sollten frühzeitig multidisziplinär erfolgen, weshalb eine S2k-Leitlinie zur Hypersalivationstherapie erarbeitet wurde. Schwerpunkte sind die Abklärung von Schluckstörungen mit Speichelaspiration und von orofazialen motorischen Defiziten. Die endoskopische Schluckdiagnostik und die Videofluoroskopie können wichtige Informationen zur Therapiekontrolle liefern. Insbesondere bei traumatischen oder tumortherapeutischen Defektstörungen sind schlucktherapeutische Übungsmaßnahmen zur Aktivierung von Kompensationsmechanismen zweckmäßig. Vor allem bei Kindern mit hypotoner perioraler Muskulatur können Stimulationsplatten über einen vermehrten Lippenschluss zur Symptomreduktion führen. Sinnvolle medikamentöse Therapien bei akuter Hypersalivation sind insbesondere Glycopyrrolat und Scopolamin, jedoch ist die Langzeitanwendung kritisch zu betrachten. Zuletzt hat sich die Injektion von Botulinumtoxin in die Speicheldrüsen als effektive und sichere Behandlungsform mit einer lang anhaltenden Speichelreduktion erwiesen. Chirurgische Eingriffe der Speicheldrüsen bleiben zunehmend Einzelfällen vorbehalten. Die externe Bestrahlung der Speicheldrüsen gilt als ultima ratio. In der Nachsorge sind Therapieeffekte zu erfassen; insbesondere bei neurodegenerativen Erkrankungen ist die individuelle Dynamik der Symptomverschlechterung zu berücksichtigen. Der Einfluss der resultierenden relativen Mundtrockenheit soll vom behandelnden Arzt in Hinblick auf die Mund- und Zahnhygiene evaluiert werden.

Abstract

Hypersalivation – Inauguration of the S2k Guideline (AWMF) in Short Form

Hypersalivation describes a relatively excessive salivary flow, which wets the patient himself and his surroundings. It may result because of insufficient oro-motor function, dysphagia, decreased central control and coordination. This reduces social interaction chances and burdens daily care. Multidisciplinary diagnostic and treatment evaluation is recommended already at early stage and focus on dysphagia, and saliva aspiration. Therefore, a multidisciplinary S2k guideline was developed. Diagnostic tools such as fiberoptic endoscopic evaluation of swallowing and videofluoroscopic swallowing studies generate important data on therapy selection and control. Especially traumatic and oncologic cases profit from swallowing therapy programmes in order to activate compensation mechanisms. In children with hypotonic oral muscles, oralstimulation plates can induce a relevant symptom release because of the improved lip closure. In acute hypersalivation, the pharmacologic treatment with glycopyrrolate and scopolamine in various applications is useful but its value in long-term usage critical. The injection of botulinum toxin into the salivary glands has shown safe and effective results with long lasting saliva reduction. Surgical treatment should be reserved for isolated cases. External radiation is judged as ultima ratio. Therapy effects and symptom severity has to be followed, especially in neurodegenerative cases. The resulting xerostomia should be critically evaluated by the responsible physician regarding oral and dental hygiene.

Schlüsselwörter

Hypersalivation - Drooling - Schluckstörung - Glycopyrrolat - Scopolamin - Übungstherapie - Botulinumtoxin

Key words

hypersalivation - drooling - dysphagia - glycopyrrolate - scopolamine - oro-sensory therapy - botulinum toxin

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