13 Posterior drooling, saliva that leaks to the oropharynx, might lead to aspiration pneumonia and asphyxia and thereby death. More than 50% of patients with cerebral palsy die from respiratory complications, which is related to aspiration in the majority of patients.24, 25 In conclusion, drooling is associated with physical, psychosocial, and emotional distress, which should be recognized and treated accordingly. Pathophysiology The primary cause of drooling is dysfunctional oral motor control that impairs effective and regular swallowing. Drooling is, however, multifactorial and dependent on various other clinical variables such as gross motor function, dental occlusion, mouth closure, and posture.26-28 Drooling is rarely caused by hypersalivation.29 The submandibular gland is responsible for most salivary production in the resting state (60-70%). The submandibular gland is located in the submandibular triangle, which is bounded by the inferior margin of the mandible, the anterior and posterior belly of the digastric muscle. The gland drains through the 5 cm long submandibular duct (Wharton’s duct), which originates medially to the gland. From here it runs between the mylohyoid and hyoglossus muscle through the genioglossus muscle. The submandibular duct has its opening in the anterior floor of the mouth (sublingual caruncle).30 The sublingual gland, responsible for approximately 10% of saliva production in the resting state, is located just inferior to the floor of the mouth and partly shares drainage with the submandibular gland through the duct of Bartholin, which interconnects the sublingual gland to the submandibular duct. The sublingual gland furthermore drains through approximately 8 to 20 smaller ductules, dubbed the ductuli of Rivini.30, 31 The parotid gland is the largest and is situated pre-auricularly from the zygomatic arch to the angulus of the mandible. The parotid gland drains through the 5cm
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