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Differential Diagnosis: Ptyalism/Pseudoptyalism

Julie Allen, BVMS, MS, MRCVS, DACVIM (SAIM), DACVP, Cornell University

Internal Medicine

|April 2020|Peer Reviewed

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Differential Diagnosis: Ptyalism/Pseudoptyalism

Following are differential diagnoses for patients presented with ptyalism/pseudoptyalism.*

  • GI condition
    • Abdominal pain (eg, from visceral stretching)
    • Disease associated with nausea
    • Esophageal disease (eg, reflux esophagitis, megaesophagus, foreign body, neoplasia, stricture, spirocercosis)
    • Gastric dilatation volvulus
    • Gastric ulceration
    • Hepatic failure (eg, hepatic encephalopathy), particularly in cats
    • Hiatal hernia
    • Renal failure
  • Idiopathic or nonresponsive condition
  • Neurologic condition
    • Facial nerve paralysis
    • Idiopathic trigeminal neuritis
    • Infectious disease (eg, rabies, pseudorabies, tetanus, botulism)
    • Lesions of cranial nerves IX, X, or XII
    • Myasthenia gravis
    • Nausea from vestibular disease
    • Seizures
  • Oral cavity or maxillofacial cause
    • Craniomandibular osteopathy
    • Faucitis
    • Foreign body
    • Immune-mediated disease (eg, masticatory muscle myositis, pemphigus)
    • Lip fold abnormalities
    • Mandibular fracture
    • Oropharyngeal neoplasia (eg, tonsillar squamous cell carcinoma)
    • Oropharyngeal trauma (eg, laceration)
    • Periodontal disease
    • Stomatitis (eg, calicivirus, herpesvirus, FeLV/FIV, caustic agent, electrical burn, ulceration secondary to systemic disease [eg, uremia])
    • Temporomandibular joint luxation or fracture
    • Tongue lesion (eg, linear foreign body), glossitis (eg, uremia, caustic agent, electrical burn), or tumor
  • Physiologic reaction
    • Excitement
    • Hyperthermia
    • Purring
    • Response to feeding
  • Reaction to medication
    • Anesthesia
    • Avermectins (eg, ivermectin, moxidectin/imidacloprid, selamectin) given topically or PO
    • Bitter drugs
    • Cholinergic drugs (eg, bethanechol), anticholinesterase drugs (eg, pyridostigmine), cholinesterase inhibitors (eg, organophosphates)
    • Pancreatic enzyme supplements
    • Pyrethrins/pyrethroids
  • Salivary gland condition
    • Foreign body
    • Salivary gland neoplasia
    • Salivary mucocele
    • Sialadenitis or necrotizing sialometaplasia (ie, inflammation of the salivary glands)
    • Sialadenosis (idiopathic, noninflammatory salivary gland enlargement)
      • May be a form of limbic epilepsy 
    • Sialolithiasis
  • Sepsis
  • Toxicosis
    • 5-hydroxytryptophan (ie, Griffonia seed extract)
    • Bite from a venomous animal (eg, black widow spider, scorpion, toad [Bufo spp], coral snake, sea hare [Aplysia spp])
    • Household cleaner 
    • Human sleep aid (eg, zolpidem)
    • Human tricyclic antidepressant (eg, clozapine)
    • Illicit drug (eg, cocaine, amphetamine)
    • Insecticide/pesticide (eg, boric acid, aldicarb)
    • Metaldehyde
    • Mushroom (eg, Amanita muscaria)
    • Plant/tree (eg, Kentucky coffee tree, poinsettia)
    • Rodenticide (eg, zinc phosphide)
*Differentiating between ptyalism and pseudoptyalism can be challenging; some conditions (eg, oropharyngeal and CNS diseases) can result in both increased salivary production and the inability to swallow.
Rabies should always be considered in patients presented with drooling.


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