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Miller AL, Hysinger EB, Tabangin ME, Torres-Silva C, de Alarcon A, Hart CK. Pulmonary and Clinical Outcomes After Bilateral Submandibular Gland Excision and Parotid Duct Ligation for Refractory Sialorrhea. JAMA Otolaryngol Head Neck Surg 2024; 150:57-64. [PMID: 38008865 PMCID: PMC10666045 DOI: 10.1001/jamaoto.2023.3670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/01/2023] [Indexed: 11/28/2023]
Abstract
Importance Refractory sialorrhea in children can result in pulmonary aspiration and irreversible lung damage. Despite many studies devoted to the surgical treatment of sialorrhea, there is a paucity of objective outcome measures after surgery, especially with regard to pulmonary health. Objectives To assess whether bilateral submandibular gland excision and bilateral parotid duct ligation ("DROOL" procedure) is associated with reduced pulmonary inflammation in bronchoalveolar lavage (BAL) samples after surgery and to assess patient factors associated with improvement after surgery. Design, Setting, and Participants This retrospective case series included all 112 patients undergoing the DROOL procedure at a single tertiary care pediatric children's hospital from January 1, 2012, to December 31, 2021. Statistical analysis was performed from March 30 to June 10, 2023, and August 20 to September 23, 2023. Exposure DROOL procedure for refractory sialorrhea. Main Outcomes and Measures Degree of pulmonary inflammation (neutrophil percentage) according to BAL cytologic findings and overall bronchoscopy findings up to 12 months before and after the DROOL procedure. Secondary outcomes included number of annual hospitalizations, caregiver report of function before and after the procedure, and need for revision procedures and/or additional operations for secretion management. Results A total of 112 patients (median age, 3.4 years [IQR, 2.0-7.1 years]; 65 boys [58.0%]) underwent DROOL procedures and had both preoperative and postoperative BAL samples during the study period. Patients demonstrated objective improvement in pulmonary inflammation after surgery, with the median polymorphonuclear neutrophil percentage decreasing from 65.0% (IQR, 14.0%-86.0%) before the surgery to 32.5% (IQR, 3.0%-76.5%) after the surgery (median difference in percentage points, -9.0 [95% CI, -20.0 to 0.0]). Prior to the DROOL procedure, 34 patients (30.4%; 95% CI, 21.8%-38.9%) were hospitalized 2 or more times annually for respiratory illness, which decreased to 10.1% (11 of 109; 95% CI, 4.4%-15.7%) after surgery (3 patients did not have hospitalization data available following surgery). Most caretakers (73 [65.2%]) reported improved secretion management after the procedure. Conclusions and Relevance This study suggests that patients with impaired secretion management who underwent a DROOL procedure demonstrated improvement in pulmonary inflammation and a reduction in hospitalizations after surgery. Caretakers were also likely to report subjective improvement in secretion management and quality of life. Additional research is necessary to guide optimal timing and patient selection for this procedure.
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Affiliation(s)
- Ashley L. Miller
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Now with Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Erik B. Hysinger
- Aerodigestive and Esophageal Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Meredith E. Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Cherie Torres-Silva
- Aerodigestive and Esophageal Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Aerodigestive and Esophageal Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Catherine K. Hart
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Aerodigestive and Esophageal Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Chen DW, Billings KR, Ida JB, Lavin J, Ghadersohi S, Valika T. Salivary gland surgery and nonviral respiratory-related hospitalizations in children with neurodevelopmental impairment. Int J Pediatr Otorhinolaryngol 2022; 163:111362. [PMID: 36327912 DOI: 10.1016/j.ijporl.2022.111362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/31/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Neurodevelopmentally impaired (NI) children with chronic sialorrhea are at elevated risk for aspiration and respiratory tract infections. Direct resection or ligation ("DROOL") of the submandibular glands (SMG) with parotid duct ligation are surgical interventions intended to decrease salivary output. The objective of this study is to determine the impact of DROOL surgery on the incidence of nonviral respiratory-related (NVR) post-procedure hospital encounters including emergency department visits and admissions. METHODS Retrospective case series of NVR related outcomes after DROOL surgery in children performed at a single institution, tertiary referral center. RESULTS A total of 35 gastrostomy tube-dependent patients (60% male, average age 8.2 [SD 6.0] years) with NI underwent DROOL surgery (86% SMG excision). Pre- and post-surgical follow-up time was 3.6 and 3.2 years, respectively. Presurgical and postsurgical NVR hospital encounters occurred in 28 (80%) and 14 (40%) patients, respectively (p < 0.01). Mean (SD) postoperative NVR hospital encounters occurred less frequently when compared to presurgical period (0.4 [0.6] vs. 1.0 [1.2] per year, p < 0.01) with average change of -0.7 encounters per year (SD 1.4, 95% CI -1.0 to -0.2). Patients with encounters within a year preceding DROOL (OR 4.9, p = 0.04, 95% CI 1.1-22.8), or those with at least 3 preoperative encounters (OR 8.0, p = 0.01, 95% CI 1.6-40.3) were significantly associated with a postsurgical NVR event. Fewer patients used anti-sialorrhea medication postoperatively compared to preoperatively (60% vs. 17%, p < 0.01). No patient developed surgical site complications requiring operative interventions. CONCLUSIONS DROOL surgery for chronic sialorrhea in patients with NI was associated with decreased hospitalization and ED visits for NVR respiratory events post-procedurally. Sialorrhea may be an actionable source of recurrent respiratory illnesses requiring hospitalizations. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Diane W Chen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, IL, USA
| | - Kathleen R Billings
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, IL, USA
| | - Jonathan B Ida
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, IL, USA
| | - Jennifer Lavin
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, IL, USA
| | - Saied Ghadersohi
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, IL, USA
| | - Taher Valika
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, IL, USA.
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3
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Delsing CP, Bekkers S, Erasmus CE, van Hulst K, van den Hoogen FJ. Posterior drooling in children with cerebral palsy and other neurodevelopmental disorders. Dev Med Child Neurol 2021; 63:1093-1098. [PMID: 33844298 DOI: 10.1111/dmcn.14888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 12/14/2022]
Abstract
AIM To evaluate the effect of botulinum neurotoxin A (BoNT-A) injections, submandibular gland excision (SMGE), and bilateral submandibular duct ligation (2DL) for the control of posterior drooling in children with neurological impairment. METHOD In a retrospective cohort, children with neurological impairment (e.g. cerebral palsy) treated between 2000 and 2016 were identified. Mean age at time of surgery was 9 years (range 1-21y). The primary outcome was posterior drooling severity by a visual analogue scale (VAS; 0-10) at baseline, 8-weeks, and 32-weeks follow-up. The secondary outcome was lower respiratory tract infections during the follow-up period. RESULTS Ninety-two patients (out of 475; 47 males, 45 females) were identified. They were undergoing three different treatments: BoNT-A (n=63), SMGE (n=16), and 2DL (n=13). A significant reduction in VAS over time was observed in the total group of 92 patients. After SMGE, VAS decreased significantly from 6.82 (SD 3.40) at baseline to 2.29 (SD 1.93) at 8 weeks, and 2.17 (SD 2.58) at 32 weeks (F[2.34]=11.618, p<0.001). There was no significant decrease after both BoNT-A and 2-DL. INTERPRETATION Posterior drooling is an unfamiliar, potentially life-threatening condition that is treatable with medication, BoNT-A injections, or surgery. Although all treatments reduced signs and symptoms of posterior drooling, there is a greater effect after SMGE compared to BoNT-A and 2-DL. What this paper adds Submandibular gland excision has better results for posterior drooling than botulinum toxin A or submandibular duct ligation.
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Affiliation(s)
- Corinne Pa Delsing
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Stijn Bekkers
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Corrie E Erasmus
- Department of Pediatric Neurology, Donders Institute for Medical Neurosciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Karen van Hulst
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Frank Ja van den Hoogen
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
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Gibson N, Blackmore AM, Chang AB, Cooper MS, Jaffe A, Kong W, Langdon K, Moshovis L, Pavleski K, Wilson AC. Prevention and management of respiratory disease in young people with cerebral palsy: consensus statement. Dev Med Child Neurol 2021; 63:172-182. [PMID: 32803795 PMCID: PMC7818421 DOI: 10.1111/dmcn.14640] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 01/31/2023]
Abstract
Respiratory illness is the leading cause of mortality in children with cerebral palsy (CP). Although risk factors for developing chronic respiratory illness have been identified, comprehensive clinical care recommendations for the prevention and management of respiratory illness do not currently exist. We invited over 200 clinicians and researchers from multiple disciplines with expertise in the management of respiratory illness in children with CP to develop care recommendations using a modified Delphi method on the basis of the RAND Corporation-University of California Los Angeles Appropriateness Method. These recommendations are intended for use by the wide range of practitioners who care for individuals living with CP. They provide a framework for recognizing multifactorial primary and secondary potentially modifiable risk factors and for providing coordinated multidisciplinary care. We describe the methods used to generate the consensus recommendations, and the overall perspective on assessment, prevention, and treatment of respiratory illness in children with CP. WHAT THIS PAPER ADDS: The first consensus statement for preventing and managing respiratory disease in cerebral palsy (CP). Risk factors for respiratory disease in CP should be identified early. Individuals with CP at risk of respiratory disease require regular assessment of risk factors. Effective partnerships between multidisciplinary teams, individuals with CP, and families are essential. Treatment of respiratory disease in individuals with CP must be proactive.
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Affiliation(s)
- Noula Gibson
- PhysiotherapyPerth Children’s HospitalNedlandsWAAustralia
- Research, Ability CentreMount LawleyWAAustralia
| | | | - Anne B Chang
- Department of Respiratory and Sleep MedicineQueensland Children’s HospitalQueensland University of TechnologyBrisbaneQLDAustralia
| | - Monica S Cooper
- Department of Neurodevelopment and DisabilityThe Royal Children’s HospitalMelbourneVICAustralia
| | - Adam Jaffe
- School of Women’s and Children’s HealthUNSW MedicineUNSWSydneyNSWAustralia
| | - Wee‐Ren Kong
- Department of PhysiotherapyWomen’s and Children’s HospitalAdelaideSAAustralia
| | - Katherine Langdon
- Paediatric RehabilitationPerth Children’s HospitalNedlandsWAAustralia
| | - Lisa Moshovis
- Therapy and Health ServicesAbility CentreMount LawleyWAAustralia
| | | | - Andrew C Wilson
- Respiratory MedicinePerth Children’s HospitalNedlandsWAAustralia
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5
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Gubbay A, Marie Blackmore A. Effects of salivary gland botulinum Toxin-A on drooling and respiratory morbidity in children with neurological dysfunction. Int J Pediatr Otorhinolaryngol 2019; 124:124-128. [PMID: 31185343 DOI: 10.1016/j.ijporl.2019.05.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the effects of salivary gland Botulinum Toxin-A (SG BoNT-A) on children with drooling due to neurological dysfunction. METHODS This was a 3½-year prospective observational case series design of children referred for SG BoNT-A injections at a pediatric hospital (2010-2014). Outcomes were parent-reported severity, frequency, impact of drooling, and respiratory morbidity; and, from hospital records, number of respiratory hospital admissions. RESULTS Out of 17 children treated, complete data were available for 15 (including 8 boys) aged 3-14 years (Mean = 9.9 years; SD = 3.4), with a combined total of 71 injections. Most had cerebral palsy (n = 11), classified as Level V (n = 10) or IV (n = 1) on the Gross Motor Function Classification Scale (GMFCS). In almost all instances, parents reported reductions in severity, frequency, and impact of drooling, and parent-reported respiratory morbidity. Among those with posterior drooling (n = 12), most children (n = 10) did not have advanced respiratory disease. A trend towards reduced respiratory-related hospital admissions was observed during SG BoNT-A treatment periods. CONCLUSION SG BoNT-A can improve severity, frequency, and impact of drooling. It can also reduce respiratory-related hospital admissions in children with posterior drooling without advanced respiratory disease. For children with advanced respiratory disease, it may reduce severity and impact of drooling.
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Affiliation(s)
- Anna Gubbay
- Paediatric Rehabilitation, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia.
| | - A Marie Blackmore
- Research and Development, Ability Centre, Mount Lawley, Western Australia, Australia
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6
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Blackmore AM, Gibson N, Cooper MS, Langdon K, Moshovis L, Wilson AC. Interventions for management of respiratory disease in young people with cerebral palsy: A systematic review. Child Care Health Dev 2019; 45:754-771. [PMID: 31276598 DOI: 10.1111/cch.12703] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/30/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Respiratory disease is a leading cause of hospitalizations and deaths in young people with cerebral palsy (CP). It is insidious and multifactorial. Clinical management can be complex. This systematic review describes effects of interventions for the prevention and management of respiratory disease in young people with CP. METHODS Nine databases (Cochrane, CINAHL, Embase, EMCare, MEDLINE, PEDro, OpenGrey, ScienceDirect, and SpeechBITE) were searched. Eligibility criteria were as follows: the population included at least 50% individuals with CP aged under 26 years, the intervention was for chronic respiratory illness, the outcomes were any measurable indicators of respiratory health or morbidity; the study design could be any original study reporting effects of an intervention on measurable outcomes, and the study was published January 1998 or later. The American Academy for Cerebral Palsy and Developmental Medicine methodology guided study appraisal and synthesis. The review was registered with PROSPERO (reference number CRD42018086314). RESULTS The search yielded 3,347 papers; 37 papers (reporting 34 studies) of these met the eligibility criteria. They included 582 participants with CP (ranging from 1 to 77 across studies) with ages from 5 months to 25 years. Interventions were diverse and included: airway clearance techniques, exercise, positioning, mealtime management, salivary management, upper airway interventions, antibiotics, gastro-intestinal interventions, and spinal surgery. There were no interventions aimed at prevention of respiratory disease in this population. Research designs were classified as Levels 2 (n = 3), 3 (n = 2), 4 (n = 25), and 5 (n = 4). CONCLUSIONS Evidence for most respiratory interventions for young people with CP is absent or weak. No controlled trials demonstrated significant effects on respiratory morbidity, owing to their scarcity, weak designs, and inadequate power. There is an urgent need for well-designed prospective controlled studies investigating prevention and management of respiratory disease in young people with CP.
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Affiliation(s)
| | - Noula Gibson
- Research, Ability Centre, Perth, Western Australia, Australia
| | - Monica S Cooper
- Department of Neurodevelopment & Disability, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Katherine Langdon
- Paediatric Rehabilitation Medicine, Paediatric Rehabilitation, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Lisa Moshovis
- Mealtime Service, Ability Centre, Perth, Western Australia, Australia
| | - Andrew C Wilson
- Department, Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
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Boel L, Pernet K, Toussaint M, Ides K, Leemans G, Haan J, Van Hoorenbeeck K, Verhulst S. Respiratory morbidity in children with cerebral palsy: an overview. Dev Med Child Neurol 2019; 61:646-653. [PMID: 30320434 DOI: 10.1111/dmcn.14060] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2018] [Indexed: 12/15/2022]
Abstract
Respiratory problems have a significant impact on morbidity and mortality in patients with cerebral palsy (CP). In particular, recurrent aspiration, impaired airway clearance, spinal and thoracic deformity, impaired lung function, poor nutritional status, and recurrent respiratory infections negatively affect respiratory status. Bronchopulmonary dysplasia may contribute to pulmonary problems, but asthma is not more common in CP than in the general population. We discuss treatment options for each of these factors. Multiple coexisting and interacting factors that influence the respiratory status of patients with CP should be recognized and effectively addressed to reduce respiratory morbidity and mortality. WHAT THIS PAPER ADDS: Respiratory problems are a significant cause of morbidity in patients with cerebral palsy (CP). Respiratory status in patients with CP is influenced by recurrent aspiration and impaired airway clearance. Spinal and thoracic deformity, impaired lung function, poor nutrition, and respiratory infections also negatively affect respiratory status. These factors should all be addressed to reduce respiratory problems in patients with CP.
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Affiliation(s)
- Lieve Boel
- Department of Paediatric Pulmonology, Antwerp University Hospital, Antwerp, Belgium
| | - Kurt Pernet
- Neuromuscular Reference Centre and Centre for Home Mechanical Ventilation, Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
| | - Michel Toussaint
- Neuromuscular Reference Centre and Centre for Home Mechanical Ventilation, Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
| | - Kris Ides
- Department of Pulmonology, Antwerp University Hospital, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Glenn Leemans
- Department of Pulmonology, Antwerp University Hospital, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Jurn Haan
- Neuromuscular Reference Centre and Centre for Home Mechanical Ventilation, Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
| | - Kim Van Hoorenbeeck
- Department of Paediatric Pulmonology, Antwerp University Hospital, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
| | - Stijn Verhulst
- Department of Paediatric Pulmonology, Antwerp University Hospital, Antwerp, Belgium.,Neuromuscular Reference Centre and Centre for Home Mechanical Ventilation, Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
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8
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Is necrotizing sialometaplasia an oncological problem? INT J PEDIAT OTO CAS 2018. [DOI: 10.1016/j.pedeo.2018.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Dias BLS, Fernandes AR, Maia Filho HDS. Sialorrhea in children with cerebral palsy. J Pediatr (Rio J) 2016; 92:549-558. [PMID: 27281791 DOI: 10.1016/j.jped.2016.03.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 03/07/2016] [Accepted: 03/09/2016] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To review the literature on sialorrhea in children with cerebral palsy. SOURCE OF DATA Non-systematic review using the keywords "sialorrhea" and "child" carried out in the PubMed®, LILACS®, and SciELO® databases during July 2015. A total of 458 articles were obtained, of which 158 were analyzed as they were associated with sialorrhea in children; 70 had content related to sialorrhea in cerebral palsy or the assessment and treatment of sialorrhea in other neurological disorders, which were also assessed. DATA SYNTHESIS The prevalence of sialorrhea is between 10% and 58% in cerebral palsy and has clinical and social consequences. It is caused by oral motor dysfunction, dysphagia, and intraoral sensitivity disorder. The severity and impact of sialorrhea are assessed through objective or subjective methods. Several types of therapeutic management are described: training of sensory awareness and oral motor skills, drug therapy, botulinum toxin injection, and surgical treatment. CONCLUSIONS The most effective treatment that addresses the cause of sialorrhea in children with cerebral palsy is training of sensory awareness and oral motor skills, performed by a speech therapist. Botulinum toxin injection and the use of anticholinergics have a transient effect and are adjuvant to speech therapy; they should be considered in cases of moderate to severe sialorrhea or respiratory complications. Atropine sulfate is inexpensive and appears to have good clinical response combined with good safety profile. The use of trihexyphenidyl for the treatment of sialorrhea can be considered in dyskinetic forms of cerebral palsy or in selected cases.
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Affiliation(s)
| | | | - Heber de Souza Maia Filho
- Universidade Federal Fluminense (UFF), Programa de Mestrado Profissional em Saúde Materno-Infantil, Niterói, RJ, Brazil
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Scofano Dias BL, Fernandes AR, Maia Filho HDS. Sialorrhea in children with cerebral palsy. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2016. [DOI: 10.1016/j.jpedp.2016.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Noonan K, Prunty S, Ha JF, Vijayasekaran S. Surgical management of chronic salivary aspiration. Int J Pediatr Otorhinolaryngol 2014; 78:2079-82. [PMID: 25277057 DOI: 10.1016/j.ijporl.2014.09.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 08/30/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022]
Abstract
AIM OF THE STUDY Sialorrhoea and chronic salivary aspiration are a major problem in many neurologically impaired children causing embarrassment, skin issues and recurrent lower respiratory tract infections (LRTI). The aim of this study was to assess the efficacy of salivary gland surgery in the treatment of chronic salivary aspiration in such children. OBJECTIVES To compare admission rates for LRTI per annum before and after surgical intervention. METHODS Retrospective review of all patients who underwent salivary management surgery for chronic aspiration under Princess Margaret Hospital's (PMH) Otolaryngology department from 2006 until 2013. RESULTS Twelve patients were included in this review. Their ages ranged from 3 to 21 years (mean=11.4). Their genders were equally distributed. Two patients had underlying congenital disorders; one had an acquired brain injury, while the majority (n=9, 75%) had cerebral palsy secondary to a sustained perinatal injury. Most patients (n=11, 91.7%) had bilateral submandibular gland excision and parotid duct ligation as a primary procedure. One patient had a laryngotracheal separation. Two patients went on to have a second procedure. The mean follow up time was five years. Using Wilcoxon Signed-Rank test we showed that the median rate of admission per annum for LRTI pre-operatively was 1.0. This was reduced to 0.5 post-operatively, which was statistically significant (p≤0.05). CONCLUSIONS We hypothesize that the combination of bilateral submandibular gland excision and bilateral parotid duct ligation is effective in reducing admissions with aspiration pneumonia in neurologically impaired children, and therefore improves the quality of life in these patients.
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Affiliation(s)
- Katharine Noonan
- Department of Otolaryngology, Head & Neck Surgery, Princess Margaret Hospital for Children, Roberts Road, Subiaco 6008, Western Australia, Australia
| | - Sarah Prunty
- Department of Otolaryngology, Head & Neck Surgery, Princess Margaret Hospital for Children, Roberts Road, Subiaco 6008, Western Australia, Australia.
| | - Jennifer F Ha
- Department of Otolaryngology, Head & Neck Surgery, Princess Margaret Hospital for Children, Roberts Road, Subiaco 6008, Western Australia, Australia; Department of Otolaryngology, Head & Neck Surgery, School of Surgery, University of Western Australia, Australia
| | - Shyan Vijayasekaran
- Department of Otolaryngology, Head & Neck Surgery, Princess Margaret Hospital for Children, Roberts Road, Subiaco 6008, Western Australia, Australia; Department of Otolaryngology, Head & Neck Surgery, School of Surgery, University of Western Australia, Australia
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12
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Wallis C, Ryan M. Assessing the Role of Aspiration in Pediatric Lung Disease. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2012. [DOI: 10.1089/ped.2012.0148] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Colin Wallis
- Respiratory Unit, Great Ormond Street Hospital and the Institute of Child Health, London, United Kingdom
| | - Martina Ryan
- Speech and Language Therapy Department, Great Ormond Street Hospital, London, United Kingdom
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Abstract
Palliative care has always been a part of the care of children. It includes any intervention that focuses on relieving suffering, slowing the progression of disease, and improving quality of life at any stage of disease. In addition, for even the child with the most unpredictable disease, there are predictable times in this child's life when the child, family, and care team will be suffering in ways that can be mitigated by specific interventions. Rather than defining pediatric palliative care in terms of a patient base, severity of disease, or even a general philosophy of care, palliative care can best be understood as a specific set of tasks directed at mitigating suffering. By understanding these tasks; learning to identify predictable times and settings of suffering; and learning to collaborate with multidisciplinary specialists, use communication skills, and identify clinical resources, the pediatrician can more effectively support children with life-threatening illnesses and their families. In this article, we define palliative care as a focus of care integrated in all phases of life and as a set of interventions aimed at easing suffering associated with life-threatening conditions. We detail an approach to these interventions and discuss how they can be implemented by the pediatrician with the support of specialists in hospice and palliative medicine. We discuss common and predictable times of suffering when these interventions become effective ways to treat suffering and improve quality of life. Finally, we discuss those situations that pediatricians most commonly and intensely interface with palliative care-the care of the child with complex, chronic conditions and severe neurologic impairment (SNI).
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Affiliation(s)
- Jeffrey C Klick
- The University of Pennsylvania School of Medicine, Pediatric Hospice and Palliative Medicine, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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14
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Abstract
BACKGROUND Drooling is a common dysfunction in children with cerebral palsy and may also affect neurologically unimpaired children. It causes significant social handicap to both children and their families. METHODS The data in this article are supported by a Medline search (November 2008) utilising the keywords drooling, sialorrhea, botulinum toxin, salivary duct ligation and also by the use of the personal bibliographies of the senior authors. RESULTS The majority of the published literature for drooling is of level III/IV evidence. CONCLUSION Multiple therapeutic interventions are available for paediatric drooling. These are most appropriately introduced in a stepwise progression from behaviour therapy, to pharmacotherapy to surgical procedures.
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Affiliation(s)
- S A Little
- Department of Otolaryngology, Ninewells Hospital & Tayside Children's Hospital, Dundee, UK
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15
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Manrique D, Sato J. Salivary gland surgery for control of chronic pulmonary aspiration in children with cerebral palsy. Int J Pediatr Otorhinolaryngol 2009; 73:1192-4. [PMID: 19535155 DOI: 10.1016/j.ijporl.2009.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 05/02/2009] [Accepted: 05/05/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the outcome of surgical saliva reduction to decrease pulmonary aspiration in children with cerebral palsy and its repercussions in respiratory infection control. METHODS Twenty-nine children with neurological impairment and diagnosis of chronic pulmonary aspiration were submitted to bilateral submandibular gland excision and bilateral parotid duct ligation at the Association for the Welfare of Physically Handicapped Children, from December 2001 to December 2004. Postoperative frequency of lower respiratory tract infection, hospitalization rate due to pulmonary infection and airway secretion level after the surgery were compared to preoperative period. RESULTS Twenty-nine children with cerebral palsy aged 18 months to 9 years were submitted to submandibular glands excision and parotid ducts ligation. All children had gastrostomy and no oral intake. There were no major complications; two children had reopening of one parotid duct. Frequency of lower respiratory tract infections, rate of hospitalization for treatment of pulmonary infections and level of airway secretion were statistically reduced. Preoperative mean rate of lower respiratory tract infection was 6.9/year; in postoperative period, rate was 2.4/year (p<0.001). Pneumonia hospitalization mean rate was 63.4 days/year preoperatively and 17.5 days/year postoperatively (p<0.001). There was also a significant improvement in the need for suctioning of upper airway secretion (mean 11 times/day in preoperative period and 3.1 times/day in the postoperative period; p<0.001). CONCLUSION In children with cerebral palsy, surgical saliva reduction by submandibular glands excision and parotid ducts ligation is an effective and safe technique for frequency reduction of lower respiratory tract infection and level of airway secretion.
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Affiliation(s)
- Dayse Manrique
- Association for the Welfare of Physically Handicapped Children, Federal University of São Paulo, Av. Prof. Ascendino Reis 724, Ibirapuera, São Paulo (SP), Brazil.
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16
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Hauer JM. Respiratory Symptom Management in a Child with Severe Neurologic Impairment. J Palliat Med 2007; 10:1201-7. [DOI: 10.1089/jpm.2007.9907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Julie M. Hauer
- Department of Pediatrics, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN 55414. E-mail:
- Gillette Children's Specialty Healthcare, St. Paul, Minnesota
- Children's Hospital Boston, Palliative Care Fellow, Boston, Massachusetts
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