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Orriëns LB, van Aarle LGJM, Erasmus CE, van Hulst K, van der Burg JJW. Social and emotional impact of anterior drooling in school-age children and young people with neurodevelopmental disabilities. Eur J Pediatr 2024; 183:4491-4498. [PMID: 39145887 DOI: 10.1007/s00431-024-05714-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 07/30/2024] [Accepted: 08/02/2024] [Indexed: 08/16/2024]
Abstract
PURPOSE Anterior drooling is a common comorbidity in children and young people (CYP) with neurodevelopmental disabilities. This study aimed to assess the social and emotional impact of drooling in CYP with a developmental age (DA) of 6 years and older, in whom this impact may differ from those with a lower DA due to their developing sense of self and awareness of their position within social groups. METHODS Questionnaire data collected for routine clinical care were used to assess parental perceptions of the impact of drooling on (1) social interaction; (2) satisfaction with social interaction, appearance, family relations and life in general and (3) the way CYP expressed feelings on appearance, acceptance by peers and acceptance by adults. Fisher's exact tests and Mann-Whitney U tests were applied to identify associations between clinical characteristics and the social and emotional impact of drooling. RESULTS Seventy-nine CYP with an estimated DA ≥ 6 years were included. The majority experienced frequent to constant (83%) and profuse (61%) drooling. Drooling frequently compromised social interaction with peers (49%) and adults (28%), and cognitive abilities were underestimated in 40%. Dissatisfaction with physical appearance (25%) related to drooling was noted. One-fifth of CYP reportedly expressed negative feelings on acceptance by peers related to drooling. CONCLUSIONS These findings underscore the substantial impact of drooling on CYP with a DA of 6 years and older, primarily through avoidance by peers and underestimated cognitive abilities, emphasizing that recognizing and addressing these social-emotional consequences should be integral to clinical care. WHAT IS KNOWN • Anterior drooling is common among children and youth with neurodevelopmental disabilities. WHAT IS NEW • There seems to be a heightened prevalence of impaired social interaction with peers and underestimation of cognitive abilities due to drooling among children with a developmental age of at least 6 years compared to previous studies with more heterogeneous populations. • The impact of drooling can extend to domains that affect self-esteem, although this may not be fully captured with standardized questions, requiring clinicians to address these consequences in a way that is tailored to the child's experiences.
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Affiliation(s)
- Lynn B Orriëns
- Department of Paediatric Neurology, Division of Paediatrics, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, the Netherlands.
| | | | - Corrie E Erasmus
- Department of Paediatric Neurology, Division of Paediatrics, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, the Netherlands
| | - Karen van Hulst
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Jan J W van der Burg
- School of Pedagogical and Educational Science, Radboud University Nijmegen, Nijmegen, the Netherlands
- Department of Paediatric Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands
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2
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Saniasiaya J, van der Meer G, Toll EC. Outcome of kinesio taping in drooling children: A systematic review. Int J Pediatr Otorhinolaryngol 2024; 184:112057. [PMID: 39121685 DOI: 10.1016/j.ijporl.2024.112057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/14/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION Drooling is a troublesome condition, especially in children with neuromuscular and intellectual disability. Over the past decade, novel interventions have been trialled to alleviate drooling in the affected children. Kinesio tape (KT) application has shown promising results in controlling drooling in children. We reviewed the literature to determine the outcome of KT application in drooling children. METHODS A literature search was conducted from January 1, 1990 to March 2024 by searching several databases over a 1-month period (April 2024) according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome was defined as the success of the intervention determined by the improvement or resolution of symptoms, and the secondary outcome was determined by adjunct or repeated procedures and the presence of complications. RESULTS Overall, 172 children from 10 studies were identified. All studies included are retrospective studies (Level III). This review included 172 children, with a mean age of 8.2 years (Male: 58.7 %). All included children had underlying comorbidities (100 %), with neurological disorders (77 %) being the most prevalent. KT application was performed predominantly over the orbicularis oris in 6 studies, 118 children[68.6 %], suprahyoid region in 3 studies, 45 children (26.2 %) and multiregion over the head and neck in 1 study of children (5.2 %). Drooling was assessed subjectively in all 100 % of children with objective measurement performed in 3 studies. KT was the only intervention in 40.7 % of the included children, whereas KT was performed in combination with oromotor therapy in 48 children, speech therapy in 44 children, and manipulation therapy in 10 children. All included children (100 %) reported improvement in drooling. No studies reported adverse reactions to KT application. CONCLUSIONS KT application is a safe, effective alternative for drooling children. The effect of KT, however, may be temporary. The quality of the evidence is inadequate to recommend widespread use of the intervention until a better-quality study has been completed. Future randomised controlled studies with a large sample size are warranted to determine the efficacy of this intervention among children.
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Affiliation(s)
- Jeyasakthy Saniasiaya
- Department of Otorhinolaryngology, Starship Children Hospital, Te Whatu Ora Te Toka Tumai Auckland, New Zealand; Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Malaysia.
| | - Graeme van der Meer
- Department of Otorhinolaryngology, Starship Children Hospital, Te Whatu Ora Te Toka Tumai Auckland, New Zealand
| | - Ed C Toll
- Department of Otorhinolaryngology, Starship Children Hospital, Te Whatu Ora Te Toka Tumai Auckland, New Zealand
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Sarvas E, Webb J, Landrigan-Ossar M, Yin L. Oral Health Care for Children and Youth With Developmental Disabilities: Clinical Report. Pediatrics 2024; 154:e2024067603. [PMID: 39034828 DOI: 10.1542/peds.2024-067603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 07/23/2024] Open
Abstract
Oral health is an essential component of overall health for all individuals. The oral health of children and youth with developmental disabilities (CYDD) involves unique characteristics and needs of which pediatricians and pediatric clinicians can be aware. Risk for oral disease in CYDD is multifactorial and includes underlying medical conditions, medications, and ability to participate in preventive oral health care and treatment, and lack of access to providers is common for this population despite being eligible for Medicaid. Pediatric clinicians are uniquely positioned to support the oral health needs of CYDD and their families through the medical home. This clinical report aims to inform pediatric clinicians about the unique oral health needs of CYDD. It provides guidance on assessing caries risk and periodontal status using structured screening instruments; understanding dental trauma, the role of diet and caries risk, trauma prevention, and malocclusion; and providing anticipatory guidance on oral hygiene that includes tooth brushing, use of fluoridated toothpaste, assessing community water fluoridation, advocating for a dental home by 1 year of age, and transition to adult dental care as part of adolescent health care. It also highlights special considerations for dental treatment rendered under sedation or general anesthesia that CYDD may need. Pediatric clinicians can help reduce risk of CYDD developing dental disease by understanding the unique needs of their patients and their barriers to accessing oral health care in their community, communicating with the child's dental home, and advocating for safe and accessible dental procedures.
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Affiliation(s)
| | | | | | - Larry Yin
- Associate Professor of Clinical Pediatrics, Keck School of Medicine of USC and Children's Hospital Los Angeles, Los Angeles, California
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Wang JJ, Shao MM, Zhou XZ, Lin ZC, Li HY, Yuan ZZ, Ma QQ, Li F, Fu WB. Intraoral Acupuncture for Sialorrhea in Stroke Patients: a Study Protocol for a Randomized Controlled Trial. J Acupunct Meridian Stud 2024; 17:100-109. [PMID: 38898647 DOI: 10.51507/j.jams.2024.17.3.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/27/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Importance Post-stroke sialorrhea (PSS) refers to excessive saliva flowing out the lip border after a stroke. PSS negatively affects patient self-image and social communication and may lead to depression. Limited evidence supports the link between excessive salivation and PSS. No large-scale, strictly controlled randomized controlled trials have shown the effectiveness of acupuncture in treating PSS patients. Objective We aim to compare the effects of intraoral and sham acupuncture in PSS patients and explore relationships among salivation and drooling severity and frequency and swallowing function in stroke patients. Design Clinical study protocol, SPIRIT compliant. Setting Prospective, single-center, randomized, and sham-controlled trial. Population We will recruit 106 PSS patients to receive 4-week intraoral or sham acupuncture. Additionally, 53 stroke patients without PSS will undergo a conventional 4-week treatment program to compare salivation between PSS and non-PSS patients. Exposures Intraoral or sham acupuncture. Main Outcomes and Measures The main evaluation index will be the 3-minute saliva weight (3MSW), comparing changes in 3MSW from baseline to weeks 4 and 8. Secondary assessment indices will include the “Drooling Severity and Frequency Scale” and “Functional Oral Intake Scale.” Results The results from this study will be published in peer-reviewed journals. Conclusion Comparing effects of intraoral and sham acupuncture in PSS patients, this study may contribute important evidence for future PSS treatment and provide valuable insights into whether salivation issues in stroke patients are attributed to heightened salivary secretion or dysphagia.
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Affiliation(s)
- Jin-Jin Wang
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Meng-Meng Shao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xue-Zhen Zhou
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zu-Chen Lin
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hai-Yan Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zheng-Zhong Yuan
- Department of TCM, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qin-Qin Ma
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fang Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wen-Bin Fu
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Acupuncture and Moxibustion, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
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Jost WH, Bäumer T, Bevot A, Birkmann U, Buhmann C, Grosheva M, Guntinas-Lichius O, Laskawi R, Paus S, Pflug C, Schroeder AS, Spittau B, Steffen A, Wilken B, Winterholler M, Berweck S. Botulinum neurotoxin type A in the interdisciplinary treatment of sialorrhea in adults and children-update and practice recommendations. Front Neurol 2023; 14:1275807. [PMID: 38162447 PMCID: PMC10757066 DOI: 10.3389/fneur.2023.1275807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024] Open
Abstract
Sialorrhea is defined as a chronic excessive flow of saliva from the mouth, often with adverse consequences for health and quality of life of patients. In addition to currently used non-drug treatment and systemic drugs, intraglandular Botulinum Neurotoxin A (BoNT/A) injections have been examined in case studies, controlled trials and clinical practice. Two pivotal Phase III trials recently led to market approval in the USA and EU for IncobotulinumtoxinA [Xeomin®, IncoBoNT/A, Clostridium botulinum neurotoxin type A (150 kD), free from complexing proteins, Merz Pharmaceuticals GmbH] for treatment of chronic sialorrhea in adults and pediatric patients. This review provides a multidisciplinary approach to discuss the current state of sialorrhea therapy as well as benefits and current limitations of BoNT/A injections. A consensus regarding treatment recommendations made available to physicians in Germany in 2022 has now been updated here for presentation to an international audience. This review provides a framework including a flow chart for patient selection, recommendations for dosing and the injection process, as well as a discussion of therapeutic goals, long-term benefits and safety aspects. This review is aimed at supporting physicians in developing multidisciplinary and individualized treatment approaches to achieve optimal benefits for patients.
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Affiliation(s)
| | - Tobias Bäumer
- Institute of Systemic Motor Science, CBBM, University of Lübeck, Lübeck, Germany
| | - Andrea Bevot
- Department of Neuropediatrics and Developmental Medicine, University Children’s Hospital Tübingen, Tübingen, Germany
| | - Ulrich Birkmann
- Department of Neurology, Schluckambulanz, GFO Clinics Troisdorf, Troisdorf, Germany
| | - Carsten Buhmann
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Grosheva
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | | | - Rainer Laskawi
- Department of Otorhinolaryngology, University Hospital Göttingen, Göttingen, Germany
| | - Sebastian Paus
- Department of Neurology, GFO Clinics Troisdorf, Troisdorf, Germany
| | - Christina Pflug
- Department of Voice, Speech and Hearing Disorders, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - A. Sebastian Schroeder
- Clinic for Child Neurology and Social Pediatrics, Child Center Maulbronn, Maulbronn, Germany
| | - Björn Spittau
- Anatomy and Cell Biology, Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Armin Steffen
- Department for Otorhinolaryngology, University of Lübeck, Lübeck, Germany
| | - Bernd Wilken
- Department of Pediatric Neurology, Klinikum Kassel, Kassel, Germany
| | - Martin Winterholler
- Department of Neurology, Sana Hospital Rummelsberg, Nuremberg/Schwarzenbruck, Germany
| | - Steffen Berweck
- Specialist Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Clinic, Vogtareuth, Germany
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Ishida N, Ono S, Suzuki R, Nojiri K, Ootsuki S, Zakoji N. Comparison of factors associated with drooling between intractable neuromuscular disease and cerebral palsy. J Clin Neurosci 2023; 115:71-76. [PMID: 37499322 DOI: 10.1016/j.jocn.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/17/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
Drooling represents a common and noteworthy symptom in patients with intractable neuromuscular disease (IND) and cerebral palsy (CP) and can lead to poor quality of life (QOL) and higher incidence of death due to aspiration of saliva. Identifying the factors affecting drooling is crucial to improving QOL and improving the poor prognosis of patients with IND and CP. This study sought to assess the prevalence of drooling and to elucidate the associated factors, drugs, and differences between patients with IND and CP. We included hospitalized patients with IND and CP. Among the 269 patients, 69 of 162 patients with IND (42.6%) and 75 of 107 patients with CP (70.1%) exhibited drooling. Drooling in IND was significantly higher in patients with tube feeding and those who had a previous stroke than in patients with potential oral intake and those having no history of stroke. In individuals with CP, drooling was significantly negatively associated with age. Taltirelin in patients with IND had a significant positive association with drooling, and antipsychotics and centrally acting muscle relaxants in those with CP had a significant negative association with drooling. Our results suggest that the factors associated with frequent drooling differ between IND and CP cases, and patients who should be screened for drooling are those with decreased swallowing function, those with IND who have had a previous stroke, and young patients with CP. Moreover, clinicians should consider the impact of drugs on drooling in IND and CP cases.
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Affiliation(s)
- Natsuko Ishida
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University, Ishikawa, Japan.
| | - Shunsuke Ono
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University, Ishikawa, Japan
| | - Ryohei Suzuki
- Department of Pharmacy, National Hospital Organization Higashinagoya National Hospital, Aichi, Japan
| | - Kei Nojiri
- Department of Pharmacy, National Hospital Organization Suzuka National Hospital, Mie, Japan; Department of Pharmacy, National Hospital Organization Shizuoka Medical Center, Shizuoka, Japan
| | - Shinnosuke Ootsuki
- Department of Pharmacy, Hokuriku Brain and Neuromuscular Disease Center, National Hospital Organization Iou National Hospital, Ishikawa, Japan
| | - Nobuyuki Zakoji
- Department of Pharmacy, National Hospital Organization Shizuoka Medical Center, Shizuoka, Japan
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7
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Delsing CPA, Adriaansens C, van Hulst K, Erasmus CE, van den Hoogen FJA. Long-term effects of submandibular gland excision on drooling in children with neurodevelopmental disorders: A cross-sectional study. Int J Pediatr Otorhinolaryngol 2023; 164:111377. [PMID: 36403383 DOI: 10.1016/j.ijporl.2022.111377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/31/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
AIM Submandibular gland excision (SMGE) is suitable for the management of drooling in patients with non-progressive neurodisabilities. We aimed to investigate the long-term effects of SMGE. METHOD Patients who had SMGE between 2007 and 2018 were included. Main outcomes were a Visual Analogue Scale (VAS), Drooling Severity (DS), and Drooling Frequency (DF) collected at baseline, 8 weeks, 32 weeks and with a median of 313 weeks after SMGE (long-term). Secondary outcomes were satisfaction with the procedure, Drooling Quotient (DQ) and adverse events (AEs). RESULTS We included thirty-five patients in the long-term analysis with a mean age of 14.5 years. A baseline VAS score of 80.4 was found, which improved on the long-term (mean difference -21.8, t(26) = 4.636, p < 0.0005)). DS and DF decreased significantly at the long-term compared to baseline (Z = -4.361, p < 0.0001 for DS, Z = -3.065, p = 0.002 for DF). Twenty-three out of 35 (66%) patients would recommend the procedure to peers. INTERPRETATION This study indicates a long-term stable effect on drooling after SMGE in patients with anterior drooling. Recurrence of drooling occurs due to unknown reasons, nevertheless most caregivers and/or patients are still satisfied and would recommend the procedure to others.
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Affiliation(s)
- Corinne P A Delsing
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Philips Van Leijdenlaan 15 (route 377), Postbus 9101, Nijmegen, 6500 HB, the Netherlands.
| | - Carleen Adriaansens
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Philips Van Leijdenlaan 15 (route 377), Postbus 9101, Nijmegen, 6500 HB, the Netherlands
| | - Karen van Hulst
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Corrie E Erasmus
- Department of Pediatric Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Philips Van Leijdenlaan 15 (route 377), Postbus 9101, Nijmegen, 6500 HB, the Netherlands
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8
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Jost WH, Bäumer T, Berweck S, Laskawi R, Spittau B, Steffen A, Winterholler M. [Therapy of Sialorrhea with Botulinum Toxin - An Update]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2022; 90:222-232. [PMID: 35453157 DOI: 10.1055/a-1802-3867] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The most important salivary glands are the paired parotid and submandibular glands. Adults produce 1 to 1.5 liters of saliva which are then regularly swallowed. When the act of swallowing is disturbed, salivation occurs. More rarely, the cause can be found in increased saliva production, for example, when caused through medication. Sialorrhea impairs the quality of life substantially and is frequently often socially stigmatizing. Therapy includes conservative measures such as functional dysphagia therapy, oral or transdermal application of anticholinergics, as well as, in selected cases, radiation and surgical measures. Over the last 20 years, local injection of botulinum toxin has been successfully applied in the treatment of this condition. With approval of incobotulinumtoxinA toxin for children and adults, this procedure will become the therapy of choice for chronic sialorrhea. The results of the phase III registration trials have demonstrated high efficacy and good safety of the injection treatment in both children and adults.
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Affiliation(s)
| | - Tobias Bäumer
- Institut für Systemische Motorikforschung, CBBM, Sektion Zentrum für Seltene Erkrankungen, UKSH, Universität zu Lübeck, Lübeck, Germany
| | - Steffen Berweck
- Schön Klinik Vogtareuth, Vogtareuth, Germany.,Dr von Haunersches Kinderspital Kinderklinik und Kinderpoliklinik der Ludwig Maximilian Universitat München, München, Germany
| | - Rainer Laskawi
- Georg-August-Universitat Göttingen HNO-Klinik, Göttingen, Germany
| | - Björn Spittau
- Anatomie und Zellbiologie, Medizinische Fakultät OWL, Universität Bielefeld, Bielefeld, Germany
| | - Armin Steffen
- Universitätsklinikum Schleswig-Holstein Campus Lübeck HNO Klinik, Lübeck, Germany
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Chafin JB, Bayazid L. Pediatric Salivary Gland Disease. Pediatr Clin North Am 2022; 69:363-380. [PMID: 35337545 DOI: 10.1016/j.pcl.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Salivary gland disease in the pediatric population is rare, yet it encompasses a wide spectrum of disease. It is estimated that 4.3% of salivary gland disease occurs in the pediatric population, with most classified as nonneoplastic. Further extrapolation reveals that 5% of salivary gland neoplastic diseases occur in patients younger than 20 years. Moreover, salivary gland tumors represent 1% of all head and neck tumors across all ages. Regardless, clinicians across all fields should be familiar with the workup of various pediatric salivary gland diseases and appropriate referral to a pediatric otolaryngologist.
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Affiliation(s)
- James Brett Chafin
- Department of Pediatric Otolaryngology-Head & Neck Surgery, Nemours Children's Health System, 807 Childrens Way 4th Floor, Jacksonville, FL 32207, USA.
| | - Leith Bayazid
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida College of Medicine, 12901 Bruce B. Downs Boulevard, MDC 73, Tampa, FL 33612, USA
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10
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Sforza E, Onesimo R, Leoni C, Giorgio V, Proli F, Notaro F, Kuczynska EM, Cerchiari A, Selicorni A, Rigante D, Zampino G. Drooling outcome measures in paediatric disability: a systematic review. Eur J Pediatr 2022; 181:2575-2592. [PMID: 35441248 PMCID: PMC9192436 DOI: 10.1007/s00431-022-04460-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 11/28/2022]
Abstract
Drooling, or sialorrhea, is a common condition in patients with cerebral palsy, rare diseases, and neurodevelopmental disorders. The goal of this review was to identify the different properties of sialorrhea outcome measures in children. Four databases were analysed in search of sialorrhea measurement tools, and the review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. The COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist was used for quality appraisal of the outcome measures. The initial search yielded 891 articles, 430 of which were duplicates. Thus, 461 full-text articles were evaluated. Among these, 21 met the inclusion criteria, reporting 19 different outcome measures that encompassed both quantitative measures and parent/proxy questionnaires. Conclusions: Among the outcome measures found through this review, the 5-min Drooling Quotient can objectively discriminate sialorrhea frequency in patients with developmental disabilities. The Drooling Impact Scale can be used to evaluate changes after treatment. The modified drooling questionnaire can measure sialorrhea severity and its social acceptability. To date, the tests proposed in this review are the only tools displaying adequate measurement properties. The acquisition of new data about reliability, validity, and responsiveness of these tests will confirm our findings. What is Known: • Although sialorrhea is a recognized problem in children with disabilities, especially those with cerebral palsy (CP), there is a lack of confidence among physicians in measuring sialorrhea. What is New: • Few sialorrhea measures are available for clinicians that may guide decision-making and at the same time have strong evidence to provide confidence in the results. • A combination of both quantitative measures and parent/proxy questionnaires might provide an adequate measurement of sialorrhea in children.
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Affiliation(s)
- E. Sforza
- Department of Pediatrics, Faculty of Medicine and Surgery, Catholic University of Rome, Rome, Italy
| | - R. Onesimo
- Centre for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - C. Leoni
- Centre for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - V. Giorgio
- Centre for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - F. Proli
- Centre for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - F. Notaro
- Centre for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - E. M. Kuczynska
- Centre for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - A. Cerchiari
- Feeding and Swallowing Services Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - A. Selicorni
- Department of Paediatrics, ASST Lariana, Presidio S. Fermo, Como, Italy
| | - D. Rigante
- Centre for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy ,Department of Pediatrics, Faculty of Medicine and Surgery, Catholic University of Rome, Rome, Italy
| | - G. Zampino
- Centre for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy ,Department of Pediatrics, Faculty of Medicine and Surgery, Catholic University of Rome, Rome, Italy
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11
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Bekkers S, Pruijn IMJ, van der Burg JJW, van Hulst K, Kok SE, Delsing CP, Scheffer ART, van den Hoogen FJA. Surgery versus botulinum neurotoxin A to reduce drooling and improve daily life for children with neurodevelopmental disabilities: a randomized controlled trial. Dev Med Child Neurol 2021; 63:1351-1359. [PMID: 33997959 PMCID: PMC8597158 DOI: 10.1111/dmcn.14924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/28/2022]
Abstract
AIM To compare the effect of bilateral submandibular duct ligation and botulinum neurotoxin A (BoNT-A) on drooling severity and its impact on daily life and care in children and adolescents with moderate-to-severe drooling. METHOD This was a randomized, interventional, controlled trial in which 53 children and adolescents (31 males, 22 females, mean age 11y, range 8-22y, SD 2y 10mo) with cerebral palsy (58.5%) or other non-progressive developmental disorders (41.5%) were randomized to BoNT-A (n=26) or bilateral submandibular duct ligation (n=27). A parent questionnaire on the severity of drooling in specific positions and daily activities and the impact of drooling on daily life and care was filled out at baseline and 8 and 32 weeks posttreatment. RESULTS Both BoNT-A and bilateral submandibular duct ligation had a positive effect on daily care, damage to electronic equipment and/or furniture, social interactions, and self-esteem. However, bilateral submandibular duct ligation had a significant greater and longer-lasting short- (8wks) and medium-term (32wks) effect on daily care, reducing damage to electronic devices, and improving social interactions and satisfaction with life in general. INTERPRETATION This randomized controlled trial confirms reduced drooling by both BoNT-A and bilateral submandibular duct ligation, but provides new evidence on improved well-being through a reduction in drooling. Even though there is a greater risk of complications and morbidity after bilateral submandibular duct ligation, compared to BoNT-A there was a significantly greater and longer-lasting positive effect on most outcomes. What this paper adds Bilateral botulinum neurotoxin A (BoNT-A) and submandibular duct ligation had a positive effect on the well-being of individuals with moderate-to-severe drooling. Bilateral submandibular duct ligation had a greater effect on the impact of drooling during daily care than BoNT-A. Bilateral submandibular duct ligation reduced damage to electronic devices and improved social interactions and satisfaction with life.
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Affiliation(s)
- Stijn Bekkers
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Ineke M J Pruijn
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Jan J W van der Burg
- Department of Pediatric RehabilitationSint MaartenskliniekNijmegenthe Netherlands,School of Pedagogical and Educational ScienceRadboud UniversityNijmegenthe Netherlands
| | - Karen van Hulst
- Department of RehabilitationRadboud University Medical CenterDonders Institute for Brain, Cognition and BehaviourNijmegenthe Netherlands
| | - Saskia E Kok
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Corinne P Delsing
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Arthur R T Scheffer
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
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12
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Thangirala A, Zhu H, Lambert EM. Submandibular excision with and without parotid duct ligation for sialorrhoea. Br J Oral Maxillofac Surg 2021; 59:1291-1295. [PMID: 34563353 DOI: 10.1016/j.bjoms.2021.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/23/2021] [Indexed: 11/15/2022]
Abstract
In this case series with retrospective review we compared the outcomes of patients with sialorrhoea who had a submandibular excision (SE) alone and those who had submandibular excision with parotid duct ligation (SE + PL) between 2012 and 2018. Primary endpoints of complication rates and caregivers' perceptions of success were collected. A total of 41 submandibular excisions were performed for sialorrhoea (26 patients underwent SE, while 15 underwent SE + PL). Significant differences in the groups existed at baseline with patients in the SE plus PL group being more likely to have a tracheostomy (p = 0.015), to use sublingual atropine (p = 0.038) and respiratory medications (albuterol p = 0.0075, gentamicin p = 0.018), to have more pneumonias six months prior to the procedure (p < 0.001), and more hospitalisations six months prior to the procedure (p = 0.046). More postoperative surgical site complications were associated with ligation (p = 0.012). There was no difference in systemic infection (p = 0.25), and no difference in caregivers' perceptions of success in reducing sialorrhoea (18/24 SE compared with 10/14 SE + PL, p = 1.00). There were more surgical site complications in those undergoing SE plus PL than in those who had SE alone. Given this data, parotid duct ligation may not yield additional benefit when combined with submandibular excision.
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Affiliation(s)
- A Thangirala
- Department of Medicine, New York University, New York, NY, 10016
| | - H Zhu
- Department of Otolaryngology, Texas Children's Hospital, 6701 Fannin St, Houston, TX 77030
| | - E M Lambert
- Department of Otolaryngology, Texas Children's Hospital, 6701 Fannin St, Houston, TX 77030.
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13
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Steffen A, Rohrbach-Volland S. [Functional Hypersalivation in children and adults - therapy under consideration of recent guideline]. Laryngorhinootologie 2021; 100:402-412. [PMID: 33915594 DOI: 10.1055/a-1355-7642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A functional hypersalivation reduces patient's quality of life by the need of repeated changes of cloths, skin damage around the mouth and reduced personal contacts. The indication to treat hypersalivation is justified furthermore when respiratory infections by saliva aspiration occur. Transnasal swallowing endoscopy allows to evaluate sufficiently dysphagia with limited risks. With this method therapy options can be judged for effectiveness. There are other additional radiologic assessments to complete diagnostic. Swallowing therapy should be initiated as first-line approach for hypersalivation and offers several treatment concepts to overcome the syndrome. Glycopyrrolate bromid received approval for children and adolescents as it reduces saliva flow relevantly with limited risk. Other anticholinergic drugs are restricted in use because of their side effects and off-label-use situation. Ultrasound guided injections of botulinum toxine in salivary glands are an established treatment option since decades. Meanwhile, the evidence for this method has improved, so Incobotulinum toxine is an approved therapy for chronic hypersalivation in adults, whereby new injections are needed about every four months. In the light of effective medical options, surgical approaches such as salivary duct relocation are recommended less often today because of invasiveness and failure. Radiotherapy is reserved mainly for neurodegenerative diseases and shows good response, but the cancer induction risks need to be discussed. A close follow-up regime is necessary to establish compliance not only by the patient, but also by his family and caregivers. By this, treatment effects can be optimized and therapies can be adjusted individually.
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14
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Varley LP, Gooney M, Denieffe S, Murphy A. Sialorrhoea Management Practices in Residential Older Adults Care Settings: A Qualitative Study. J Nurs Manag 2020; 29:989-997. [PMID: 33316108 DOI: 10.1111/jonm.13236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/27/2020] [Accepted: 12/09/2020] [Indexed: 01/26/2023]
Abstract
AIM The aim of this research was to explore both older adults' and health care professionals' experience and views of sialorrhoea management practices in older adult residential care settings. BACKGROUND Sialorrhoea is quite a bothersome symptom among patients with certain neurological conditions. The complexity of sialorrhoea and its complications can be quite challenging for health care professionals. In the management of sialorrhoea, a multidisciplinary approach is proposed as an effective way of sialorrhoea management. METHODS Thematic analysis of collected data via semi-structured qualitative interviews with five focus groups involving 28 multidisciplinary health care members and 1 patient. RESULTS The older adult and multidisciplinary health care professionals' view of the management of sialorrhoea in residential care settings were established under three main themes: 1) 'Sialorrhoea compromising patient's dignity', 2) 'Ad hoc local management' and 3) 'Further integration of care required'. CONCLUSION At present, there have been no comprehensive multidisciplinary sialorrhoea management strategies to meet the various needs of older adults with sialorrhoea. IMPLICATION FOR NURSING MANAGEMENT It is important to minimize the negative impact of sialorrhoea on the patients. The recognition of issues associated with sialorrhoea provides constructive scope for the health care professionals to further investigate and develop more effective integrated sialorrhoea care protocols.
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Affiliation(s)
- Li Ping Varley
- Department of Nursing, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - Martina Gooney
- Department of Nursing and Health Care, Waterford Institute of Technology, Ireland
| | - Suzanne Denieffe
- School of Humanities, Waterford Institute of Technology, Ireland
| | - Annette Murphy
- Department of Nursing, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
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15
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Bekkers S, van Ulsen KJ, M M Adang E, R T Scheffer A, J A van den Hoogen F. Cost-effectiveness of botulinum neurotoxin A versus surgery for drooling: a randomized clinical trial. Dev Med Child Neurol 2020; 62:1302-1308. [PMID: 32706122 PMCID: PMC7589433 DOI: 10.1111/dmcn.14636] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2020] [Indexed: 11/27/2022]
Abstract
AIM This study compared the cost-effectiveness of botulinum neurotoxin A (BoNT-A) injections with two-duct ligation of the submandibular glands as treatment for severe drooling after one treatment cycle. METHOD The study was part of a larger, partly single-blinded, randomized clinical trial (trialregister.nl identifier NTR3537). Data were collected between 2012 and 2017. Evaluation was at 32 weeks after one treatment cycle. Fifty-seven patients with cerebral palsy or other neurological, non-progressive disorders and severe drooling classified as having a drooling frequency ≥3 or a drooling severity ≥2, in whom conservative treatment was deemed ineffective, were randomized to treatment by BoNT-A or two-duct ligation. An incremental cost-effectiveness ratio (ICER) was calculated using the success rates as the measure of benefit. Treatment success was defined as a decrease ≥50% from baseline to 32 weeks in the subjective visual analogue scale for the severity of drooling or the objective drooling quotient. RESULTS Fifty-three patients were analysed (22 females, 31 males; mean age 11y, range 8-22y). Average costs for one treatment cycle, which included one BoNT-A injection, were €1929 (standard error 62) for BoNT-A and €3155 (standard error 99) for two-duct ligation. Treatment success was in favour of two-duct ligation (63% vs 27%; number needed to treat 3). The ICER was €34 per 1% gain in treatment success in favour of two-duct ligation versus BoNT-A. INTERPRETATION The additional cost of two-duct ligation is to some extent offset by a larger treatment success rate compared with BoNT-A. WHAT THIS PAPER ADDS Botulinum neurotoxin A (BoNT-A) is less expensive per percentage of success than two-duct ligation. The additional cost of two-duct ligation over BoNT-A is offset by greater treatment success.
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Affiliation(s)
- Stijn Bekkers
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Kim J van Ulsen
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Eddy M M Adang
- Department for Health Evidence RehabilitationRadboud University Medical CenterNijmegenthe Netherlands
| | - Arthur R T Scheffer
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
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16
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Van Hulst K, Van Der Burg JJW, Jongerius PH, Geurts ACH, Erasmus CE. Changes in severity and impact of drooling after submandibular gland botulinum neurotoxin A injections in children with neurodevelopmental disabilities. Dev Med Child Neurol 2020; 62:354-362. [PMID: 31729034 PMCID: PMC7028146 DOI: 10.1111/dmcn.14391] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2019] [Indexed: 11/29/2022]
Abstract
AIMS To examine changes in objective and subjective drooling severity measures after submandibular botulinum neurotoxin A injection in children with neurodevelopmental disabilities, explore their relationship, and evaluate if clinically relevant responses relate to changes in the impact of drooling. METHOD This longitudinal, observational cohort study involved 160 children (92 males, 68 females; 3-17y, mean 9y 1mo, SD 3y 6mo) treated between 2000 and 2012 at the Radboud University Medical Center, Nijmegen, the Netherlands. Repeated measures analysis of variance was used to compare the 5-minute Drooling Quotient (DQ5) and Visual Analogue Scale (VAS) for drooling severity pretreatment and posttreatment, and Pearson's rho to assess their association. A parent questionnaire was used to assess drooling impact in responders (defined as ≥50% reduction in DQ5 and/or ≥2 SD reduction in VAS for drooling severity 8wks postintervention) and non-responders. RESULTS One hundred and twelve children (70%) were responders. Their mean VAS for drooling severity and DQ5 scores were significantly lower 32 weeks postintervention compared to baseline. At baseline, the VAS for drooling severity-DQ5 relationship was 'weak' (rs =0.15, p=0.060), whereas it was 'fair' at 8 weeks (rs =0.43, p=0.000) and 32 weeks (rs =0.30, p=0.000). For responders, a significant change was found regarding the impact of drooling on daily care and social interactions at 8 weeks after intervention; most of these effects were maintained at 32 weeks. INTERPRETATION A clinically relevant response based on a combination of objective and subjective measures of drooling severity was accompanied by positive changes regarding the impact of drooling on daily care and social interactions. WHAT THIS PAPER ADDS Botulinum neurotoxin A injection into the submandibular glands reduced drooling severity in 70% of children with neurodevelopmental disabilities. Objective (5-minute Drooling Quotient) and subjective (Visual Analogue Scale for drooling severity) measures correlated 8 and 32 weeks after treatment. Objective and subjective measures complemented each other when changes in drooling severity were assessed. Reduced drooling severity was accompanied by positive changes with regard to the impact of drooling.
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Affiliation(s)
- Karen Van Hulst
- Radboud University Medical CenterDonders Institute for BrainCognition and BehaviourDepartment of RehabilitationNijmegenthe Netherlands
| | - Jan JW Van Der Burg
- Rehabilitation Center Sint MaartenskliniekDepartment of RehabilitationNijmegenthe Netherlands,Radboud UniversitySchool of Pedagogical and Educational ScienceNijmegenthe Netherlands
| | - Peter H Jongerius
- Rehabilitation Center Sint MaartenskliniekDepartment of RehabilitationNijmegenthe Netherlands
| | - Alexander CH Geurts
- Radboud University Medical CenterDonders Institute for BrainCognition and BehaviourDepartment of RehabilitationNijmegenthe Netherlands
| | - Corrie E Erasmus
- Radboud University Medical CenterDonders Institute for BrainCognition and BehaviourDepartment of Pediatric NeurologyNijmegenthe Netherlands
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17
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Jost WH, Bäumer T, Laskawi R, Slawek J, Spittau B, Steffen A, Winterholler M, Bavikatte G. Therapy of Sialorrhea with Botulinum Neurotoxin. Neurol Ther 2019; 8:273-288. [PMID: 31542879 PMCID: PMC6858891 DOI: 10.1007/s40120-019-00155-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Indexed: 12/11/2022] Open
Abstract
Botulinum neurotoxin (BoNT) is considered the treatment of choice for various symptoms and diseases such as focal dystonia and focal spasticity. The effects of BoNT on the salivary glands have also been known for years, but their use was limited because of a lack of approval studies. Now the indication of sialorrhea is approved in some countries for incobotulinumtoxinA, such as the USA and Europe, and therapy could also become the treatment of choice. According to the pivotal study, a dose of 100 units of incobotulinumtoxinA, which is divided into the parotid and submandibular glands, is recommended. RimabotulinumtoxinB is approved in the USA only. To define the value of this therapy, we must consider anatomy, physiology, and available therapies. Therapy includes conservative measures such as functional dysphagia therapy, oral or transdermal application of anticholinergics, and, in selected cases, radiotherapy and surgical procedures. A combination of different approaches is optional. On the basis of the evidence and clinical experience, BoNT injections will be the first line of pharmacotherapy for chronic sialorrhea.
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Affiliation(s)
| | - Tobias Bäumer
- Paediatric and Adult Movement Disorders and Neuropsychiatry, Institut of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Rainer Laskawi
- ENT Department, University Medical Center, Göttingen, Germany
| | - Jaroslaw Slawek
- Neurology Department, Medical University of Gdansk, Gdańsk, Poland
| | - Björn Spittau
- Center for Transdisciplinary Neurosciences Rostock (CTNR), University of Rostock, Rostock, Germany
| | - Armin Steffen
- Department for Otorhinolaryngology, University of Lübeck, UKSH, Lübeck, Germany
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18
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Varley LP, Denieffe S, O'Gorman C, Murphy A, Gooney M. A systematic review of noninvasive and invasive sialorrhoea management. J Clin Nurs 2019; 28:4190-4206. [DOI: 10.1111/jocn.15009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/29/2019] [Accepted: 06/30/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Li Ping Varley
- Department of Nursing and Health Care, School of Health Sciences Waterford Institute of Technology Waterford Ireland
| | - Suzanne Denieffe
- School of Humanities Waterford Institute of Technology Waterford Ireland
| | - Claire O'Gorman
- Department of Nursing and Health Care, School of Health Sciences Waterford Institute of Technology Waterford Ireland
| | - Annette Murphy
- Department of Nursing and Health Care, School of Health Sciences Waterford Institute of Technology Waterford Ireland
| | - Martina Gooney
- Department of Nursing and Health Care, School of Health Sciences Waterford Institute of Technology Waterford Ireland
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19
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Reid SM, Westbury C, Chong D, Johnstone BR, Guzys A, Reddihough DS. Long-term impact of saliva control surgery in children with disability. J Plast Reconstr Aesthet Surg 2019; 72:1193-1197. [DOI: 10.1016/j.bjps.2019.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/14/2019] [Accepted: 02/12/2019] [Indexed: 11/16/2022]
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20
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Steffen A, Jost W, Bäumer T, Beutner D, Degenkolb-Weyers S, Groß M, Grosheva M, Hakim S, Kahl KG, Laskawi R, Lencer R, Löhler J, Meyners T, Rohrbach-Volland S, Schönweiler R, Schröder SC, Schröder S, Schröter-Morasch H, Schuster M, Steinlechner S, Urban R, Guntinas-Lichius O. Hypersalivation: update of the German S2k guideline (AWMF) in short form. J Neural Transm (Vienna) 2019; 126:853-862. [DOI: 10.1007/s00702-019-02000-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/27/2019] [Indexed: 12/11/2022]
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21
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Gutierrez GM, Siqueira VL, Loyola-Rodriguez JP, Diniz MB, Guaré RO, Ferreira ACFM, Santos MTBR. Effects of treatments for drooling on caries risk in children and adolescents with cerebral palsy. Med Oral Patol Oral Cir Bucal 2019; 24:204-210. [PMID: 30818313 PMCID: PMC6441593 DOI: 10.4317/medoral.22729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/24/2018] [Indexed: 11/29/2022] Open
Abstract
Background Neuromuscular impairment makes individuals with cerebral palsy (CP) more prone to drooling. Among the treatment options, there are procedures that interfere with saliva production. It is imperative to evaluate the effect of the different modalities since the reduction in salivary flow rate/production may exacerbate the risk of dental caries. Material and Methods The aim of this study was to compare the effects of different treatments for drooling on caries risk and salivary parameters in children and adolescents with CP. Study design A total of 142 children and adolescents with CP, aged 6 to 18 years, were assigned to groups based on the different treatments they had received for drooling: G1—anticholinergic drugs (n = 18), G2—botulinum toxin injection (n = 16), G3—salivary glands surgery (n = 16), G4—no treatment (n = 42), and G5—non-drooling subjects (n = 50). All participants were evaluated on the Simplified Oral Hygiene Index, and for the prevalence of dental caries (decayed, missing, and filled teeth index and white spot lesions). Unstimulated whole saliva was collected, and salivary flow rate and osmolality were measured. Chi-square, ANOVA and Poisson regression were calculated. Prevalence ratios and their respective 95 % confidence intervals were obtained. The significance level was fixed at 5%. Results No differences were found in the decayed, missing, and filled teeth index (p = 0.128) and Simplified Oral Hygiene Index (p = 0.674) among the different groups. G3 presented significantly higher percentages of WSL (p<0.001), lower values of salivary flow rate (p<0.001), and higher values of osmolality (p<0.001). The white spot lesion prevalence ratio was higher only for G3 (Prevalence ratio = 14.36; IC 95% = 4.64-44.40; p<0.001). Conclusions Children and adolescents with CP who had received surgical treatment for drooling exhibited higher number of white spot lesions because of the reduced salivary flow rate and higher salivary osmolality. Key words:Cerebral palsy, saliva, sialorrhea, dental caries, osmolar concentration.
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Affiliation(s)
- G-M Gutierrez
- Universidade Cruzeiro do Sul, Rua Constantino de Sousa, 454, apto 141, zip code: 04605-001, São Paulo - SP, Brazil,
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Bekkers S, Delsing CP, Kok SE, van Hulst K, Erasmus CE, Scheffer ART, van den Hoogen FJA. Randomized controlled trial comparing botulinum vs surgery for drooling in neurodisabilities. Neurology 2019; 92:e1195-e1204. [PMID: 30728311 DOI: 10.1212/wnl.0000000000007081] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 11/04/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the effect of submandibular duct ligation (2-DL) and submandibular botulinum neurotoxin type A (BoNT-A) for drooling in children and adolescents with neurodevelopmental disabilities. METHODS A randomized, interventional, controlled, and partly single-blinded study was performed in which submandibular BoNT-A was compared with 2-DL to treat excessive drooling. Main outcomes included a Visual Analog Scale (VAS), drooling quotient (DQ), drooling severity (DS) scale and drooling frequency (DF) scale. Each was obtained at baseline, and 8 and 32 weeks post treatment. RESULTS Fifty-seven patients (mean age: 11 years, mean baseline VAS score 7.9, mean baseline DQ 27.3%) were randomized to the 2-DL or BoNT-A group. Four patients were excluded from analyses, leaving 53 patients for intention-to-treat analyses. Response to treatment, defined as a ≥50% reduction in DQ or VAS score, was higher for 2-DL after 32 weeks (63.0% vs 26.9%, p = 0.008). Both VAS score (24.5, p < 0.001) and DQ (-9.3%, p = 0.022) were significantly lower at follow-up after 2-DL vs BoNT-A. The total number of adverse events (p = 0.088, 40.7% vs 19.2%) and postoperative complaints was higher (p < 0.001, mean 9.6 vs 3.6 days) for 2-DL than for BoNT-A. CONCLUSION The 2-DL procedure is a more effective treatment for drooling than botulinum toxin, but carries a slightly greater risk of complications and morbidity. TRIALREGISTERNL IDENTIFIER NTR3537. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that for children and adolescents with neurodevelopmental disabilities and severe drooling, 2-DL compared to a one-time intraglandular BoNT-A injection is more effective at reducing drooling at 32 weeks.
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Affiliation(s)
- Stijn Bekkers
- From the Department of Otorhinolaryngology and Head and Neck Surgery (S.B., C.P.D., S.E.K., A.R.T.S., F.J.A.v.d.H.), Radboud University Medical Centre, Nijmegen; and Departments of Rehabilitation (K.v.H.) and Paediatric Neurology (C.E.E.), Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands.
| | - Corinne P Delsing
- From the Department of Otorhinolaryngology and Head and Neck Surgery (S.B., C.P.D., S.E.K., A.R.T.S., F.J.A.v.d.H.), Radboud University Medical Centre, Nijmegen; and Departments of Rehabilitation (K.v.H.) and Paediatric Neurology (C.E.E.), Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Saskia E Kok
- From the Department of Otorhinolaryngology and Head and Neck Surgery (S.B., C.P.D., S.E.K., A.R.T.S., F.J.A.v.d.H.), Radboud University Medical Centre, Nijmegen; and Departments of Rehabilitation (K.v.H.) and Paediatric Neurology (C.E.E.), Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Karen van Hulst
- From the Department of Otorhinolaryngology and Head and Neck Surgery (S.B., C.P.D., S.E.K., A.R.T.S., F.J.A.v.d.H.), Radboud University Medical Centre, Nijmegen; and Departments of Rehabilitation (K.v.H.) and Paediatric Neurology (C.E.E.), Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Corrie E Erasmus
- From the Department of Otorhinolaryngology and Head and Neck Surgery (S.B., C.P.D., S.E.K., A.R.T.S., F.J.A.v.d.H.), Radboud University Medical Centre, Nijmegen; and Departments of Rehabilitation (K.v.H.) and Paediatric Neurology (C.E.E.), Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Arthur R T Scheffer
- From the Department of Otorhinolaryngology and Head and Neck Surgery (S.B., C.P.D., S.E.K., A.R.T.S., F.J.A.v.d.H.), Radboud University Medical Centre, Nijmegen; and Departments of Rehabilitation (K.v.H.) and Paediatric Neurology (C.E.E.), Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Frank J A van den Hoogen
- From the Department of Otorhinolaryngology and Head and Neck Surgery (S.B., C.P.D., S.E.K., A.R.T.S., F.J.A.v.d.H.), Radboud University Medical Centre, Nijmegen; and Departments of Rehabilitation (K.v.H.) and Paediatric Neurology (C.E.E.), Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
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Calim OF, Hassouna HNH, Yildirim YS, Dogan R, Ozturan O. Pediatric Sialorrhea: Submandibular Duct Rerouting and Intraparotid Botulinum Toxin A Injection With Literature Review. Ann Otol Rhinol Laryngol 2018; 128:104-112. [PMID: 30371109 DOI: 10.1177/0003489418808305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES: The aim of this study was to assess the effectiveness of bilateral submandibular duct relocation and bilateral sublingual gland excision in combination with botulinum toxin A injection into the parotid glands in children with sialorrhea. Previously in the literature, either surgery or botulinum toxin injection but not their combination has been reported. METHODS: Preoperative and at least 6-month postoperative assessments using the Drooling Severity Scale and Drooling Frequency Scale (Thomas-Stonell and Greenberg classification) and the Teacher Drooling Scale and by interviewing parents and caregivers face to face or via telephone were performed. Also, decreases in the daily number of bib changes and hourly frequency of saliva wiping were recorded as success. Complications were recorded. RESULTS: The Drooling Frequency and Severity Scale, the Teacher Drooling Scale, daily number of bib changes, and hourly frequency of saliva wiping decreased significantly in 21 patients (95.5%) and remained unchanged in 1 patient (4.5%). Postoperative bleeding was observed in 1 patient (4.5%). CONCLUSIONS: Drooling is a complex problem that benefits from a multidisciplinary approach. Many treatment methods exist, each with advantages and disadvantages. In this study botulinum toxin A injection was applied in conjunction with bilateral submandibular duct relocation and bilateral sublingual gland excision surgery, achieving a success rate of 95.5%. Moreover, minimal complications and no recurrence after at least 6-month follow-up were observed. The authors therefore recommend further use of this combination treatment. Larger and longer term studies may also help clarify its effectiveness.
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Affiliation(s)
- Omer Faruk Calim
- 1 Faculty of Medicine, Department of Otolaryngology, Head and Neck Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Hasan N H Hassouna
- 1 Faculty of Medicine, Department of Otolaryngology, Head and Neck Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Yavuz Selim Yildirim
- 2 Department of Otolaryngology, Head and Neck Surgery, Hisar Intercontinental Hospital, Istanbul, Turkey
| | - Remzi Dogan
- 1 Faculty of Medicine, Department of Otolaryngology, Head and Neck Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Orhan Ozturan
- 1 Faculty of Medicine, Department of Otolaryngology, Head and Neck Surgery, Bezmialem Vakif University, Istanbul, Turkey
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Submandibular duct transposition for drooling in children: A Casuistic review and evaluation of grade of satisfaction. Int J Pediatr Otorhinolaryngol 2018; 113:58-61. [PMID: 30174011 DOI: 10.1016/j.ijporl.2018.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/15/2018] [Accepted: 07/15/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Drooling of saliva is the unintentional loss of saliva from the mouth resulting in excess pooling of saliva in the anterior portion of the oral cavity. It is considered normal in infants and usually resolves itself by 15-18 months of age. It is a common problem in pediatric patients with cerebral palsy or other neurological disorders. Drooling interferes with speech, impairs oral hygiene and contributes to oral dermatitis, aspiration pneumonias and fluid electrolyte imbalances. It has a profoundly negative impact on quality of life and contributes to social exclusion, self-esteem problems and significant discomfort, especially amongst school-aged children. In addition, it can present a serious challenge for caregivers. Various approaches to manage this condition have been described in the literature. Submandibular duct relocation allows salivary flow and is the surgical approach undertaken by the authors. OBJECTIVES The aim of this study is to share our experience with the surgical approach to drooling children and to evaluate clinical outcomes and long-term caregiver satisfaction outcomes. METHODS The authors conducted a retrospective study with a review of the medical records of 43 children and adolescents who had been submitted to submandibular duct relocation in the Centro Hospitalar Tondela-Viseu, between January 2003 and December 2017. The authors analyzed the clinical history, bibs used per day before and after surgery, and caregivers' satisfaction was assessed by interview using a questionnaire. The results of this procedure, technical considerations and outcomes are presented in this work. RESULTS Forty-three patients (15 girls and 28 boys), between the ages of 3 and 18 at time of surgery (mean age of 9), underwent bilateral submandibular duct transposition for drooling. All children have neurological disorders, with cerebral palsy being the predominant diagnosis. The majority were hospitalized for 1-2 days and no surgical complications were observed. The number of bib or clothing changes fell from more than ten in 23 patients (53%) pre-operatively to less than five in 33 patients (77%) post-operatively. 30% of caregivers were satisfied and 53% were very satisfied with the results of surgery. CONCLUSIONS The results of this study show that submandibular duct relocation is an effective method in the resolution of uncontrolled drooling in children, contributing to the improvement of children's quality of life. The degree of satisfaction with the surgical results is in agreement with the published international studies, proving once again the effectiveness of the surgical technique implemented in our Hospital.
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Job A, Naina P, Syed KA, Thomas M, John M, Varghese AM. Validation of a drooling questionnaire in Indian children with cerebral palsy. Int J Pediatr Otorhinolaryngol 2018; 112:55-60. [PMID: 30055740 DOI: 10.1016/j.ijporl.2018.06.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/17/2018] [Accepted: 06/17/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Drooling of saliva is a common problem in children with cerebral palsy. In addition to causing impairment in articulation, drooling also affects socialization, interpersonal relationships and integration into society for these children. There are various methods to assess drooling which measure directly the amount of saliva drooled. However the most convenient and popular method is the use of questionnaires which are mostly western based and need slight modification for the Indian scenario Aim-Validation of a modified questionnaire for the assessment of drooling in children with cerebral palsy. METHOD The modified questionnaire was administered to parents of children with cerebral palsy willing to participate in the study. The drooling score was compared with objective tests, namely cotton pad test and drooling quotient. Internal consistency was assessed using the Cronbach's alpha, test retest reliability by Intraclass Correlation and sensitivity analysis by the Receiver operating characteristic curve. RESULTS The modified questionnaire was found to be easy to administer. The Cronbach's alpha coefficient was between 0.867 and 0.879 which implies a high degree on internal consistency. The intraclass correlation and the test retest reliability was found to be statistically significant with a p value < 0.001 which show that the questionnaire was highly reliable for repeat administration as well as administration by different investigators. The ROC Area was found to be 0.94 with a standard error of 0.02 with a 95% confidence interval of 0.88-0.99, which suggests that the score has great specificity, closer agreement between specificity and sensitivity and excellent precision. CONCLUSION Our modified questionnaire was easy to administer, highly reliable and valid with high internal consistency. A score of 24 on the questionnaire was found to be the most sensitive and specific point to discriminate between the mild and severe droolers in children with cerebral palsy.
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Affiliation(s)
- Anjana Job
- -Department of ENT, Christian Medical College, Vellore, 632004, India
| | - P Naina
- -Department of ENT, Christian Medical College, Vellore, 632004, India.
| | - Kamran Asif Syed
- -Department of ENT, Christian Medical College, Vellore, 632004, India
| | - Maya Thomas
- -Department of Neurological Sciences, Christian Medical College, Vellore, 632004, India
| | - Mary John
- -Department of ENT, Christian Medical College, Vellore, 632004, India
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Abstract
PURPOSE OF REVIEW Our goal is to present the most up-to-date options in the surgical management of drooling in the paediatric population. While the clinical assessment of the drooling child and conservative management options are discussed, this review focuses on the most recent evidence for surgical interventions to treat drooling in children. RECENT FINDINGS In terms of advances in the management of drooling, further experience and outcomes with the use of botulinum toxin injections is discussed. Moreover, the latest evidence-base for salivary duct ligation and relocation procedures are presented. Finally, the trans-oral approach to submandibular gland excision for the management of drooling may gain popularity through the aim of reducing surgical morbidity. SUMMARY The drooling child should be managed with an evidence-based stepwise approach delivered by a multidisciplinary team (MDT). Children with normal neurological development should be treated conservatively through parental reassurance. There are numerous interventions available for the drooling child with impaired neuromuscular development. When conservative measures fail, treatment options include botulinum toxin injections and surgical procedures such as salivary duct ligation, salivary duct relocation and salivary gland excision. Management must be targeted to the individual needs and comorbidities of the child to maximise treatment outcomes.
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Affiliation(s)
- Rachael Lawrence
- Specialist Registrar in ENT, Queen’s Medical Centre, Nottingham, NG7 2UH UK
| | - Neil Bateman
- Paediatric ENT, Royal Manchester Children’s Hospital, Oxford Road, Manchester, M13 9WL UK
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