Evolução de 31 crianças submetidas à ressecção bilateral das glândulas submandibulares e ligadura dos ductos parotídeos para controlar a sialorréia

Uso da bandagem elástica associada ao tratamento fonoaudiológico no controle da sialorréia

OBJETIVO:verificar a efetividade do uso da bandagem elástica associada ao tratamento fonoaudiológico no controle da sialorréia.MÉTODOS:estudo longitudinal realizado com onze crianças com quadro de sialorréia crônica e alteração neurológica. Foi verificada a percepção do fonoaudiólogo e do responsável acerca da gravidade e o número de toalhas/paninhos de boca utilizados ao dia. Empregou-se também a sialometria. Cada participante recebeu a aplicação da bandagem elástica Kinesio Tape na região da musculatura supra-hióidea por 30 dias. As crianças foram avaliadas sem a bandagem (T0), imediatamente após a retirada da bandagem (T1) e três meses após (T2). O tratamento fonoaudiológico foi realizado pelo o mesmo profissional em duas sessões semanais. Os dados foram analisados estatisticamente.RESULTADOS:no questionário verificou-se redução da queixa de engasgos com saliva em T1 (p=0,024).A média de uso diário de toalhas/paninhos era de quatro (10,2%) em T0, duas (5,1%) em T1 e quatro (10,2%) em T2.De acordo com a sialometria, verificou-se redução da sialorréia de T0 para T1 (p=0,018) e ausência de diferença entre T0 e T2 (p=0,215) e aumento de T1 para T2 (p=0,05).De acordo com a percepção do fonoaudiólogo houve redução da sialorréia 30 dias após o uso da bandagem, entretanto não se observou melhora ao se comparar os resultados 30 dias após o uso e três meses sem a bandagem.CONCLUSÃO:a bandagem elástica se mostrou eficaz no controle da sialorréia durante seu período de uso, não sendo observada permanência dos resultados após interrupção da aplicação.

Surgical management of chronic sialorrhea in pediatric patients: 10-year experience from one tertiary care institution

BACKGROUND

Chronic sialorrhea is a common problem for pediatric patients with disorders that affect swallowing. While many patients are successfully treated with medical therapies such as Robinul and Scopolamine, a number of such children are not able to tolerate the side effects of these medications. In these cases, surgical treatments can include Botulinum toxin A (Botox) injections into the major salivary glands, sublingual or submandibular gland excision (SMGE), submandibular duct ligation, parotid duct ligation (PDL), or any combination of the above procedures. The purpose of this study is to report on the 10-year experience with the surgical management of chronic sialorrhea at one tertiary care institution, and compare the efficacy of open surgical procedures versus Botox injections for reduction in salivary flow.

METHODS

A retrospective chart review identified 27 pediatric patients with chronic sialorrhea; 21 of whom underwent Botox injections and 15 of whom underwent surgical procedures. Preoperative and follow-up clinic notes were reviewed to determine the level and severity of drooling as well as the effectiveness of sialorrhea reduction, as assessed by the Teacher Drooling Scale (TDS).

RESULTS

42% of those receiving Botox injections reported a reduction in drooling, with the average pre- and post-Botox TDS of 4.3 and 3.9, respectively (p=0.02 by the Wilcoxon signed rank test). Nine of the patients receiving Botox injections (43%) required multiple injections, with an average duration of effect of 3.9 months, and 7 patients (33%) eventually required surgery. All of the children who underwent surgery (7 bilateral SMGE with PDL, 6 SMGE only, and 2 PDL only) experienced a reduction in drooling, with average pre- and post-operative TDS of 4.5 and 2.2, respectively. This reduction was significant by the Wilcoxon signed rank test (p=0.001).

CONCLUSIONS

The ten-year experience at our institution demonstrates the safety, efficacy and long-term control of drooling in the patients undergoing surgery for intractable sialorrhea.

Videoendoscopic rehabilitation of iatrogenous Stensen-duct-acquired atresia in a patient with ring chromosome 21 syndrome and drooling

Drooling generally arises as a result of neurologic or muscular impairments, especially in subjects affected by cerebral palsies. It has never previously been described in patients with ring chromosome 21 syndrome. We describe the video-assisted surgical rehabilitation of the left parotid duct in a child with ring chromosome 21 syndrome and a persistent and painful swelling of the left parotid region after the surgical ligation of the Stensen ducts because of drooling. The diagnosis of Stensen duct dilatation as a result of iatrogenous complete distal acquired atresia was made by means of clinical and magnetic resonance evaluations. Video-assisted sialoendoscopical surgical rehabilitation of the left parotid duct was successfully performed; based on this experience, this minimally invasive procedure is preferred before traditional invasive parotid surgery in these cases. Other therapeutical options such as botulinum toxin therapy might be considered for the management of drooling in such young patients.