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McInerney M, Imms C, Carding PN, Reddihough DS. Evaluation of an intensive voice treatment to reduce anterior drooling in children with cerebral palsy: Protocol for a concurrent multiple-baseline, single case experimental design study. Contemp Clin Trials Commun 2021; 24:100872. [PMID: 34825105 PMCID: PMC8605272 DOI: 10.1016/j.conctc.2021.100872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/29/2021] [Accepted: 11/13/2021] [Indexed: 12/04/2022] Open
Abstract
Anterior drooling is common in children with cerebral palsy (CP) and poses significant risks to the child's health. Causes of drooling include oro-motor dysfunction, inefficient swallowing and reduced sensation in the orofacial musculature. Behavioural interventions are frequently recommended to reduce drooling; however, this is in the absence of high-quality research evidence. This paper describes a protocol for evaluating the effectiveness of the Lee Silverman Voice Treatment LOUD (LSVT LOUD®) in reducing drooling; and optimising speech and swallowing in a group of children with CP. A structured and systematic visual analysis supplemented with statistical analyses will be used to analyse the data. The risk of bias in n-of-1 trials (RoBiNT) Scale [1] guided the design and implementation of the study.
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Affiliation(s)
- Michelle McInerney
- Lecturer in Speech Pathology, School of Allied Health, Australian Catholic University, Level 3 TWH, 8-20 Napier Street, North Sydney, NSW, 2060, Australia
| | - Christine Imms
- Apex Australia Chair of Neurodevelopment and Disability, Fellow, Occupational Therapy Australia Research Academy, Department of Paediatrics, The University of Melbourne, Australia
| | - Paul N Carding
- Professor of Speech Pathology, Director, Oxford Institute of Nursing, Midwifery and Allied Health Research (INMAHR), Oxford Brookes University, Oxford, UK
| | - Dinah S Reddihough
- The Royal Children's Hospital Melbourne, Department of Paediatrics, The University of Melbourne, Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia
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Miles BL, Ang SL, Simons CT. Development of a "pure-tactile" assessment of edge discrimination in the hands and oral cavity. Physiol Behav 2020; 224:113035. [PMID: 32598940 DOI: 10.1016/j.physbeh.2020.113035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 10/24/2022]
Abstract
Oral cavity edge perception acuity relative to the fingertip has previously been evaluated by the utilization of cognitively-loaded, stereognostic methods. However, with the lack of connection of the tongue to the visual association cortex, there is concern the superior acuity of the fingertip may be attributable to the cognitive component of the task. Here, perception acuity is evaluated by assessing participants' (n=29) just-noticeable-difference threshold for edge sharpness tiles using the finger and tongue. As expected, the pure-tactile task found greater acuity in the tongue, suggesting the cognitive component of the previous task confounded results and should not be used.
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Affiliation(s)
- Brittany L Miles
- Department of Food Science & Technology, The Ohio State University, 2015 Fyffe Rd., Columbus, OH, 43210-1007, USA
| | - Sok Lin Ang
- Department of Food Science & Technology, The Ohio State University, 2015 Fyffe Rd., Columbus, OH, 43210-1007, USA
| | - Christopher T Simons
- Department of Food Science & Technology, The Ohio State University, 2015 Fyffe Rd., Columbus, OH, 43210-1007, USA.
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Mikami DLY, Furia CLB, Welker AF. Addition of Kinesio Taping of the orbicularis oris muscles to speech therapy rapidly improves drooling in children with neurological disorders. Dev Neurorehabil 2019; 22:13-18. [PMID: 28933983 DOI: 10.1080/17518423.2017.1368729] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the effects of Kinesio Taping (KT) of the orbicularis oris muscles as an adjunct to standard therapy for drooling. METHODS Fifteen children with neurological disorders and drooling received speech therapy and twice-weekly KT of the orbicularis muscles over a 30-day period. Drooling was assessed by six parameters: impact on the life of the child and caregiver; severity of drooling; frequency of drooling; drooling volume (estimated by number of bibs used); salivary leak; and interlabial gap. Seven markers of oral motor skills were also assessed. RESULTS KT of the orbicularis oris region reduced the interlabial gap. All oral motor skills and almost all markers of drooling improved after 15 days of treatment. CONCLUSION In this sample of children with neurological disorders, adding KT of the orbicularis oris muscles to speech therapy caused rapid improvement in oral motor skills and drooling.
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Affiliation(s)
- Denise Lica Yoshimura Mikami
- a Departamento de Pós-Graduação em Ciência e Tecnologia em Saúde , Universidade de Brasília (UNB) , Campus Ceilândia, Brasília, Brazil
| | - Cristina Lemos Barbosa Furia
- a Departamento de Pós-Graduação em Ciência e Tecnologia em Saúde , Universidade de Brasília (UNB) , Campus Ceilândia, Brasília, Brazil
| | - Alexis Fonseca Welker
- a Departamento de Pós-Graduação em Ciência e Tecnologia em Saúde , Universidade de Brasília (UNB) , Campus Ceilândia, Brasília, Brazil
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Sjögreen L, Gonzalez Lindh M, Brodén M, Krüssenberg C, Ristic I, Rubensson A, McAllister A. Oral Sensory-Motor Intervention for Children and Adolescents (3-18 Years) With Dysphagia or Impaired Saliva Control Secondary to Congenital or Early-Acquired Disabilities: A Review of the Literature, 2000 to 2016. Ann Otol Rhinol Laryngol 2018; 127:978-985. [PMID: 30296844 DOI: 10.1177/0003489418803963] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES: Dysphagia and impaired saliva control are common in children and adolescents with congenital and developmental disabilities. The aim of the present review was to investigate the evidence base for oral sensory-motor interventions in children and adolescents with dysphagia or impaired saliva control secondary to congenital or early-acquired disabilities and to make recommendations regarding methods for intervention. METHODS: A review of the literature from 2000 to 2016, including oral sensory-motor intervention studies for children and adolescents (3-18 years of age) with dysphagia or impaired saliva control secondary to congenital or early-acquired disabilities, was performed. The literature search included the PubMed, CINAHL, Medline, SpeechBITE, OVID, ERIC, Cochrane, and Google Scholar databases. Primary studies were evaluated on a 4-grade scale using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Twenty primary studies of oral sensory-motor interventions for dysphagia and 6 studies for the treatment of impaired saliva control fulfilled the inclusion criteria. Of these, 3 were randomized, controlled trials. Five systematic reviews and 16 narrative reviews were also included. Limited and moderately strong recommendations were made on the basis of the grading results from the primary studies. The studies reported good results, but study design was often insufficient, and the study groups were small. The systematic reviews confirmed the lack of high scientific support for oral sensory-motor interventions in children and adolescents with congenital and developmental disabilities. CONCLUSIONS: There is an urgent need for high-quality studies that could serve as the basis for strong recommendations relating to oral sensory-motor interventions for children with dysphagia and impaired saliva control.
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Affiliation(s)
- Lotta Sjögreen
- 1 Mun-H-Center Orofacial Resource Centre for Rare Diseases, Public Dental Service, Gothenburg, Sweden
| | | | - Madeleine Brodén
- 3 Child and Adolescent Habilitation Services, Kronoberg County, Växjö, Sweden
| | | | | | - Agneta Rubensson
- 6 The Queen Silvia Children's Hospital, Regional Rehabilitation Centre, Gothenburg, Sweden
| | - Anita McAllister
- 7 Division of Speech and Language Pathology, CLINTEC, Karolinska Institutet, Functional Area Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
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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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Faria J, Harb J, Hilton A, Yacobucci D, Pizzuto M. Salivary botulinum toxin injection may reduce aspiration pneumonia in neurologically impaired children. Int J Pediatr Otorhinolaryngol 2015; 79:2124-8. [PMID: 26478107 DOI: 10.1016/j.ijporl.2015.09.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/15/2015] [Accepted: 09/23/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Neurologically impaired children often drool and aspirate saliva leading to recurrent aspiration pneumonia and frequent hospitalizations. Salivary botulinum toxin injection is known to reduce sialorrhea. This study evaluates whether this intervention affects the frequency and duration of respiratory infections including aspiration pneumonia and hospitalizations in neurologically impaired children. METHODS Retrospective review of patients treated with salivary botulinum toxin at a tertiary care pediatric hospital from January 2009 to December 2013. Each patient was their own control and 180 day pre-injection and post-injection time periods were compared. Outcomes evaluated included: number of hospital days, intensive care unit days, days of antibiotic treatment, chest X-rays, and infiltrates on chest X-ray. RESULTS 13 patients accumulated 539 hospital days. All children were gastrostomy tube dependent. 54% were tracheostomy tube dependent. Amongst all patients, the total hospital days decreased from 385 to 154 (P=0.02), the mean days treated with antibiotics decreased from 214 to 47 (P=0.02), and the number of chest X-ray confirmed infiltrates decreased from 20 to 6 (P=0.02) after injection. CONCLUSION In this review, there was a decrease in hospitalized days, antibiotic usage, and chest X-ray infiltrates after the salivary botulinum toxin injection. A prospective study is needed to evaluate whether this treatment can prevent aspiration pneumonia in neurologically impaired children.
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Affiliation(s)
- John Faria
- Department of Otolaryngology, State University of New York at Buffalo, 1237 Delaware Avenue, Buffalo, NY 14209, USA
| | - Jennifer Harb
- Department of Otolaryngology, State University of New York at Buffalo, 1237 Delaware Avenue, Buffalo, NY 14209, USA
| | - Aaron Hilton
- Department of Otolaryngology, State University of New York at Buffalo, 1237 Delaware Avenue, Buffalo, NY 14209, USA
| | - Dean Yacobucci
- Pediatric Interventional Radiology, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY 14222, USA
| | - Michael Pizzuto
- Department of Otolaryngology, State University of New York at Buffalo, 1237 Delaware Avenue, Buffalo, NY 14209, USA.
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Secondary Effects of Botulinum Toxin Injections Into Salivary Glands for the Management of Pediatric Drooling. J Craniofac Surg 2013; 24:28-33. [DOI: 10.1097/scs.0b013e31827102a0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Affiliation(s)
- Peter Blasco
- Oregon Health & Science University - Child Development and Rehabilitation Center, Portland, OR, USA
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Santos MTBR, Ferreira MCD, Leite MF, Guaré RO. Salivary parameters in Brazilian individuals with cerebral palsy who drool. Child Care Health Dev 2011; 37:404-9. [PMID: 21083696 DOI: 10.1111/j.1365-2214.2010.01176.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although drooling of saliva is considered abnormal in a child over 4 years of age, it has been estimated to occur in approximately in 10-37% of children with cerebral palsy. AIM The aim of this study was to evaluate the flow rate, pH and buffering capacity in saliva of Brazilian individuals with cerebral palsy who drool. METHODS Cross-sectional assessment of saliva from 139 individuals with cerebral palsy (3-16 years old) enrolled in a specialized rehabilitation centre in Sao Paulo, Brazil, divided into two groups, according to the presence (G1) or absence (G2) of drooling and controls (G3): G1 consisted of 63 individuals who drool; G2 consisted of 76 who do not drool; and G3 consisted of 47 individuals with no neurological damage of similar age and sex. Unstimulated whole saliva was collected and salivary flow rate (mL/min), initial pH and buffering capacity, by titration of saliva with a constant amount of 0.01 N HCl, were evaluated. The results from G1, G2 and G3 were compared by one-way anova and the χ(2) -test. RESULTS A higher percentage of severe drooling (60.3%) was observed compared with moderate (27.0%) and mild (12.7%) in the cerebral palsy individuals who drool and the prevalence of drooling was highest among children and adolescents with spastic quadriplegia. Significant reductions in salivary flow rate, initial pH, buffering capacity of whole saliva in pH range 6.0-6.9 and total buffering capacity occurred in G1 and G2 compared with G3. CONCLUSION All individuals with cerebral palsy present lower flow rate, pH and buffering capacity of saliva, which increases the risk of oral diseases.
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Affiliation(s)
- M T B R Santos
- Discipline of Dentistry, Persons with Disabilities Division, Universidade Cruzeiro do Sul, São Paulo, Brazil.
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Scheffer ART, Erasmus C, VAN Hulst K, VAN Limbeek J, Rotteveel JJ, Jongerius PH, van den Hoogen FJA. Botulinum toxin versus submandibular duct relocation for severe drooling. Dev Med Child Neurol 2010; 52:1038-42. [PMID: 20561006 DOI: 10.1111/j.1469-8749.2010.03713.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Botulinum neurotoxin type A (BoNT-A) has been described as an effective intervention for drooling and is being increasingly adopted. However, its effectiveness compared with established treatments is still unknown. We undertook a within-participants observational study to examine this. METHOD An historic cohort was formed of 19 children and young adults (10 males, nine females) with severe drooling who underwent BoNT-A injections followed by surgical re-routing of the submandibular duct at least 6 months later. Mean age at time of admission was 11 years 5 months (range 5-17 y) and mean age at the time of surgery was 14 years (range 6-23 y). Fifteen children were diagnosed with bilateral cerebral palsy (CP), three with unilateral CP, and one with non-progressive developmental delay. Gross Motor Function Classification System levels were the following: level I, n=1; level II, n=2; level III, n=7; level IV, n=6; and level V, n=3). The primary outcome was the drooling quotient, which was assessed before each intervention and 8 and 32 weeks thereafter. A multivariate analysis of variance of repeated measures was performed, with the measurement points as the within-participant variables. RESULTS The drooling quotient was reduced to a greater extent after surgery than after BoNT-A administration (p=0.001). Compared with a baseline value of 28, the mean drooling quotient 8 weeks after surgery was 10, and 32 weeks after surgery was 4 (p<0.001). Among the group treated with BoNT-A, the drooling quotient showed a significant reduction from a baseline value of 30 to 18 after 8 weeks (p=0.02), and a continued but diminished effect after 32 weeks (drooling quotient 22; p=0.05). INTERPRETATION Both interventions are effective, but surgery provides a larger and longer-lasting effect.
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Affiliation(s)
- Arthur R T Scheffer
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands.
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Hegde AM, Pani SC. Drooling of saliva in children with cerebral palsy-etiology, prevalence, and relationship to salivary flow rate in an Indian population. SPECIAL CARE IN DENTISTRY 2009; 29:163-8. [DOI: 10.1111/j.1754-4505.2009.00085.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Greensmith AL, Johnstone BR, Reid SM, Hazard CJ, Johnson HM, Reddihough DS. Prospective analysis of the outcome of surgical management of drooling in the pediatric population: a 10-year experience. Plast Reconstr Surg 2006; 116:1233-42. [PMID: 16217462 DOI: 10.1097/01.prs.0000182221.11733.12] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sialorrhea is a common problem in the neurologically impaired pediatric patient and surgery is the mainstay of treatment for severely affected patients refractory to conservative or medical treatment. METHODS The results of the surgical protocol used since 1993 at the Royal Children's Hospital in Melbourne, Australia, are reported. Seventy-two patients underwent bilateral submandibular duct transposition combined with bilateral sublingual gland excision. Patients were analyzed prospectively and reviewed at 1, 6, and 12 months, then at 2 and 5 years postoperatively. RESULTS Of 67 patients with 2 years of complete follow-up, the median score for the frequency of drooling fell from 4.0 to 2.9 (p < 0.001) and the median severity-of-drooling score decreased from 4.8 to 3.0 (p < 0.001). There was a fall in the number of clothing/bib changes from a median of four per day to zero (p < 0.0001). Of 41 patients followed to 5 years, both the median frequency and severity of drooling scores remained at 3. Overall the majority of patients benefited from surgery. Thirteen patients (18 percent) experienced complications which were major in 9 percent. CONCLUSION We have found bilateral sublingual gland excision in combination with bilateral submandibular duct transposition to be superior to bilateral submandibular duct transposition plus parotid duct ligation. The surgical treatment of sialorrhea continues to be a rewarding experience for our multidisciplinary team.
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Affiliation(s)
- Andrew L Greensmith
- Department of Plastic and Maxillofacial, Royal Children's Hospital, Melbourne, Australia
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Abstract
Drooling is a frequent complaint for individuals with developmental disabilities and their families. A variety of treatment options exist including behavioral or oral motor therapies, medications and surgical interventions. Several novel alternative therapies are also being explored. However, most treatments lack evidence-based demonstration of efficacy. Management of problem drooling benefits from a team approach.
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Affiliation(s)
- Timothy J Brei
- Indiana University School of Medicine, Indianapolis, IN, USA
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Abstract
OBJECTIVE To study the outcome of 21 typically developing children who had been referred to the Saliva Control Clinic at the Royal Children's Hospital, Melbourne. METHOD Information was collected on various aspects of the child's health, oromotor function and severity of drooling. A follow-up telephone survey was completed by the parents of these children after a mean period of 3.4 years. Information was gathered regarding their child's drooling, current health, oromotor status and the usefulness of the clinic. RESULTS There was a statistically significant improvement (P < 0.01) in the saliva control measures analysed on follow-up. Thirteen children ceased to drool, three still drooled occasionally, and five continued to drool. The recommendations, mainly advice and referrals to other health professionals, were generally reported to be helpful by the parents. CONCLUSIONS This cohort of children was established retrospectively, and the study is therefore limited in both numbers and design. The results indicate that some typically developing children may be delayed in the development of saliva control. Parents and professionals can be reassured that this problem is likely to resolve.
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Affiliation(s)
- H Johnson
- SCIOP, Spastic Society of Victoria, St Kilda, Victoria, Australia.
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Chang CJ. Intraductal laser photocoagulation of the bilateral parotid ducts for reduction of drooling in patients with cerebral palsy. Plast Reconstr Surg 2001; 107:907-13. [PMID: 11252081 DOI: 10.1097/00006534-200104010-00001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patients with cerebral palsy who experience drooling are often isolated from social interaction. Surgical treatment is effective in reducing abnormal, profuse drooling in patients who have low cognitive function, but it has a risk of complications. In this study, a new, simple procedure using laser intervention that minimizes surgical complications is described. Forty-eight patients with cerebral palsy and persistent drooling after more than 6 months of conservative treatment were enrolled in this study. An Nd:YAG laser (1064 nm) was used for intraductal laser photocoagulation of the bilateral parotid ducts at 7 to 10 W for 10 seconds. The outcome was evaluated by questionnaire-based, semiquantitative assessments of drooling severity and frequency, collection and measurement of stimulated saliva, and salivary amylase measurement. The entire procedure was completed in 25 to 65 minutes, with a mean duration of 38.4 minutes. Early complications included transient facial swelling in all patients. Swelling persisted for 6 to 37 days (mean, 11 days). One hematoma (2.1 percent of patients), two infections (4.2 percent of patients), and two cystic formations (4.2 percent of patients) also occurred. No obvious xerostomia or visible scar was noted after the procedure. In the final assessment, a significant improvement in drooling severity (p < 0.05) and frequency (p < 0.05) was noted in the majority of cases. Forty patients (83.3 percent) demonstrated remarkable improvement in drooling severity, seven patients (14.6 percent) showed significant improvement, and one patient (2.1 percent), who was also autistic, continued to experience severe drooling after the laser procedure. The decrease in the amount of saliva produced ranged from 20 to 60 percent at 12 weeks after surgery. The decrease in the amount of salivary amylase measured ranged from 4 to 97 percent at 12 weeks after surgery (p < 0.05). In conclusion, the intraductal laser photocoagulation of bilateral parotid ducts is a simple, effective procedure for reducing drooling in patients who have cerebral palsy. This procedure minimizes risks and complications, compared with those associated with conventional surgery.
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Affiliation(s)
- C J Chang
- Departments of Plastic and Reconstructive Surgery and Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
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Wong AM, Chang CJ, Chen LR, Chen MM. Laser intraductal photocoagulation of bilateral parotid ducts for reducing drooling of cerebral palsied children: a preliminary report. JOURNAL OF CLINICAL LASER MEDICINE & SURGERY 1998; 15:65-9. [PMID: 9612179 DOI: 10.1089/clm.1997.15.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Previous reports suggested that surgical treatment was effective to reduce abnormal, profuse drooling in children with low cognitive function, but with risk of complications. Laser photocoagulation might be an option to simplify the procedure and decrease complications. Our study considered whether laser photocoagulation could improve drooling in children with cerebral palsy (CP). CP children with drooling were recruited from the pediatric rehabilitation clinic, all of whom had persistent profuse drooling after 6 months of conservative treatment. They received neodymium:yttrium aluminum garnet (Nd:YAG) laser for intraductal photocoagulation to bilateral parotid ducts, and were followed up for 2 to 3 months. Each patient was assessed before and after the procedure by: 1) questionnaire-based semiquantitative assessment of drooling severity and frequency (Thomas-Stonell and Greensberg 1988); 2) quantitative assessment of saliva amount by collection of stimulated saliva for 2 minutes in cooperative children. Six CP children with severe drooling received laser photocoagulation, five of them had remarkable decrease of drooling 1 month later. Patients had cool liquid intake soon after the procedure, and were discharged on the second day after treatment. A period of transient face swelling ranged from 6 to 37 days. No antibiotic treatment was indicated nor were any complications noted after the procedure. As a result of these studies, it is suggested that laser intraductal photocoagulation of bilateral parotid duct could be used as a simple and effective procedure for reducing drooling in CP children, and would avoid complications from conventional surgery.
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Affiliation(s)
- A M Wong
- Department of Physical Medicine and Rehabilitation, Chang Gung Childrens Hospital, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, R.O.C
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Abstract
Thirty-nine patients who had undergone transposition of the submandibular ducts and unilateral ligation of a parotid duct for saliva control were followed up six years after surgery. Overall improvement was documented according to a drooling quotient, drooling severity and drooling frequency measures. Despite this superficially favourable outcome, a significant proportion of patients (39 per cent) or their caregivers had not found the surgery helpful. Complications included ranula formation, complaints of dry mouth, difficulty with swallowing, and changes in the consistency of oral secretions. More knowledge is needed of the likely outcomes of this procedure in individual patients, so that appropriate advice can be given and complications minimised.
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Affiliation(s)
- K Webb
- Department of Child Development and Rehabilitation, Royal Children's Hospital, Parkville, Victoria, Australia
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Lespargot A, Langevin MF, Muller S, Guillemont S. Swallowing disturbances associated with drooling in cerebral-palsied children. Dev Med Child Neurol 1993; 35:298-304. [PMID: 8335144 DOI: 10.1111/j.1469-8749.1993.tb11641.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The oral stage of swallowing was studied in two groups of 10 cerebral-palsied (CP) children (one drooled and the other did not), and 10 normal children, aged six to 14 years. Small amounts of liquid (0.5 to 1mL) were placed under the tongue or behind the lower lip and intra-oral pressure was measured during the suction and propulsion stages. The CP children who drooled showed no abnormality in the propulsion of liquid towards the pharynx, but all showed abnormal suction of liquid onto the tongue. The difficulty seems to be associated with three types of disturbance: incomplete lip-closure during swallowing, low suction-pressure and prolonged delay between the suction and propelling stages.
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Affiliation(s)
- A Lespargot
- Laboratoire Perce-Neige, Augerville-la-Rivière, France
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