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Ha TAN, Shih MC, Lambert EM. Comparing botulinum toxin and 4-duct ligation for Sialorrhea in children - A systematic review. Am J Otolaryngol 2024; 45:104119. [PMID: 38043299 DOI: 10.1016/j.amjoto.2023.104119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/19/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION Sialorrhea or drooling can result in physical and psychosocial complications, such as aspiration and social isolation. Treatment options include botulinum toxin into the salivary glands and 4-duct ligation (i.e., simultaneous ligation of the bilateral parotid and submandibular ducts). This systematic review aimed to compare the efficacy and complication rates of botulinum toxin and 4-duct ligation for the treatment of drooling in children. METHODS Following PRISMA guidelines, PubMed, Embase, Web of Science, and Cochrane Library were searched from inception through June 17, 2021 for studies examining the efficacy of botulinum toxin or 4-duct ligation for drooling in children. Data were summarized by pooled counts, percentages, and means. Complication rates were compared by a chi-squared test. RESULTS A total of 22 studies (n = 606) examining botulinum toxin and 5 studies (n = 124) examining 4-duct ligation were included. From 12 botulinum toxin studies (n = 211), mean drooling frequency and severity scores was 7.5 at baseline. Mean difference from baseline was -2.6 (n = 92) at 4 weeks follow-up, -2.1 at 8 weeks (n = 41), -2.1 at 12 weeks (n = 56), and - 2.1 at 16 weeks (n = 58). From 4 4-duct ligation studies (n = 103), mean baseline drooling frequency and severity score was 8.4. Mean difference was -3.7 at mean follow-up of 35.6 months (n = 103). Eighteen botulinum studies (n = 343) recorded 53 (15.5 %) complications, including thickened saliva (n = 9), dysphagia (n = 4), and cheek abscesses (n = 4). Four 4-duct ligation studies (n = 108) recorded 25 (23.1 %) complications, including parotid gland swelling (n = 4), aspiration pneumonia (n = 3), and oxygen desaturation (n = 3). There was no statistically significant difference in complication rates between botulinum toxin and four-duct ligation (p = 0.065). CONCLUSION Botulinum toxin injection and 4-duct ligation are both effective in improving sialorrhea in children and have comparable complication rates.
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Affiliation(s)
- Tu-Anh N Ha
- Baylor College of Medicine, Bobby R. Alford Department of Otolaryngology, 1977 Butler Boulevard, Houston, TX 77030, USA; Texas Children's Hospital, Department of Surgery, Division of Otolaryngology, Houston, TX, USA
| | - Michael C Shih
- Baylor College of Medicine, Bobby R. Alford Department of Otolaryngology, 1977 Butler Boulevard, Houston, TX 77030, USA; Texas Children's Hospital, Department of Surgery, Division of Otolaryngology, Houston, TX, USA
| | - Elton M Lambert
- Baylor College of Medicine, Bobby R. Alford Department of Otolaryngology, 1977 Butler Boulevard, Houston, TX 77030, USA; Texas Children's Hospital, Department of Surgery, Division of Otolaryngology, Houston, TX, USA.
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Miller AL, Hysinger EB, Tabangin ME, Torres-Silva C, de Alarcon A, Hart CK. Pulmonary and Clinical Outcomes After Bilateral Submandibular Gland Excision and Parotid Duct Ligation for Refractory Sialorrhea. JAMA Otolaryngol Head Neck Surg 2024; 150:57-64. [PMID: 38008865 PMCID: PMC10666045 DOI: 10.1001/jamaoto.2023.3670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/01/2023] [Indexed: 11/28/2023]
Abstract
Importance Refractory sialorrhea in children can result in pulmonary aspiration and irreversible lung damage. Despite many studies devoted to the surgical treatment of sialorrhea, there is a paucity of objective outcome measures after surgery, especially with regard to pulmonary health. Objectives To assess whether bilateral submandibular gland excision and bilateral parotid duct ligation ("DROOL" procedure) is associated with reduced pulmonary inflammation in bronchoalveolar lavage (BAL) samples after surgery and to assess patient factors associated with improvement after surgery. Design, Setting, and Participants This retrospective case series included all 112 patients undergoing the DROOL procedure at a single tertiary care pediatric children's hospital from January 1, 2012, to December 31, 2021. Statistical analysis was performed from March 30 to June 10, 2023, and August 20 to September 23, 2023. Exposure DROOL procedure for refractory sialorrhea. Main Outcomes and Measures Degree of pulmonary inflammation (neutrophil percentage) according to BAL cytologic findings and overall bronchoscopy findings up to 12 months before and after the DROOL procedure. Secondary outcomes included number of annual hospitalizations, caregiver report of function before and after the procedure, and need for revision procedures and/or additional operations for secretion management. Results A total of 112 patients (median age, 3.4 years [IQR, 2.0-7.1 years]; 65 boys [58.0%]) underwent DROOL procedures and had both preoperative and postoperative BAL samples during the study period. Patients demonstrated objective improvement in pulmonary inflammation after surgery, with the median polymorphonuclear neutrophil percentage decreasing from 65.0% (IQR, 14.0%-86.0%) before the surgery to 32.5% (IQR, 3.0%-76.5%) after the surgery (median difference in percentage points, -9.0 [95% CI, -20.0 to 0.0]). Prior to the DROOL procedure, 34 patients (30.4%; 95% CI, 21.8%-38.9%) were hospitalized 2 or more times annually for respiratory illness, which decreased to 10.1% (11 of 109; 95% CI, 4.4%-15.7%) after surgery (3 patients did not have hospitalization data available following surgery). Most caretakers (73 [65.2%]) reported improved secretion management after the procedure. Conclusions and Relevance This study suggests that patients with impaired secretion management who underwent a DROOL procedure demonstrated improvement in pulmonary inflammation and a reduction in hospitalizations after surgery. Caretakers were also likely to report subjective improvement in secretion management and quality of life. Additional research is necessary to guide optimal timing and patient selection for this procedure.
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Affiliation(s)
- Ashley L. Miller
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Now with Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Erik B. Hysinger
- Aerodigestive and Esophageal Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Meredith E. Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Cherie Torres-Silva
- Aerodigestive and Esophageal Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Aerodigestive and Esophageal Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Catherine K. Hart
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Aerodigestive and Esophageal Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Zhang HR, Zhang DL, Yan XH, Zhang XP, Shang XL, Meng YB. [Clinical effect of free posterior interosseous artery perforator flap carrying superficial vein for reconstructing severe perioral scar hyperplasia and contracture]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2023; 39:1175-1179. [PMID: 38129305 DOI: 10.3760/cma.j.cn501225-20231031-00162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Objective: To observe the clinical effect of free posterior interosseous artery perforator flap carrying superficial vein for reconstructing severe perioral scar hyperplasia and contracture. Methods: The retrospective observational study method was used. From August 2019 to March 2023, 11 patients with severe perioral scar hyperplasia and contracture after severe facial burns who met the inclusion criteria were admitted to General Hospital of TISCO (the Sixth Hospital of Shanxi Medical University). All patients were male and aged 23 to 56 years, with an average age of 31.3 years. After the perioral scar was removed and released, the wound area was 3.0 cm×2.0 cm to 10.5 cm×2.0 cm. The free posterior interosseous artery perforator flap carrying superficial vein was used to repair the wound, and the flap incision area was 3.5 cm×2.5 cm to 11.0 cm×2.5 cm. Among them, 6 patients required repair of wounds after resecting scar around ipsilateral upper and lower lips, and the lobular treatment of the flap was conducted. The wound in the flap donor area was directly sutured. After surgery, the survival of the flap and the occurrence of vascular crisis were observed. During follow-up after surgery, the appearance, texture, and color of the flap, the appearance of the flap donor area, and improvements of crooked mouth, drooling, limited mouth opening, and lip valgus in patients were observed. Results: All the flaps in patients completely survived after surgery, with no occurrence of vascular crisis. During follow-up of 6 to 36 months after surgery, the flap was not significantly bloated, was soft in texture, and had a similar color to that of the normal facial skin. Only linear scars were left in the flap donor area, and crooked mouth, drooling, limited mouth opening, and lip valgus in patients were significantly improved. Conclusions: The free posterior interosseous artery perforator flap carrying superficial vein can reconstruct severe perioral scar hyperplasia and contracture, with low incidence of postoperative flap vascular crisis, and the lobular treatment of flaps can repair wounds around unilateral upper and lower lips at the same time. After surgery, the appearance and function of the perioral area are significantly improved. The flap is a good choice for repairing small area of severe perioral scar hyperplasia and contracture.
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Affiliation(s)
- H R Zhang
- Institute of Burns, General Hospital of TISCO (the Sixth Hospital of Shanxi Medical University), Taiyuan 030009, China
| | - D L Zhang
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - X H Yan
- Institute of Burns, General Hospital of TISCO (the Sixth Hospital of Shanxi Medical University), Taiyuan 030009, China
| | - X P Zhang
- Department of Orthopedics, Xiyang County Medical Group People's Hospital, Xiyang 045300, China
| | - X L Shang
- Department of Orthopedics, Xiyang County Medical Group People's Hospital, Xiyang 045300, China
| | - Y B Meng
- Institute of Burns, General Hospital of TISCO (the Sixth Hospital of Shanxi Medical University), Taiyuan 030009, China
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Chen DW, Billings KR, Ida JB, Lavin J, Ghadersohi S, Valika T. Salivary gland surgery and nonviral respiratory-related hospitalizations in children with neurodevelopmental impairment. Int J Pediatr Otorhinolaryngol 2022; 163:111362. [PMID: 36327912 DOI: 10.1016/j.ijporl.2022.111362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/31/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Neurodevelopmentally impaired (NI) children with chronic sialorrhea are at elevated risk for aspiration and respiratory tract infections. Direct resection or ligation ("DROOL") of the submandibular glands (SMG) with parotid duct ligation are surgical interventions intended to decrease salivary output. The objective of this study is to determine the impact of DROOL surgery on the incidence of nonviral respiratory-related (NVR) post-procedure hospital encounters including emergency department visits and admissions. METHODS Retrospective case series of NVR related outcomes after DROOL surgery in children performed at a single institution, tertiary referral center. RESULTS A total of 35 gastrostomy tube-dependent patients (60% male, average age 8.2 [SD 6.0] years) with NI underwent DROOL surgery (86% SMG excision). Pre- and post-surgical follow-up time was 3.6 and 3.2 years, respectively. Presurgical and postsurgical NVR hospital encounters occurred in 28 (80%) and 14 (40%) patients, respectively (p < 0.01). Mean (SD) postoperative NVR hospital encounters occurred less frequently when compared to presurgical period (0.4 [0.6] vs. 1.0 [1.2] per year, p < 0.01) with average change of -0.7 encounters per year (SD 1.4, 95% CI -1.0 to -0.2). Patients with encounters within a year preceding DROOL (OR 4.9, p = 0.04, 95% CI 1.1-22.8), or those with at least 3 preoperative encounters (OR 8.0, p = 0.01, 95% CI 1.6-40.3) were significantly associated with a postsurgical NVR event. Fewer patients used anti-sialorrhea medication postoperatively compared to preoperatively (60% vs. 17%, p < 0.01). No patient developed surgical site complications requiring operative interventions. CONCLUSIONS DROOL surgery for chronic sialorrhea in patients with NI was associated with decreased hospitalization and ED visits for NVR respiratory events post-procedurally. Sialorrhea may be an actionable source of recurrent respiratory illnesses requiring hospitalizations. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Diane W Chen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, IL, USA
| | - Kathleen R Billings
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, IL, USA
| | - Jonathan B Ida
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, IL, USA
| | - Jennifer Lavin
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, IL, USA
| | - Saied Ghadersohi
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, IL, USA
| | - Taher Valika
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Otolaryngology-Head and Neck Surgery, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Chicago, IL, USA.
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Chen CC, Wang SH, Lin SL. Modified Stair-Step Flap With Turnover Flap for Drooling Correction After Lower Lip Composite Defect Reconstruction. Ann Plast Surg 2021; 87:657-661. [PMID: 33625021 DOI: 10.1097/sap.0000000000002774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Oral commissure and buccal complex defects are commonly seen after cancer ablation. Free flap reconstruction can offer adequate soft tissue volume and outer skin lining. However, oral incompetence often occurs when an oral commissure has defects, particularly when the patient receives postoperative radiotherapy. The purpose of this article was to describe our method of the modified stair-step technique and improve the oral competence. METHODS This study involves 22 patients who had partial lower lip and/or upper lip defects and underwent flap reconstruction and/or postoperative radiotherapy resulting in oral incontinence. Fourteen patients had been treated with an anterolateral thigh flap, 7 patients had been treated with a radial forearm flap, and 1 patient had been treated with a fibular osteocutaneous flap. Our modified stair-step commissuroplasty was done in all cases, and a debulking procedure was done in each second operation. RESULTS Acceptable oral continence and contour were achieved in 19 patients. Some patients still had drooling after their second operation, but it was considerably less than before. CONCLUSIONS This technique is an easy procedure for revision of lower lip deformities after oral commissure reconstruction.
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Affiliation(s)
| | | | - Shih-Lung Lin
- Department of Plastic and Reconstructive Surgery, Changhua Christian Hospital, Changhua, Taiwan
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Yamaura M, Hayashi K, Shirato Y, Muto J, Kouchi K. [Bilateral submandibular gland excision for treatment of drooling in a child with mitochondrial encephalomyopathy]. No To Hattatsu 2017; 49:56-57. [PMID: 30011162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Marinho AS, Sousa C, Coelho A, Barbosa-Sequeira J, Recamán M, Carvalho F. [Bilateral submandibulectomy for the treatment of drooling in pediatric age: 10 years of experience]. Cir Pediatr 2016; 29:101-104. [PMID: 28393503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Sialorrhea is a medical problem and can become a social issue, common in children with neurological disabilities. The bilateral submandibulectomy is one of the available treatment options for managing this pathology. AIM OF THE STUDY The aim of this study is to evaluate the effectiveness of bilateral submandibulectomy in the management of sialorrhea in children with neurological disabilities through the parents' satisfaction grade. PATIENTS AND METHODS We retrospectively analyzed 91 bilateral submandibulectomies for a period of time of 10 years (2004-2015). Data were taken from surgical records and patients files and were informatically processed. The severity grade before and after surgery was evaluated in line with the modified Teacher scale. Parental satisfaction was evaluated by applying a scale graded into five classes, according to the degree of sialorrhea severity in postoperative period. RESULTS During the reporting period, 91 children underwent bilateral submandibulectomy in our center. Of these, 7 cases were excluded for lack of data. The average age of the children was 8,9 [± 3,5] years; 58,3% were male. The degree of preoperative sialorrhea severity was, in 52,4% of cases, level 4 (severe drooling), and in 28,6%, level 5 (very severe). The grade of parental satisfaction in postoperative period was ranked, in 73,8% of cases, between 81-100%. CONCLUSIONS For children with drooling, a bilateral submandibulectomy emerges as an effective and efficient treatment, leaving parents with an extremely high satisfaction grade.
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Affiliation(s)
- A S Marinho
- Serviço de Cirurgía Pediátrica, Centro Materno-Infantil do Norte. Departamento da Criança e Adolescência, Centro Hospitalar do Porto EPE. Porto (Portugal)
| | - C Sousa
- Serviço de Cirurgía Pediátrica, Centro Materno-Infantil do Norte. Departamento da Criança e Adolescência, Centro Hospitalar do Porto EPE. Porto (Portugal)
| | - A Coelho
- Serviço de Cirurgía Pediátrica, Centro Materno-Infantil do Norte. Departamento da Criança e Adolescência, Centro Hospitalar do Porto EPE. Porto (Portugal)
| | - J Barbosa-Sequeira
- Serviço de Cirurgía Pediátrica, Centro Materno-Infantil do Norte. Departamento da Criança e Adolescência, Centro Hospitalar do Porto EPE. Porto (Portugal)
| | - M Recamán
- Serviço de Cirurgía Pediátrica, Centro Materno-Infantil do Norte. Departamento da Criança e Adolescência, Centro Hospitalar do Porto EPE. Porto (Portugal)
| | - F Carvalho
- Serviço de Cirurgía Pediátrica, Centro Materno-Infantil do Norte. Departamento da Criança e Adolescência, Centro Hospitalar do Porto EPE. Porto (Portugal)
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Abstract
OBJECTIVES: To investigate the efficacy and quality of life impact of intra-oral surgery for sialorrhea and to provide long-term outcome measures. METHODS: A retrospective review and telephone survey of patients seen in a multi-disciplinary saliva control clinic who underwent surgery between 1999 and 2003. RESULTS: Sixteen of 31 patients underwent 4-duct ligation, 12 patients underwent submandibular gland duct ligation, and three patients underwent a 3-duct ligation procedure. The mean presurgical drooling score (maximum 10) was 9.5, 8.8, and 9, respectively. Recurrence was seen in 68% of patients at a mean of four months. Additional surgery was required in five patients. Phone survey was accomplished in 10 patients. Two of 10 caregivers reported sustained improvement of sialorrhea at two and three years. CONCLUSIONS: Intra-oral surgery provides minimal longterm control of sialorrhea. Additional medical and surgical therapy was needed in a significant portion of patients in this long-term review.
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Affiliation(s)
- Timothy J Martin
- Department of Otolaryngology, Division of Pediatric Otolaryngology, Children's Hospital of Wisconsin, Medical College of WI, Milwaukee, WI 53226, USA.
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Duan Y, Gao X, Luo X, Sun C. Evaluation of the efficacy of cervical perivascular sympathectomy on drooling in children with athetoid cerebral palsy. Eur J Paediatr Neurol 2015; 19:280-5. [PMID: 25662757 DOI: 10.1016/j.ejpn.2015.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 01/16/2015] [Accepted: 01/18/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the efficacy of cervical perivascular sympathectomy (CPVS) for drooling in children with athetoid cerebral palsy (ACP). METHODS The severity and frequency of drooling and the amount of salivation of 32 ACP children with drooling were evaluated before CPVS and at 4th, 12th and 24 weeks postoperatively by the teacher drooling scale (TDS) and salivary flow rate (SFR). RESULTS Fifteen children exhibited improvements on drooling according to the TDS score at 4th week after surgery (P < 0.05). Later, the number of children decreased to 10 at 12th week (P < 0.05) and to 8 at 24 week after surgery (P < 0.05). SFR was 0.67 mg/min at baseline, which decreased to 0.58 mg/min (P < 0.05) at 4th week after surgery. However, SFR showed a gradual increase at 12th week and 24 week with no significant difference. CONCLUSIONS Although CPVS was effective in improving drooling in some children with ACP, the results were not satisfactory. Thus, CPVS still needs to be cautiously used. Furthermore, more rigorous clinical studies should be performed to detect the effectiveness and safety of this procedure.
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Affiliation(s)
- Yu Duan
- Department of Cerebral Palsy Center, Sichuan Rehabilitation Hospital, Bayi road, Yongning Town, Wenjiang District, Chengdu, Sichuan, 611135, China
| | - Xing Gao
- Department of Functional Neurosurgery, Shanghai Tong Ren Hospital, # 1111, Xianxia road, Changning District, Shanghai, 200336, China
| | - Xiaoqi Luo
- Department of Functional Neurosurgery, Shanghai Tong Ren Hospital, # 1111, Xianxia road, Changning District, Shanghai, 200336, China
| | - Chengyan Sun
- Department of Cerebral Palsy Center, Sichuan Rehabilitation Hospital, Bayi road, Yongning Town, Wenjiang District, Chengdu, Sichuan, 611135, China; Department of Functional Neurosurgery, Shanghai Tong Ren Hospital, # 1111, Xianxia road, Changning District, Shanghai, 200336, China.
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Delsing CPA, Erasmus C, van der Burg J, van Hulst K, Jongerius PH, van den Hoogen FJA. [The treatment of drooling in children]. Ned Tijdschr Geneeskd 2014; 158:A7695. [PMID: 25115208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Undesirable drooling in children is an underexposed problem and difficult to treat, although there are multiple treatment options. A multidisciplinary approach is preferable for the examination and treatment of patients with drooling. The injection of botulinum toxin is the most frequently performed treatment for children who drool, but the effects are temporary. If drooling persists despite conservative treatment, surgical interventions performed by an otolaryngologist may be considered and may offer a more definitive solution.
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Chanu NP, Sahni JK, Aneja S, Naglot S. Four-duct ligation in children with drooling. Am J Otolaryngol 2012; 33:604-7. [PMID: 22682954 DOI: 10.1016/j.amjoto.2012.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 03/25/2012] [Accepted: 04/02/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The objective of this study is to assess the improvement in drooling in children undergoing 4-duct ligation procedure for excessive drooling and to study its effect on their quality of life. MATERIALS AND METHODS A prospective, nonrandomized interventional study was done between November 2009 and September 2011. Thirty drooling children of both sexes aged 4 to 15 years underwent 4-duct ligation, that is, ligation of bilateral submandibular ducts and bilateral parotid ducts. Comparison of preoperative and postoperative drooling scores using Thomas-Stonell and Greenberg classification was done. Glasgow Children's Benefit Inventory Score was used to assess the improvement in the quality of life. RESULTS Success rate in terms of improvement in drooling was 93.33%. A complication rate of 16.67% was found. The mean improvement in total drooling score after 12 months was 4.43. The paired t test applied on preoperative and postoperative combined drooling scores showed P < .001. The mean Glasgow Children's Benefit Inventory score was 36.15. In the postoperative period, transient swelling of cheeks, transient swelling of submandibular glands, change in the consistency of saliva, cheek abscess, collection of saliva in the cheek, and parotid duct fistula were observed. CONCLUSIONS Four-duct ligation causes marked improvement in drooling and significantly increases the quality of life in drooling children. It has few complications, which can be managed effectively.
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Affiliation(s)
- Ningthoujam Pinky Chanu
- Otorhinolaryngology and Head and Neck Surgery, LHMC and Associated Hospitals, New Delhi, India.
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13
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Celebiler Ö, Şirinoğlu H. A new method for the treatment of severe drooling: the four duct diversion: our experience in 8 children. Clin Otolaryngol 2012; 37:67-70. [PMID: 22433140 DOI: 10.1111/j.1749-4486.2011.02421.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Oliveira RS, Resende C, Campos J, Salgado C. [Surgical approach to sialorrhea: a casuistic review and evaluation of grade of satisfaction]. Cir Pediatr 2010; 23:211-214. [PMID: 21520552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Drooling or sialorrhea is the involuntary, passive spillage of saliva from the mouth due to inability to handle oral secretions. The medical, psychosocial and economic impact of drooling is underestimated. Treatment should always involve a multidisciplinary team and can include a medical or surgical approach. Various surgical techniques are used to manage drooling; re-routing of the salivary ducts is one of the preferred methods in more significant situations. OBJECTIVES To analyze retrospectively the group of children submitted to surgical correction of drooling in São Teotónio's Hospital and evaluate the clinical and caregiver satisfaction outcomes. MATERIAL AND METHODS We analyse the clinical process of children submitted to surgical correction of drooling. Satisfaction scores were obtained by phone interview. RESULTS Between January of 2003 and June of 2009, 16 child were submitted to surgical intervention for drooling, with a total of 17 surgeries. Most of them were males and have ages between 3 and 23 years, with the majority with ages between 10 and 15 years. All of them suffered from neurologic disease, mainly cerebral palsy. The majority were hospitalised for I to 2 days and no surgical complications were observed. In a significant percentage, good results were obtained and in 3 cases total resolution of drooling were reported. In about 44% of caregivers stayed very happy with the results of surgery. CONCLUSIONS Drooling is an important comorbility in child with neuro-muscular disease and is treatment can never be underestimated. By the analyses of the results of our surgical center, the re-routing of salivary ducts method reveals to be effective.
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Affiliation(s)
- R S Oliveira
- Departamento de Cirurgía Pedidtrica, Servicio de Pediatria, Hospital São Teotónio EPE, Viseu, Portugal.
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15
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van Onna M, van Laar T. [Treatment of drooling in patients with parkinsonism]. Ned Tijdschr Geneeskd 2010; 154:A2282. [PMID: 21083950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Between 50% and 60% of patients with parkinsonism suffer from severe drooling (sialorrhoea). Sialorrhoea is a major social problem with medical risks as well, e.g. aspiration pneumonia. Sialorrhoea is not caused by increased production of saliva, but by impaired swallowing, leading to storage of saliva in the anterior part of the mouth. Sialorrhoea can be treated by anticholinergics, botulinum toxin injections, surgery and radiotherapy of the salivary glands. The optimal treatment of sialorrhoea needs to be determined individually, for which a decision tree is available.
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Affiliation(s)
- Marieke van Onna
- Universitair Medisch Centrum Groningen, afd. Neurologie, Groningen, The Netherlands
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16
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Abstract
UNLABELLED Submandibular duct relocation plus or minus excision of the sublingual glands are relatively simple procedures with low morbidity. Between 1981 and 2005, 71 submandibular duct relocation and 29 submandibular duct relocation plus excision of the sublingual glands procedures were conducted. OBJECTIVES To compare both procedures including operative time, length of hospital stay, postoperative complications, drooling scores and parental satisfaction. STUDY DESIGN Prospective study. SETTING Paediatric tertiary referral centre. PARTICIPANTS Patients referred with excessive drooling after failure of conservative methods. EXCLUSION CRITERIA patients with recurrent aspiration pneumonias or dental caries. Two patients were lost to follow up and excluded from the study. RESULTS Operative time and length of hospital stay were increased in the submandibular duct relocation plus sublingual gland excision group. Drooling scores and parental satisfaction results were excellent, 93% of parents in the submandibular duct relocation group and 89% of parents in the duct relocation plus sublingual glands excision were satisfied and would recommend the procedure. There was no statistical difference (P = 0.643) in drooling scores between the two procedures. Postoperative morbidity was higher with the addition of sublingual gland excision, with postoperative haemorrhage occurring in 13.7% and 36% of parents expressing concern over postoperative pain, compared with 3% postoperative haemorrhage rate with submandibular duct relocation and only 12% of parents expressing the same concerns. CONCLUSION We conclude that both procedures are effective in drooling control, but the addition of sublingual gland excision increases morbidity and we are no longer excising these glands with submandibular duct relocation.
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Affiliation(s)
- F Glynn
- Childrens University Hospital, Temple Street, Dublin, Ireland.
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17
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Abstract
OBJECTIVE The efficacy of relocating the submandibular duct to treat drooling in children with cerebral palsy was studied. METHODS This was a prospective study to assess, using a visual analogue score by the parents of the patients, the efficacy of relocating the submandibular duct to treat drooling, comparing pre- and postoperative drooling. Complications were also recorded. RESULTS Eight children were included in this study. Their mean age was 9.75 years (range, 6-14 years). Seven patients (87.5%) had significant reduction of drooling (from a score of > or = 7 before surgery to < or = 2 after surgery). All the parents of the eight children (100%) were happy with the outcome and would recommend the procedure to the parents of other children. Mean length of hospital stay was 4 days (range, 2-7 days). Three patients developed complications; one patient developed ranula 1 month postoperatively. This was successfully treated by marsupialization. Two patients developed bilateral submandibular sialoadenitis 3 days postoperatively, which resolved with antibiotic therapy. CONCLUSION We conclude that this procedure is effective and safe in reducing drooling in patients with cerebral palsy.
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Manrique D, do Brasil ODOC, Ramos H. Drooling: analysis and evaluation of 31 children who underwent bilateral submandibular gland excision and parotid duct ligation. Braz J Otorhinolaryngol 2007; 73:40-4. [PMID: 17505597 PMCID: PMC9443591 DOI: 10.1016/s1808-8694(15)31120-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Accepted: 10/07/2006] [Indexed: 11/17/2022] Open
Abstract
Summary Aim: To evaluate the safety of bilateral submandibular gland excision and parotid duct ligation in order to control drooling in children; to assess its long-term efficacy and complications. Study design longitudinal cohort. Materials and Methods Thirty-one children aged 6 to 13 years (7.6 years old in average), with multiple neurological disabilities were submitted to a bilateral submandibular gland excision with parotid duct ligation in order to control ptyalism between December 1999 and December 2005, mean follow up of 36 months. Results According to Wilkie's success criteria, 87% of children had excellent or good results and insignificant morbidity was insignificant; with temporary parotid edema as the major complication. Conclusion Bilateral submandibular gland excision with parotid duct ligation were safe to be performed in children, with 87% of success in drooling control.
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Leibovitch I, Hoyama E, Limawararut V, Crompton J, Selva D. Novel Technique to Control Hypersecretion From a Transplanted Autologous Submandibular Salivary Gland for Keratoconjunctivitis Sicca. Cornea 2006; 25:1251-3. [PMID: 17172912 DOI: 10.1097/01.ico.0000225718.93006.44] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To present a novel technique to control hypersecretion from a transplanted autologous submandibular gland (SMG) in a patient with keratoconjunctivitis sicca. METHODS A 65-year-old man presented with corneal epithelial edema and suspicious ocular surface dysplasia secondary to hypersecretion from a transplanted autologous SMG. The location and function of the gland were evaluated perioperatively using technetium-99m-pertechnetate scintigraphy. The course of the duct was marked with a radiation probe, surgically exposed, and partially ligated with titanium clips. RESULTS Marked reduction in salivary flow and resolution of corneal edema and ocular surface changes were noted. Conjunctival biopsy showed no evidence of malignancy. Symptoms were stable during a 1-year follow-up period. CONCLUSION Partial ligation of the transplanted SMG duct may be a simple and reversible technique to control hypersecreting glands with secondary corneal edema and ocular surface changes.
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Affiliation(s)
- Igal Leibovitch
- Oculoplastic and Orbital Unit, Department of Ophthalmology and Visual Sciences, University of Adelaide, South Australia, Australia.
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20
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Syeda F, Ahsan F, Nunez DA. Quality of life outcome analysis in patients undergoing submandibular duct repositioning surgery for sialorrhoea. J Laryngol Otol 2006; 121:555-8. [PMID: 17078897 DOI: 10.1017/s0022215106004105] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/04/2006] [Indexed: 11/06/2022]
Abstract
Bilateral submandibular duct transposition is one of several surgical methods described to control sialorrhoea in the paediatric patient. The purpose of this study is to assess the effect of submandibular duct repositioning surgery on the quality of life of children using the Glasgow Benefit Inventory outcome measure. Consecutive children who underwent submandibular duct repositioning surgery were invited to participate in the study. The parents or guardians of children who gave consent were interviewed. The carer's opinion of the change in salivation, responses to the items in the Glasgow Benefit Inventory score and report of the complications were recorded. Nine children aged two and a half to 16 years were studied. The mean follow-up time was four years. The mean Glasgow Benefit Inventory score of +33 related to the procedure demonstrates that submandibular duct repositioning leads to a substantial measurable improvement in the quality of life (QoL) of the drooling child.
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Affiliation(s)
- F Syeda
- Department of Otolaryngology, Head & Neck surgery, Grampian University Hospitals NHS Trust, Aberdeen, UK
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Ethunandan M, Macpherson DW. Surgical management of drooling in a pediatric population. Plast Reconstr Surg 2006; 118:559-60; author reply 560. [PMID: 16874244 DOI: 10.1097/01.prs.0000229153.06310.c8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Arnaud S, Batifol D, Goudot P, Yachouh J. Nonsurgical Management of Traumatic Injuries of the Parotid Gland and Duct Using Type A Botulinum Toxin. Plast Reconstr Surg 2006; 117:2426-30. [PMID: 16772951 DOI: 10.1097/01.prs.0000219132.34809.ae] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Sébastien Arnaud
- Department of Maxillofacial Surgery, Lapeyronie University Hospital, Montpellier, France.
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23
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Abstract
Drooling is common in patients with neurological disability and a major factor affecting quality of life. Management of this problem is best carried out by a team approach using surgical and non-surgical methods. Submandibular duct relocation is a commonly performed procedure with low complication rate. This procedure has been carried out in 56 patients over the last 14 years at the Belfast City Hospital by the senior author. All the patients underwent physiotherapy for six months before they were selected for surgery. All the patients were over five years of age and most had severe neurological impairment. For the purposes of this study, all the patients were followed by a questionnaire regarding symptomatic improvement, parent satisfaction and complication rate. All case notes were also reviewed retrospectively.Parental satisfaction was high and drooling was significantly reduced in 49 cases. The main complication was ranula formation seen in five cases. The most significant area of parental concern was post-operative pain. It is important to counsel the parents regarding the post-operative pain relief as well as failure rate of the procedure. It can be concluded that this procedure is a safe and highly successful procedure, which significantly improves the quality of life.
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Affiliation(s)
- Mriganka De
- Department of Otolaryngology, Belfast City Hospital, Belfast.
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24
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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25
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Abstract
Sialorrhoea (drooling or excessive salivation) is a common symptom of many neurological diseases (e.g., amyotropic lateral sclerosis, cerebral palsy and Parkinson's disease) and otolaryngologic diseases (tumours of upper aerodigestive tract). It is mostly caused by poor oral and facial muscle control in patients with swallowing dysfunction (secondary sialorrhoea). However, some cases of sialorrhoea are due to hypersecretion of saliva. These cases represent so-called primary sialorrhoea.
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Affiliation(s)
- Anna Potulska
- Medical University, Warsaw, Department of Neurology, Poland
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26
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McAloney N, Kerawala CJ, Stassen LFA. Management of drooling by transposition of the submandibular ducts and excision of the sublingual glands. J Ir Dent Assoc 2005; 51:126-31. [PMID: 16167621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
STATEMENT OF THE PROBLEM Persistent drooling is common in patients with neurological impairments such as cerebral palsy. Although it may be induced by an excess of saliva, it usually results from incontinence secondary to impaired cerebral control of orofacial function. Various techniques, both medical and surgical, exist to combat the problem. The patient should have a course of conservative management initially (head position, education and training, suction aids, bio-feedback and support). Non-surgical managements and medical treatment should start as early as possible. Surgery has a place, when conservative and medical treatments (drugs/botulinum toxin) have failed. PURPOSE OF THE STUDY Patients subjected to some of the more radical surgical methods may develop complications of the procedures themselves, it is important therefore that any intervention is based on sound principles. Physiology predicts that the most benefit would be derived from diversion of submandibular rather than parotid salivary flow (Fig. 1). MATERIALS AND METHODS To assess the effect of bilateral transposition of the submandibular ducts combined with excision of the sublingual glands as a treatment for drooling, a retrospective survey of 21 patients was undertaken by contacting their carers and reviewing the clinical notes. RESULTS Sixteen out of 21 patients had good to excellent control of their drooling with minimal side-effects and low morbidity. CONCLUSION Drooling should be managed with a team approach using non-surgical management in the first instance. Surgery has a place and can be beneficial with few long-term side effects. Patients require long-term paedontic/dental follow up to maintain a healthy oral cavity.
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Affiliation(s)
- N McAloney
- Department of Oral and Facial Surgery, Sunderland Royal Hospital, Kayll Road, Sunderland, Tyne and Wear, SR4 7TP, England
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Abstract
PATIENT We report the case of a 49 year old female patient who suffered from frequent secretion of the left external canal of the ear after the treatment of a chronic mycotic otitis externa. The secretion was seen in connection with food intake. An operative revision in another hospital remained without success. The diagnostics covered the biochemical verification of saliva-amylase in the secretion, but also a high resolution MRI of the parotid gland. By this diagnostics it was easy to locate the salivary fistula during the operation. DISCUSSION Salivary fistulas of the parotid gland to the external ear-canal are very rare. These fistulas develop after injury of the parenchyma or the gland ductus and also after surgery of the head- and neck-region. A otosialorrhoea rarely originates from a chronic inflammatory of the ear canal. These fistulas are assigned to the fissures of Santorini and the foramen of Huschke. The therapy of salivary fistulas to the external ear canal reaches from clossure of the fistula to total parotidectomy. But also a medicamental suppression of salivation, irradiation and a tympanic neurectomy are discussed in the literature.
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Affiliation(s)
- J Langer
- Klinik für Hals-Nasen-Ohrenheilkunde des St. Salvator-Krankenhauses Halberstadt gGmbH.
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28
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Ondzotto G, Galiba J. [Hypersialorrhea in mental retardation: interest of salivary denervation]. Odontostomatol Trop 2004; 27:27-8. [PMID: 15536718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Hypersialorrhea with mental retardation is a handicapping clinical situation with a greater psychoaffective impact and a risk of dyspneic attack by a pharyngeal salivary stasis and a disappointing treatment. We report an observation about a 22 years old child; as for as this child is concerned, the treatment has been a salivary denervation. This method is simple, efficient and without risk.
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Affiliation(s)
- G Ondzotto
- Service O.R.L--B.P 13356 C.H.U de Brazzaville--Congo
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Hockstein NG, Samadi DS, Gendron K, Handler SD. Sialorrhea: a management challenge. Am Fam Physician 2004; 69:2628-34. [PMID: 15202698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Sialorrhea (drooling or excessive salivation) is a common problem in neurologically impaired children (i.e., those with mental retardation or cerebral palsy) and in adults who have Parkinson's disease or have had a stroke. It is most commonly caused by poor oral and facial muscle control. Contributing factors may include hypersecretion of saliva, dental malocclusion, postural problems, and an inability to recognize salivary spill. Sialorrhea causes a range of physical and psychosocial complications, including perioral chapping, dehydration, odor, and social stigmatization, that can be devastating for patients and their families. Treatment of sialorrhea is best managed by a clinical team that includes primary health care providers, speech pathologists, occupational therapists, dentists, orthodontists, neurologists, and otolaryngologists. Treatment options range from conservative (i.e., observation, postural changes, biofeedback) to more aggressive measures such as medication, radiation, and surgical therapy. Anticholinergic medications, such as glycopyrrolate and scopolamine, are effective in reducing drooling, but their use may be limited by side effects. The injection of botulinum toxin type A into the parotid and submandibular glands is safe and effective in controlling drooling, but the effects fade in several months, and repeat injections are necessary. Surgical intervention, including salivary gland excision, salivary duct ligation, and duct rerouting, provides the most effective and permanent treatment of significant sialorrhea and can greatly improve the quality of life of patients and their families or caregivers.
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Affiliation(s)
- Neil G Hockstein
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
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Abstract
OBJECTIVE Sialorrhea can have a significant negative effect on quality of life, impeding social interactions and severely limiting employment opportunities. Many surgical options to control sialorrhea have been reported. One of the newest procedures is combined ligation of the submandibular and parotid ducts, reported only once in the literature in one series of five patients to date. We have compared results in our first 21 patients undergoing this procedure with results reported in the literature for other procedures to treat sialorrhea. MATERIALS AND METHODS We retrospectively reviewed medical records of all 21 children we treated with four-duct ligation, a relatively simple intraoral procedure to control sialorrhea, between August 1999 and September 2000 and contacted primary caregivers by telephone to answer a questionnaire regarding objective and subjective results of surgery. Surgery was considered successful when caregivers rated patients as 'much better' or 'better' after surgery. RESULTS Follow-up was completed in all 21 of the patients 1-14 months after surgery. The success rate of four-duct ligation ('much better' or 'better' after surgery) was 81%, and no patient's sialorrhea problem was worse after surgery. Major complications occurred in two (10%) of the patients (one ranula and one case of sialoadenitis), which were both successfully treated surgically. Minor complications occurred in four (19%) of the patients, tongue swelling that prolonged hospitalization, a ranula that resolved, and prolonged submandibular gland swelling that resolved (two cases). More than half of patients were discharged the day of or the day after surgery. CONCLUSIONS Four-duct ligation should be considered when surgery is indicated to treat sialorrhea.
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Affiliation(s)
- W Peyton Shirley
- Department of Pediatric Otolaryngology, Children's Hospital of Alabama, 1600 Seventh Avenue South ACC320, Birmingham, AL 35233, USA
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31
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Abstract
Spontaneous salivary fistulas are rare. Extremely rare are spontaneous salivary fistulas of the external auditory canal. We report a case of otorrhoea caused by such a fistula in connection with defects of the cartilagenous and the osseous external auditory canal (Fissures of Santorini, foramen of Huschke) and its successful surgical treatment.
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Affiliation(s)
- R Chilla
- HNO-Klinik ZKH St. Jürgen-Strasse, Bremen, Germany
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Ozgenel GY, Ozcan M. Bilateral parotid-duct diversion using autologous vein grafts for the management of chronic drooling in cerebral palsy. Br J Plast Surg 2002; 55:490-3. [PMID: 12479422 DOI: 10.1054/bjps.2002.3884] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Chronic drooling is a major problem in patients with cerebral palsy and other neurological dysfunctions. Various treatments, ranging from speech therapy to radical surgery, have been used to overcome this distressing problem, with surgery the most consistently successful. In this study, we used a new surgical technique to manage severe drooling. This involved the dissection of both parotid-duct orifices, and their relocation, via a submucosal tunnel, into the tonsillar pillar using autologous vein grafts. Four patients were treated using this technique together with bilateral submandibular duct rerouting. The results were analysed by subjective judgements of drooling and retrograde sialography at 90 days postoperatively. In all cases, salivary flow was reduced and drooling was significantly improved. Retrograde sialography revealed no signs of obstruction or stricture formation in any of the cases. No postoperative complications occurred. These preliminary results suggest that the bilateral surgical transposition of Stensen's ducts into the tonsillar pillar using autologous vein grafts together with bilateral submandibular duct rerouting can provide effective control of chronic drooling.
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Affiliation(s)
- G Y Ozgenel
- Department of Plastic and Reconstructive Surgery, Medical Faculty of Uludağ University, Bursa, Turkey
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Stern Y, Feinmesser R, Collins M, Shott SR, Cotton RT. Bilateral submandibular gland excision with parotid duct ligation for treatment of sialorrhea in children: long-term results. Arch Otolaryngol Head Neck Surg 2002; 128:801-3. [PMID: 12117339 DOI: 10.1001/archotol.128.7.801] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Multiple procedures have been advocated for the surgical control of chronic sialorrhea in children. However, some of them are associated with significant complications or only short-term success. OBJECTIVES To evaluate the safety of bilateral submandibular gland excision (SGE) with parotid duct ligation (PDL) and to assess its long-term complications and efficacy in the treatment of chronic sialorrhea in children. DESIGN Case series. Telephone interview of patients' families. SETTING Tertiary care children's hospital. PATIENTS Ninety-three patients with chronic sialorrhea who underwent bilateral SGE with PDL from 1988 to 1997. MAIN OUTCOME MEASURES Operative and postoperative complications, length of postoperative hospitalization, postoperative drooling, care requirements, xerostomia, dental caries, and overall satisfaction. RESULTS The mean postoperative stay was 2.4 days. There were 3 postoperative complications. Seventy-two families were interviewed (follow-up time, 1-10 years): 62 (87%) reported no further drooling or significant improvement; 7 reported the occurrence of dry mouth; and 2 reported an increase in dental caries. CONCLUSION Bilateral SGE with PDL is a safe and consistently efficient procedure for the treatment of chronic sialorrhea in children.
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Affiliation(s)
- Yoram Stern
- Department of Pediatric Otolaryngology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petah Tiqva 49 202, Israel.
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Abstract
From 1975 to 1 January 1999, 1103 neurologically involved patients (mean age 13.2 years; 686 males, 417 females) referred with problematic drooling, or sialorrhea, were assessed at a pediatric rehabilitation center by a team consisting of an otolaryngologist, speech pathologist, and a dentist. The initial standard treatment for persistent sialorrhea (in the compliant or aware patient) is oral-motor training. A group of 522 patients with persistent significant drooling after a minimum of 6 months of oral-motor training, or profuse drooling in the presence of a low cognitive level, underwent surgery, usually when over 6 years of age. From 1978 to 1 January 1998, the operation of first choice was submandibular duct relocation (SDR), and was completed in a total of 226 patients. Midway through 1988, sublingual gland excision was also completed at the time of submandibular duct relocation (SDRSGE); 249 of these procedures have been completed to January 1st 1999. Those patients who had SDRSGE had significantly fewer complications that required additional surgery than those that had SDR only. However, the impact of surgery on the drooling as evaluated in subsets of both groups (SDR n=115, SDRSGE n=106) was statistically similar. The study of 11 children with salivary gland radionuclitide scans to determine the effect of submandibular duct surgery on gland function was inconclusive. The pattern of oral-motor function in 26 children studied after SDRSGE surgery suggested that those children with severe impairment of volitional motor function and profuse drooling tended to have a poorer outcome following surgery compared to those with milder impairments.
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35
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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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36
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Abstract
Drooling is an important factor affecting the quality of lives of neurologically impaired children, and surgery often has to be performed. Submandibular duct relocation is a relatively simple procedure with a low complication rate, and has been carried out on 37 patients at the Sheffield Children's Hospital between 1986 and 1998. To determine the short-term and long-term outcome of this procedure, a questionnaire was sent to the parents/wards of the patients. Feedback was also obtained on complications, parents'/carers' perceptions and main concerns about the operation, particularly in those cases which did not improve. Both short-term (82.4%) and long-term (76.5%) control rates were high, and there were few complications, none of which had any long-term adverse effects. The most significant area of parental/carer dissatisfaction and concern in 'failed' cases was 'pain', and it was felt that proper preoperative counselling about analgesia and chances of failure is very important. We conclude that this is a safe, highly successful procedure which significantly improves the quality of lives of the majority of drooling children.
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Affiliation(s)
- A Panarese
- Department of Otolaryngology, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
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37
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Ozgenel GY, Ozcan M, Kahveci Z. An experimental study of bilateral repositioning of the Stensen's duct orifices with autologous vein and artery grafts in dogs. Br J Plast Surg 2000; 53:106-8. [PMID: 10878831 DOI: 10.1054/bjps.1999.3221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sialorrhoea is an indication of dysfunction in the coordination of the swallowing mechanism. Disturbance in this coordination results in excess pooling of saliva in the anterior mouth and resultant drooling. Several surgical techniques have been described for the management of sialorrhoea. In this experimental study, we planned to try a more safe and physiologic technique by repositioning of the parotid duct orifices into the glossopalatal arch, using autologous free grafts of vein and artery in dogs. Ten adult dogs were used. In each dog, both of the parotid duct orifices were included in the study. The surgical procedure involved the dissection of both parotid duct orifices and their relocation via a submucosal tunnel into the glossopalatal arch, using a vein graft for the right side and an artery graft for the left side. Functional assessment was based on the clinical observations and retrograde sialography done on the 60th day. Results were excellent. No stricture or obstruction was noted. Histological examinations done on the 90th day showed the replacement of endothelium by multilayered cubic Stensen's duct epithelium in both artery and vein grafts. There was no difference between the results of artery and vein grafts. Surgical transposition of Stensen's duct into the glossopalatal arch with autologous vein or artery graft is a safe technique which may be used in clinical cases of drooling as an alternative to the other techniques described.
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Affiliation(s)
- G Y Ozgenel
- Department of Plastic and Reconstructive Surgery, Medical Faculty of Uludağ University, Bursa, Turkey
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38
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Abstract
The experience of the surgical treatment of drooling in the 12-year period 1985-1997 has been retrospectively reviewed. Details of 71 out of a total of 79 patients were available. Of these, 69% underwent bilateral submandibular duct diversion and unilateral parotid duct ligation. Excellent or good control of drooling was obtained in 65 patients (92%) which compares favourably with other series. A ranula occurred in 10% and settled spontaneously. Transient airway obstruction occurred in one patient.
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Affiliation(s)
- S W Wilson
- Department of Plastic Surgery, St James' Hospital, Leeds, UK
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39
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Abstract
OBJECTIVES To determine the effectiveness of bilateral submandibular and parotid duct ligation on children with severe neuromuscular impairment and chronic aspiration of salivary secretions and to identify any predictable anatomical connections between the submandibular duct and sublingual glands. DESIGN Case series; retrospective anatomical study of adult cadaveric submandibular gland specimens. SETTING Academic tertiary referral medical center. PATIENTS Five children with severe neuromuscular impairment and recurrent aspiration pneumonitis. INTERVENTION The children underwent bilateral submandibular and parotid duct ligation. The oral cavities of 8 cadavers were dissected to identify anatomical connections between the submandibular duct and sublingual glands. MAIN OUTCOME MEASURES Incidence of postoperative aspiration pneumonitis; gross anatomical connections between the submandibular duct and sublingual gland in cadaveric specimens. RESULTS No postoperative airway obstruction, infection, or xerostomia was noted, and technetium scanning confirmed control of salivary secretions from major salivary glands. Caregivers noted diminished salivary secretions and no aspiration pneumonia. CONCLUSIONS This new, simple intraoral procedure controls aspiration pneumonitis with minimal surgical dissection and has less morbidity than procedures involving major salivary gland excision. Ranula formation, a common complication of submandibular duct transposition, is unlikely in this procedure because the sublingual ducts are not interrupted.
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Affiliation(s)
- C Klem
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA
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40
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Mankarious LA, Bottrill ID, Huchzermeyer PM, Bailey CM. Long-term follow-up of submandibular duct rerouting for the treatment of sialorrhea in the pediatric population. Otolaryngol Head Neck Surg 1999; 120:303-7. [PMID: 10064629 DOI: 10.1016/s0194-5998(99)70266-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the long-term control of sialorrhea in children who underwent submandibular duct rerouting (SMDR) and to identify potential preoperative predictors of outcome. DESIGN Retrospective chart review of children who underwent SMDR; information updated by discussion with the permanent caregiver. SETTING Tertiary care center. PATIENTS Children who had significant sialorrhea resulting from a variety of neuromuscular disabilities between January 1980 and December 1995. OUTCOME We report the outcome on 59 patients who underwent SMDR for the treatment of sialorrhea. Patients were ascribed a preoperative sialorrhea and global neurologic deficit score. Postoperative outcome was scored as marked, moderate, no improvement, or worse. Twenty-eight of 59 (47.4%), 28 of 59 (47.4%), and 3 of 59 (5.1%) of the patients had preoperative sialorrhea scores of 3 (profuse), 2 (moderate), and 1 (mild), respectively. Twenty of 59 (33.9%), 29 of 59 (49.2%), and 10 of 59 (16.9%) had preoperative scores of 3 (severe), 2 (moderate), and 1 (mild) neurologic impairment, respectively. Mean time to follow-up of the 59 patients was 5.46 years. Postoperative improvement scores were as follows: 50.8% had marked, 28.8% had moderate, and 20% had no to minimal improvement in their sialorrhea. Two patients were transiently worse. A complication rate of 11.3% (9 of 79) was demonstrated: 7 ranulae, 1 transient swelling of the floor of the mouth, and 1 submandibular gland infection. The preoperative global neurologic deficit score was found to be more predictive of surgical outcome than sialorrhea score.
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Affiliation(s)
- L A Mankarious
- Department of Otolaryngology-Head and Neck Surgery, Great Ormond Street Hospital for Children, London, England
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Ethunandan M, Macpherson DW. Persistent drooling: treatment by bilateral submandibular duct transposition and simultaneous sublingual gland excision. Ann R Coll Surg Engl 1998; 80:279-82. [PMID: 9771232 PMCID: PMC2503077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Persistent drooling in a neurologically impaired patient is often multifactorial and various treatment modalities have been employed to overcome this distressing condition. This study analysed the outcome after bilateral submandibular duct transposition and simultaneous sublingual gland excision in 20 patients with persistent drooling treated between January 1989 and July 1994. Twelve were male and eight were female and were aged 5 years to 40 years. The outcome was considered much better/excellent in 11 cases (55%), better/good in eight cases (40%), no significant improvement in one case (5%) and none were considered worse after the procedure, in the 'early' postoperative period. Long-term results, judged by an 18-point questionnaire sent to the carers after an average duration of 3.2 years post-operatively, were available for 19 patients. In all, 16 carers (84%) felt the drooling had significantly reduced, and three carers (16%) felt that there was no improvement. The three patients who were considered not to have improved were all found to have made a 'good' improvement in the early post-operative period. The morbidity associated with the procedure was of a mild and transient nature and there was a complete absence of ranula formation in our series. The procedure was well accepted by the carers, who were also willing to recommend the procedure to others with a similar problem.
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Affiliation(s)
- M Ethunandan
- Maxillofacial Unit, St Richard's Hospital, Chichester, West Sussex
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42
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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. J Clin Laser Med Surg 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] [What about the content of this article? (0)] [Affiliation(s)] [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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43
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Karas ND. Surgery of the salivary ducts. Atlas Oral Maxillofac Surg Clin North Am 1998; 6:99-116. [PMID: 11905352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Successful surgery of the salivary ducts relies on an understanding of the surrounding anatomy and the delicate dissection of tissues in order to reduce morbidity. Trauma to the ducts should be assessed when lacerations or wounds encroach on their paths. Early diagnosis and treatment will reduce the complications of stricture and fistula formation from these injuries. Sialoliths can be located in several places along the length of the salivary ducts. The correct diagnosis and positioning of the stone in the duct is important in establishing the appropriate surgical approach. Imaging using plain films, ultrasonography, and endoscopy can be very valuable, with sialography and CT scans helpful in cases of radiolucent stones, glandular atrophy, or suspected tumor. As the condition becomes more chronic, resulting in glandular atrophy, excision of the diseased gland is often indicated. Treatment of excessive salivary flow in patients with cerebral palsy can be managed by a combination of ductal repositioning and glandular excision. Redirection of both the parotid and submandibular glands can be accomplished, either to reroute excess salivary flow or salvage the duct in cases of lesion excision.
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Affiliation(s)
- N D Karas
- Department of Oral and Maxillofacial Surgery, University of California, San Francisco, San Francisco, California, USA
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44
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Abstract
Drooling is rarely seen in the normal child after the age of 6 months, but an estimated 10% of children with neurological impairment suffer significant interference with everyday living due to excessive drooling. Submandibular duct relocation is a procedure that involves the dissection and re-routing of the submandibular ducts to the posterior tonsilar pillar. This procedure has been carried out on 53 patients over the past 15 years at the Childrens Hospital, Dublin. All patients have been followed up with a detailed questionnaire to determine symptomatic improvement, parent satisfaction and complications. Parental satisfaction regarding this procedure is high, with 94% of parents stating that their child had benefited from the operation and over half the parents reported complete cessation of all drooling within 3 months of the operation. The major complication of post-operative pneumonia presumed secondary to salivary aspiration occurred in three children. These patients all made a full recovery. Early minor complications occurred in two children, involving post-operative submandibular gland swelling, and the late complication of a ranula was seen in four patients. We believe this is a safe and highly successful procedure that can significantly improve the quality of life of these children.
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Affiliation(s)
- T P O'Dwyer
- Department of Otolaryngology, Childrens Hospital, Dublin, Ireland
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45
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Abstract
The authors performed six sialodochoplasties between 1991 and 1994 to treat drooling in six children who suffered from cerebral palsy. There were three boys and three girls, aged 13 to 22 years (mean, 16 years). All patients underwent parotid duct rerouting. The first four patients (group I) also underwent associated excision of submandibular ducts, and the last two patients (group II) benefited from rerouting of the submandibular ducts. In group I, results were considered good in two cases, fair in one case, and poor in one case. A fistula of the new Stenon duct appeared in one patient, which required excision and ligation followed by progressive involution of the parotid gland. Both group II patients had excellent and rapid results. The requirements leading to surgical decision are determined. The importance of physiotherapy is emphasized. Surgical techniques are described and discussed, as are objective criteria for the assessment of surgical results, namely salivary radioisotopic scanning.
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Affiliation(s)
- F Becmeur
- Pediatric Surgery Service, Strasbourg University Hospitals, France
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46
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Abstract
Drooling occurs commonly in children with cerebral palsy (CP). Surgical procedures, known as slalodochoplasties, are often performed for the control of drooling. These include major salivary gland excision, parasympathetic nerve section, duct ligation, and duct re-routing. Alterations in saliva amount, flow, and consistency occur following sialodochoplasty, and the resultant effect on dental homeostasis requires further investigation. This controlled study investigated 19 children with CP following sialodochoplasty (surgery group) and 75 children with CP treated nonsurgically (control group) who attended our hospital. Dental caries experience-including dmft, DMFT, and partial DMFS scores of mandibular incisors and canines only-plaque index, and enamel developmental defects index were recorded. Saliva buffering capacity and bacterial counts were assessed. The surgical group (median DMFT = 5.00) had significantly more dental caries when compared with the control group (median DMFT = 0.00), Wilcoxon Signed-rank Test, P < 0.0001. This study has shown that children with CP following sialodochoplasty have increased risk of dental caries when compared with those treated nonsurgically for drooling. Although no caries predictors were identified, alterations to the caries-protective role of saliva are considered the likely cause. Children who undergo this procedure should receive intensive pre- and postsurgical preventive dental therapy.
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Affiliation(s)
- K B Hallett
- Department of Child Development and Rehabilitation, Royal Children's Hospital, Australia
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47
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Abstract
Intraoperative ultrasonography was used in six horses to aid localization and removal of bone fragments (3 horses) and foreign bodies (3 horses). The ultrasound transducer was enclosed in a sterile sleeve containing sterile aqueous gel and the examination was performed after aseptic preparation of the surgical site. Using ultrasound guidance a needle was placed in contact with the bone fragment or foreign body and an incision was made along the path of the needle to expose and remove the object. This technique resulted in decreased operative time and minimal tissue dissection.
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Affiliation(s)
- P L Rose
- Tufts New England Veterinary Medical Center, North Grafton, MA 01536, USA
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48
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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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49
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Affiliation(s)
- L M Wolford
- Baylor College of Dentistry, Dallas, TX, USA
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50
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Abstract
Few adverse effects of the surgical treatment of drooling are reported in the literature. This report describes a young man with severe extrapyramidal cerebral palsy and profuse drooling whose oral feeding behavior deteriorated following bilateral submandibular gland excision and parotid duct rerouting. Before surgery the patient had safe, functional oral feeding skills, and eating was enjoyable. Following surgery he developed progressive feeding difficulties, weight loss, and aspiration pneumonia. His deterioration led to the placement of a feeding gastrostomy and the end of all oral feedings. Surgery had a disturbing and apparently irreversible negative impact on the patient's quality of life.
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Affiliation(s)
- R D Stevenson
- Kluge Children's Rehabilitation Center, Department of Pediatrics, Charlottesville, VA 22903
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