Chronic Aspiration in Children: When Are Bilateral Submandibular Gland Excision and Parotid Duct Ligation Indicated?

Salivary gland surgery for control of chronic pulmonary aspiration in children with cerebral palsy

“…In the children evaluated and treated in this study, we observed that the reduction of saliva was related to a decrease in LRTI episodes, with this treatment being an effective alternative in the reduction of pulmonary infections when aspiration of saliva is a risk factor for developing pneumonia. Among the surgical treatments for controlling sialorrhea, the most common are surgery of the four ducts ligation (submandibular and parotid) and submandibulectomy associated with the ligation of the parotid duct [12][13][14][15]. Two retrospective studies resulted in a reduction of hospitalizations and of LRTI after surgery for the reduction of saliva [12,14].…”

“…Among the surgical treatments for controlling sialorrhea, the most common are surgery of the four ducts ligation (submandibular and parotid) and submandibulectomy associated with the ligation of the parotid duct [12][13][14][15]. Two retrospective studies resulted in a reduction of hospitalizations and of LRTI after surgery for the reduction of saliva [12,14]. In another study, surgery of the salivary glands did not influence the rate of LRTI, though there was a significant improvement in the basal saturation of oxygen [16].…”

Advances in the diagnosis and management of chronic pulmonary aspiration in children

“…Another potential treatment for aspiration of oral secretions involves the ligation and/or removal of salivary glands. Bilateral ligation of submandibular and parotid ducts or excision of submandibular glands with parotid duct ligation have been reported in children [119][120][121][122]. Both procedures are effective at reducing sialorrhoea (table 5).…”

“…STERN et al [120] reported persistent significant improvement in both quality of life and sialorrhoea at a mean follow-up of 4.2 yrs. Two retrospective studies [119,121] have documented a significant decrease in numbers of hospitalisations and lower respiratory tract infections following the procedure. Prospective trials are needed to determine whether there is a significant benefit of surgery to improve chronic salivary aspiration and how this effect might compare with botulinum injection.…”

Salivary gland surgery for chronic pulmonary aspiration in children

“…This reflex has been observed in utero as early as 16 weeks of gestation [3,4]. However, neuromuscular maturation is not sufficient to achieve effective oral feeding until 34 weeks of gestation.…”