Four-duct ligation in children with drooling

Four-Duct Ligation for the Treatment of Sialorrhea in Children

“…7,12 Similar to previous findings, most of our patient caregivers reported a subjective reduction in the amount of saliva after 4-duct ligation. 8,9,11,12 The mean duration of effect herein was 52.6 months at the most recent follow-up, which is much longer than what has been reported for 4-duct ligation in the literature. 3,[7][8][9]11,12 As expected, the observed duration of effect is significantly longer than what has been observed for botulinum toxin A injections, which is approximately 4.5 months.…”

“…8,9,11,12 The mean duration of effect herein was 52.6 months at the most recent follow-up, which is much longer than what has been reported for 4-duct ligation in the literature. 3,[7][8][9]11,12 As expected, the observed duration of effect is significantly longer than what has been observed for botulinum toxin A injections, which is approximately 4.5 months. [13][14][15] Patients herein with a diagnosis other than CP were less likely to have an improvement at the 1-month follow-up.…”

“…In these instances, the 4-duct ligation procedure offers a minimally invasive technique that has been reported to be efficacious, is easy to perform, and causes few complications. 1,11 The procedure immediately decreases the volume of saliva entering the oral cavity. Over time, it is believed that the ligated glands eventually atrophy and cease to produce saliva.…”

“…In contrast, the sublingual and minor salivary glands continue to produce saliva and may upregulate saliva production to maintain dental health and prevent xerostomia. 10 After the first report on 4-duct ligation by Klem and Mair 9 in 1999, few studies 3,7,8,11,12 have assessed the safety and efficacy of the 4-duct ligation procedure ( Table 4). To our knowledge, the present study represents the largest cohort of children treated with the 4-duct ligation procedure and observed for a significant period.…”

A Review of Options for Treating Sialorrhea in Amyotrophic Lateral Sclerosis

“…The authors concluded that 4-duct ligation is effective in controlling moderate-tosevere sialorrhea in children. 69 Three-duct ligation procedures have also been described in the literature. 47 Unfortunately, duct ligation is not a permanent solution.…”