Long‐tfrm Outcome of Saliva‐control Surgery

Abstract

SUMMARY 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. RÉSUMÉ Devenir à long terme du contrôle chirurgical du bavage Trente‐neuf patients ayant béneftcié d'une transposition des canaux sous‐maxillaires et d'une ligature unilatéral du canal de Sténon pour un contrôle de la salivation, furent suivis jusqu'à six ans aprés la chirurgie. Un bénéfice global fut notéà partir du quotient de bavagé, et des mesures de gravite et de fréquence du bavage. En dépit de cette évolution globalement favourable, une proportion significative de patients (39 pour cent) ou des personnes les prenant en charge, n'estimaient pas que la chirugie avail été bénéfique. ZUSAMMENFASSUNG Langzeitergebnisse nach chirurgischer Intervention zur Speichelfluflkontrolle 39 Patienten, bei denen eine Transposition de Submandibularisgänge und eine einseitige Ligatur eines Parotisganges zur Speichelflußkontrolle durchgeführt worden waren, wurden bis zu sechs Jahre postoperativ nachuntersucht. Die allgemcine Besserung wurde anhand eines Speichelflußquoticntcn, des Schweregrades und der Häufigkeit des Specichelflusses dokumentiert. Trotz des scheinbar günstigen Outcomes empfanden cine signifikante Anzahl von Patienten (39 Prozent) odern ihre Betreuer den ehirurgischen Eingriff als nicht erfolgreich. Zu den Komplikationen zählten: Ranulabildung, Beschwerden durch trockenen Mund, Schwierigkeiten beim Schlucken und Veränderungen der Speichelkonsistenz. Hs sind weitere Erfahrungen über mögliche Ergebnisse dieser Methode erforderlich, um genauc Beratungen durchführen und die Komplikationen auf ein Minimum beschränken zu könnon. RESUMEN Curso a largo plazo de la cirugia para el control de la saliva Treinta y nueve pacientes a los que se habia practicado la tranpposición de los conductos submaxilares y la ligadura unilateral del conducto parotídeo para el control de la saliva fueron seguidos hasta seis años después de la intervención. La mejoria en conjunto se documentó de acuerdo con el cociente de babeo, la gravedad de éste y la medición de su frecuencia. A pesar de este resultado superficialmente favorable una proporción significativa de pacientes (39 por ciento) o sus cuidadores no encontraron que la cirugia fuese útil. Las complicaciones consistieron en formación de ránula, boca seca, dificultad de deglueión y cambios en la consistencia de las secreciones buc...

Effectiveness of submandibular duct relocation in 91 children with excessive drooling: A prospective cohort study

“…Ekedahl et al measured a significant decrease in drooling by intravenously administered radioactive isotopes. Webb et al used the DQ in 28 patients and in his study the measured DQ of 50.0 at baseline decreased after surgery to 12.3. With our present study we show a significant decrease in the severity of drooling postoperatively in objective as well as subjective measurements.…”

Botulinum Toxin Type a for Control of Drooling in Asian Patients With Cerebral Palsy

“…Three methods of drooling measurement were adapted: Drooling Severity and Frequency Scale, 2 saliva weight, and drooling quotient. 3 Patients were randomly assigned to either an experimental or a control group. The experimental group patients received two units of Botox (Allergan)/kg body weight into one parotid and the contralateral submandibular gland under ultrasound guidance (GE 700, GE Company).…”

“…Current medical management is unsatisfactory. [1][2][3] Botulinum toxin type A (BoNT-A) has increasingly been used to treat drooling in neurologic disorders. [4][5][6][7] However, the optimal technique, starting dose, expected duration of effect, and relationship to certain patient characteristics remain to be clarified.…”

Disorders of the Salivary Glands in Children

“…In 1989 and 1995, two major multidisciplinary centers for the treatment of drooling reported large series of the submandibular duct relocation technique for sialorrhea in neurologically disabled children [9,47]. Drooling was reduced significantly in the majority of patients, and the high rate of complications seen with parotid duct rerout-ing was avoided.…”

“…In one large series of neurologically impaired children with sialorrhea, unilateral ligation of the parotid duct (performed in conjunction with relocation of the submandibular duct) was blamed for complications such as thick, unmanageable saliva (46% of patients), xerostomia with oral crusting (32%), dysphagia (21%), and a high rate of dental caries [47]. Once ligation of the parotid duct was abandoned in favor of relocation of the submandibular duct with excision of the sublingual gland, the majority of these problems anecdotally resolved [15].…”