Outcomes of submandibular duct relocation: a 15-year experience

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.

Does the addition of sublingual gland excision to submandibular duct relocation give better overall results in drooling control?

“…Since 1997, we have been removing the sublingual glands simultaneously with submandibular duct relocation to help prevent ranula formation, which occurs in approximately 8–9% of cases 6,11 . In our series we have a rate of 8.4%.…”

Gastrointestinal Dysfunctions in Parkinson’s Disease: Symptoms and Treatments

“…Neurectomy, that is, the surgical sectioning of the chorda tympani nerves, reduces salivary production (improvement in 74% of patients) but might induce serious complications such as hearing loss and a loss of taste [152, 188]. These invasive options (neurectomy and salivary gland/duct surgeries) can be realized individually or in combination (with >75% success) and possible adverse effects include dental caries (10% of patients), cracked lips (10%), aspiration pneumonia, and xerostomia [152, 184–186]. Due to their high risk of irreversible adverse effects, all these interventions are considered only when all other available options have failed to bring about a positive outcome [32].…”

Surgical Management of Drooling

“…However, our evidence can be interpreted to suggest that more-invasive procedures that aggressively target all 4 major salivary glands are perhaps more effective than less-invasive procedures. The trend Puraviappan et al 52 Glynn and O'Dwyer 48 McAloney et al 46 O'Dwyer and Conlon 35 Puckett et al 32 Fear et al 24 Pogrel 23 Brown et al 22 Bailey and Wadsworth 21 Cranin and Bennett 19 Crysdale 20 Cotton and Richardson 17 Morgan et al 18 Massengill 14 Chait and Kessler 11 Guerin 13 Dundas and Peterson 12 Massengill 14 Glass et al 10 Brody 7 Wilkie and Brody 8 Wilkie 4 Martln and Conley 51 Syeda et al 47 Greensmith et al 45 De et al 42 Shirley et al 43 Stern et al 41 Panarese et al 39 Wilson and Henderson 38 Klem and Mair 36 Mankarious et al 37 Becmeur et al 34 Webb et al 33 Varma et al 31 Burton et al 30 Rosen et al 29 O'Dwyer et al 27 Shott et al 28 Crysdale and White 26 Brundage and Moore 25 Hornibrook 49 Uppal et al 44 Crysdale et al …”