Surgical Management of Sialorrhea: A Systematic Review and Meta‐analysis

Abstract

Objective Chronic sialorrhea commonly occurs in patients with neurodevelopmental disorders. While conservative management can provide sufficient symptom control, surgical intervention is often required. One of the most common procedures utilized is submandibular gland excision (SMGE), with or without parotid duct ligation or rerouting (PDL or PDR). This study aims to compare these surgical approaches and their outcomes. Data Sources PubMed, Web of Science, and Embase. Review Methods This systematic review includes studies of patients with chronic sialorrhea treated with SMGE alone or SMGE plus PDR or PDL and reports on postintervention outcomes and complications. Two independent investigators assessed study eligibility, rated quality, and extracted data for analysis. A random effects model was used for meta-analysis of pooled data. Results Of 3186 studies identified, 21 met inclusion criteria, with 708 patients: 103 underwent SMGE alone (15%); 299 (42%), SMGE and PDL; and 306 (43%), SMGE plus PDR. Overall, a majority of patients had significant improvement, with very good to excellent control of symptoms after surgery: SMGE, 82% (95% CI, 73%-89%); SMGE and PDL, 79% (95% CI, 73%-85%); and SMGE and PDR, 85% (95% CI, 75%-92%). Importantly, there was no significant difference in outcomes with the addition of PDL or PDR. Reported complications included sialocele, parotitis, dental caries, and dry mouth. Conclusion Our systematic review identified consistent positive outcomes with SMGE for patients with chronic sialorrhea but no additional benefit when PDR or PDL was performed as a concurrent procedure.

Pulmonary and Clinical Outcomes After Bilateral Submandibular Gland Excision and Parotid Duct Ligation for Refractory Sialorrhea

“…Compared with other surgical options for secretion management, such as laryngotracheal separation and tympanic neurectomy, the DROOL procedure has a highly favorable therapeutic index with regard to surgical risk juxtaposed with expected benefit . However, outcome measures remain heterogenous and are overwhelmingly subjective . To our knowledge, our study is the first to compare objective measures of pulmonary health before and after surgical treatment of sialorrhea in addition to subjective (caregiver-reported) measures of postprocedure improvement.…”

“…5 However, outcome measures remain heterogenous and are overwhelmingly subjective. 3,4,[6][7][8][9] To our knowledge, our study is the first to compare objective measures of pulmonary health before and after surgical treatment of sialorrhea in addition to subjective (caregiver-reported) measures of postprocedure improvement.…”

“…An abundance of literature supports overall improvement after surgical treatment of sialorrhea and aspiration; however, outcome measures are heterogenous and subjective. 3,4,[6][7][8][9] There remains a paucity of objective data related to these procedures, especially with regard to pulmonary outcome measures.…”

Sialorrhea in patients with Parkinson's disease: A case report

“…Finally, surgical procedures for the treatment of sialorrhea, based essentially on the removal of the salivary glands or the ligation or relocation of the ducts that conduct salivary secretion, are the most invasive and non-reversible method, not being commonly used and only considered for elderly patients after the failure of non-surgical procedures [9,21,22].…”

Superhydrophilic Nanotextured Surfaces for Dental Implants: Influence of Early Saliva Contamination and Wet Storage

“…Additionally, saliva contamination at surgical sites confectioned for implant insertion constitutes a complex issue due to the difficulty to control your invasion to the site [ 26 ]. Clinical situations involving stent-guided surgeries [ 27 ], patients with hypersalivation [ 28 ], patients with special mental disabilities [ 29 ], surgeon inattention, among other factors, may generate the early saliva interaction prior to the interaction with bone tissues.…”