Which surgery for drooling in patients with cerebral palsy?

Baudin, François; Schneider, Anne; Flaum, Valérie; Klipfel, C.; Pierrel, C.; Lacreuse, I.

doi:10.1016/j.jpedsurg.2013.06.017

Cited by 14 publications

(10 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This surgery renders patients unable to phonate, which limits caregiver acceptance of this approach [12]. The response rate when combining the variety of surgical treatments for sialorrhea is reported to be 81.6% by caregiver subjective scales, and the complication rate can be up to 40% [22][23][24]. The measurement and reporting of surgical complications and adverse events are heterogeneous and provide little ground for comparison with the cohort presented in this paper.…”

Section: Discussionmentioning

confidence: 96%

Salivary gland ablation: introducing an interventional radiology treatment alternative in the management of sialorrhea

et al. 2020

View full text Add to dashboard Cite

Background Sialorrhea is common in children with neurological disorders and leads to social isolation, aspiration pneumonia and increased caregiver burden. Sialorrhea management includes anticholinergic medications and a variety of surgeries, but these are limited by side effects, recurrence and risks. Objective We present our method of salivary gland ablation, an interventional radiology treatment for sialorrhea, and report safety and efficacy data from pediatric patients who underwent salivary gland ablation. Materials and methods Salivary gland ablation uses image-guided sotradecol and ethanol dual-drug injection into the salivary glands. Submandibular and sublingual glands are injected percutaneously using ultrasound. Parotid glands are injected retrograde through Stensen ducts using fluoroscopy. We conducted a retrospective review of the medical records of patients who underwent salivary gland ablation at our institution between 2005 and 2019. Pre-and post-procedure Drooling Frequency and Drooling Severity (DFDS) scale scores were compared and caregiver satisfaction was assessed. We devised two cohorts, one to study patient safety and a subcohort to study clinical efficacy using DFDS scores. Results One hundred and seventy salivary gland ablation procedures were performed in the 99 patients comprising the safety cohort. Of the procedures, 88.8% resulted in no or minimal complications. Respiratory difficulty, temporary nerve palsy and infection represent the majority of the 11.2% of patients who experienced periprocedural complications. There were no complications resulting in permanent sequelae. Twenty-seven patients met our inclusion criteria for the efficacy subcohort with a mean follow-up time of 5.4 years. DFDS at follow-up decreased from a median score of nine to a seven post-procedure (P=0.000018). The proportion of caregivers who were satisfied with the procedure increased as more glands were ablated, which suggests a causal link between the number of glands ablated and the outcome. Conclusion Salivary gland ablation is a safe and effective procedure with the potential for permanent decrease in symptoms related to sialorrhea.

show abstract

Section: Discussionmentioning

confidence: 96%

Salivary gland ablation: introducing an interventional radiology treatment alternative in the management of sialorrhea

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Surgical interventions on the salivary glands include particularly relocating the submandibular duct and various forms of duct interruption and ligation of the large salivary glands. According to the studies published to date [12,[52][53][54][55][56][57][58][59][60] these interventions are successful. Because in relocating the ducts of the salivary glands of the submandibular glands in particular the non-stimulated basal secretion of saliva is directed right into the hypopharynx, the risk of aspiration is considerably increased and must be evaluated beforehand.…”

Section: Surgical Measuresmentioning

confidence: 99%

Therapy of Sialorrhea with Botulinum Neurotoxin

et al. 2019

View full text Add to dashboard Cite

Botulinum neurotoxin (BoNT) is considered the treatment of choice for various symptoms and diseases such as focal dystonia and focal spasticity. The effects of BoNT on the salivary glands have also been known for years, but their use was limited because of a lack of approval studies. Now the indication of sialorrhea is approved in some countries for incobotulinumtoxinA, such as the USA and Europe, and therapy could also become the treatment of choice. According to the pivotal study, a dose of 100 units of incobotulinumtoxinA, which is divided into the parotid and submandibular glands, is recommended. RimabotulinumtoxinB is approved in the USA only. To define the value of this therapy, we must consider anatomy, physiology, and available therapies. Therapy includes conservative measures such as functional dysphagia therapy, oral or transdermal application of anticholinergics, and, in selected cases, radiotherapy and surgical procedures. A combination of different approaches is optional. On the basis of the evidence and clinical experience, BoNT injections will be the first line of pharmacotherapy for chronic sialorrhea.

show abstract

“…Betrachtet man die chirurgischen Speicheldrüseneingriffe, so sind im Wesentlichen die Submandibulektomien und verschiedene Formen der Gangunterbrechungen und -ligaturen sowie die Verlagerung der Ausführungsgänge der großen Speicheldrüsen zu nennen [11,[86][87][88][89][90][91][92]. Neben der Submandibulektomie fokussiert sich die aktuelle Literatur auf die Verlagerung der Ausführungsgänge der Gll.…”

Section: Operative Maßnahmenunclassified

“…submandibulares (Whartongänge) und Ligatur der Gänge der Gll. parotideae (Stennongänge) [91][92][93][94]. Da bei der Speicheldrüsengangsverlagerung der Gll.…”

Section: Operative Maßnahmenunclassified

Hypersalivation – Aktualisierung der S2k-Leitlinie (AWMF) in gekürzter Darstellung

et al. 2019

View full text Add to dashboard Cite

ZusammenfassungHypersalivation bezeichnet einen übermäßigen Speichelfluss, der durch insuffiziente orofaziale Fähigkeiten, verminderte zentralnervöse Kontrolle und Koordination oder gestörte Schluckabläufe entstehen kann. Die Aktualisierung der S2k-Leitlinie soll den neuen diagnostischen und therapeutischen Kenntnisstand berücksichtigen.Die Diagnostik- und Therapiemaßnahmen sollten multidisziplinär erfolgen. Schwerpunkte sind die Abklärung von Schluckstörungen mit Speichelaspiration. Hier sind klinische Screeninguntersuchungen und die fiberendoskopische Schluckuntersuchung (FEES) hervorzuheben.Bei fast allen Ursachen sind die schlucktherapeutischen Übungsmaßnahmen zur Aktivierung und zum Erlernen von Kompensationsmechanismen unverzichtbar. Insbesondere bei Kindern mit hypotoner orofazialer Muskulatur sind myofunktionelle Therapiekonzepte indiziert, allerdings ist die Kompetenz zur Mitarbeit entscheidend. Zusätzlich können orale Stimulationsplatten durch die Veränderung der Zungenpositionierung zu einer Symptomreduktion führen. Sinnvolle medikamentöse Therapien sind insbesondere die verschiedenen Applikationsformen von Glycopyrrolat, von denen Sialanar® (Glycopyrronium) als Saft eine Genehmigung zur Behandlung bei Kindern ab 3 Jahren und Jugendlichen erhalten hat. Die Injektion von Botulinumtoxin in die Kopfspeicheldrüsen hat sich als effektive und sichere Behandlungsform mit einer langanhaltenden Speichelreduktion erwiesen. Für Incobotulinumtoxin A ist die Phase III-Studie bei Erwachsenen aktuell abgeschlossen und führte in den USA bereits zur Zulassungserweiterung bei Hypersalivation. Chirurgische Eingriffe der Speicheldrüsen bleiben Einzelfällen vorbehalten. Die Bestrahlung der Speicheldrüsen ist, insbesondere wenn sie in moderner 3-D-konformaler Technik zur Gewebeschonung durchgeführt wird, eine sichere und effektive Therapie. In einer regelhaften Nachsorge sind Therapieeffekte und mögliche Nebenwirkungen zu erfassen; insbesondere bei neurodegenerativen Erkrankungen ist die individuelle Dynamik der Symptomverschlechterung zu berücksichtigen.

show abstract

Which surgery for drooling in patients with cerebral palsy?

Cited by 14 publications

References 10 publications

Salivary gland ablation: introducing an interventional radiology treatment alternative in the management of sialorrhea

Salivary gland ablation: introducing an interventional radiology treatment alternative in the management of sialorrhea

Therapy of Sialorrhea with Botulinum Neurotoxin

Hypersalivation – Aktualisierung der S2k-Leitlinie (AWMF) in gekürzter Darstellung

Contact Info

Product

Resources

About