Subtotal functional sialoadenectomy vs four‐duct ligation for the treatment of drooling

Subtotal functional sialoadenectomy vs four‐duct ligation for the treatment of drooling in neurologically impaired children: long‐term follow‐up:

Abstract

Objectives

The best surgical option to treat drooling in neurodisabilitiesis still under debate. The aim of this study is to describe the technique of subtotal functional sialoadenectomy (SFS) (i.e. four‐duct ligation (4‐DL)together with bilateral sublingual gland excision) and its long‐term outcomes, in comparison with 4‐DL.

Design

Retrospective observational cohortstudy

Setting

Unit of Pediatric Surgery of Bambino Gesù Children’s Hospital (Rome)

Participants

75 patients surgically treated for drooling between 2002 and 2012, with at least five years of follow‐up, divided into two groups: 4‐DL group(19 patients) underwent four‐duct ligation, and SFS group (56 patients) underwent subtotal functional sialoadenectomy

Main outcome measures

Primary end points werethe evaluation of drooling improvement after surgery(parameters: drooling frequency and severity scale, DSFS; n° bibs/day;n° shirts/day; n° pneumonia/year; use of antidrooling drugs),and the comparison between two different surgical techniques

Results

Median age at surgery was 10 years(1‐35). Long‐term outcomes showed significant improvement in DSFS and in n° shirts/day in both groups.Significantly better results were found in SFS group than in4‐DL group as far as DSFS (P value 0.045), n° bibs/day (P value 0.041), n° shirts/day (P value 0.032) is concerned. Reoperation rate for recurrence was 42% in 4‐DL group and 0% in SFS group (P value < 0.0001). Six patients (8%; 2 in 4‐DL group, 4 in SFS group) experienced perioperative complications, whilst 4 patients (5%; 2 in 4‐DL group, 2 in SFS group) recorded long‐term complications, with no difference between groups neitherneed for surgical treatment. No surgery‐related mortality was recorded.

Conclusions

In our experience, subtotal functional sialoadenectomyensured significantly greater long‐term effectsthan four‐duct ligation for drooling treatment in neurologically impaired child, with equal complication rate.