Surgical management of drooling: clinical and caregiver satisfaction outcomes.

摘要

INTRODUCTION: Various surgical techniques are used to manage problematic drooling. These include: (1) re-routing of the submandibular ducts/excision of the sublingual glands (group 1), (2) excision of the submandibular glands/parotid duct ligation (group 2), and (3) ligation of the parotid and submandibular ducts (group 3). PURPOSE: To compare the long-term effectiveness of three surgical techniques and to evaluate long-term caregiver satisfaction. SETTING: Tertiary care children's hospital. STUDY DESIGN: 10 year retrospective chart review and telephone follow-up questionnaire. METHODS: Demographic data, drooling severity, medical management and surgical outcomes using objective severity ratings were evaluated. Satisfaction scores were obtained by phone interview. RESULTS: 33 patients, 19 male and 14 female, age 1.1-27.6 years (mean 9.4+/-4.9) underwent surgery. Six patients were in group 1, 14 in group 2 and 13 patients in group 3. There was no difference in age, sex or severity of drooling among groups. Mean follow-up was 4.5 years (range 1.1-10 years). Post-operative anti-cholinergic use was most common in group 3 (53%) compared to 21% in group 2 and 33% in group 1. Overall caregiver satisfaction for each group was 83% for group 1, 79% for group 2, and 30% for group 3. Gradual return of drooling occurred in 8 of 13 (61%) patients in group 3 and resulted in dissatisfied caregivers. CONCLUSIONS: Although recent literature advocates four-duct ligation, our long-term results do not appear favorable. Reasons for this failure and strategies for avoidance are discussed.