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Subtotal functional sialoadenectomy vs four‐duct ligation for the treatment of drooling in neurologically impaired children: Long‐term follow‐up
Author(s) -
De Peppo Francesco,
Caccamo Romina,
Garganese Maria Carmen,
Ceriati Emanuela,
Marchetti Paola,
Adorisio Ottavio Domenico,
Cerchiari Antonella,
Battaglia Sonia
Publication year - 2021
Publication title -
clinical otolaryngology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.914
H-Index - 68
eISSN - 1749-4486
pISSN - 1749-4478
DOI - 10.1111/coa.13650
Subject(s) - drooling , medicine , surgery , ligation , perioperative , retrospective cohort study
Objectives The best surgical option to treat drooling in neurodisabilities is still under debate. The aim of this study was to describe the technique of subtotal functional sialoadenectomy (SFS) (ie four‐duct ligation (4‐DL) together with bilateral sublingual gland excision) and its long‐term outcomes, in comparison with 4‐DL. Design Retrospective observational cohort study. Setting Unit of Pediatric Surgery of Bambino Gesù Children's Hospital (Rome). Participants Seventy‐five 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 were the evaluation of drooling improvement after surgery (parameters: Drooling Severity and Frequency Scale, DSFS; no of bibs/day; no of shirts/day; no of 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 no of shirts/day in both groups. Significantly better results were found in the SFS group than in the 4‐DL group as far as DSFS ( P value .045), no of bibs/day ( P value .041), no of shirts/day ( P value .032) are concerned. Reoperation rate for recurrence was 42% in the 4‐DL group and 0% in the SFS group ( P value < .0001). Six patients (8%; 2 in the 4‐DL group and 4 in the SFS group) experienced perioperative complications, while 4 patients (5%; 2 in the 4‐DL group and 2 in the SFS group) recorded long‐term complications, with no difference between groups neither need for surgical treatment. No surgery‐related mortality was recorded. Conclusions In our experience, subtotal functional sialoadenectomy ensured significantly greater long‐term effects than four‐duct ligation for drooling treatment in neurologically impaired child, with equal complication rate.