Surgical reduction of salivary flow in children with spastic disorders

• Published in: Operative techniques in otolaryngology--head and neck surgery Vol. 11; no. 3; pp. 206 - 209
• Main Author: Ernster, Joel A.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.09.2000
• ISSN: 1043-1810; 1557-9395
• DOI: 10.1053/otot.2000.7669

Neurologically impaired children with orofacial dysfunction may present with problematic drooling. Surgical endeavors to control this problem have consisted of either ablating nerves leading to the salivary glands, affecting salivary drainage, or removal of the salivary glands themselves. This article compares 2 surgical approaches on the basis of parental satisfaction. The submandibular duct rerouting procedure is compared with the submandibular gland excision and sublingual gland debulking procedure. The sublingual gland debulking procedure is described and pertinent anatomy discussed. Eighteen neurologically impaired children ranging in age from 5 to 15 years of age were studied. From 1987 to 1991, 7 children underwent bilateral submandibular duct rerouting procedures. From 1991 to 1995, 11 children underwent bilateral submandibular gland excision and sublingual gland debulking procedure. Because of the parental concern about the long-term efficacy of the submandibular duct rerouting procedure in some children, the surgical approach offered to these children was changed in 1991. Four children are in the “rerouting” group and the “excision group,” and therefore served as their own controls. The outcome being monitored was that of parental satisfaction and their assessment of several parameters. These assessments were obtained retrospectively at least 1 year after the surgical procedure was undertaken. Parental satisfaction was higher in the “excision” group of children as compared with the satisfaction expressed by parents in the “rerouting” group. Parameters assessed were: effectiveness of the procedure (0%–90% reduction in salivary flow), difficulty in tolerating the procedure, and willingness of the parent to have the child undergo the procedure again. On the basis of a parental-satisfaction survey, children who underwent the submandibular gland excision with the sublingual gland debulking procedure tolerated the procedure more easily, experienced greater reduction in salivary flow, and their parents were more willing to submit their child to the procedure again in comparison with the parents of children who were treated with the submandibular duct rerouting procedure.