Bilateral Submandibulectomy for the Treatment of Drooling in Children with Neurological Disability

Abstract

Aim of the study: Drooling is common in children with neurological disabilities (ND), and constitutes an additional burden with many medical complications in an already socially disadvantaged patient. This study aims to evaluate the effectiveness of bilateral submandibulectomy (BS) to treat drooling with regard to the parental satisfaction grade, complications and recurrence of drooling in children with ND.

Patients/Material and Methods: A retrospective study was performed of all children with ND and drooling who underwent BS in our Department between January 1996 and November 2008. Data were taken from surgical records and patient files. Parental satisfaction was graded into four classes: A: 75–100% satisfaction (infrequent drooling, small amounts; absence of drooling); B: 50–75% satisfaction (occasional drooling, on and off all day; infrequent drooling, small amounts); C: 25–50% satisfaction (frequent drooling, but not profusely; occasional drooling, on and off all day); D: 0–25% satisfaction (constant drooling, always wet; frequent drooling, but not profusely).

Results: BS was performed in 85 patients (38% male; 62% female; median age, 9 years). 35 patients had to be excluded from our study because their medical records were unavailable. Only 3 out of the remaining 50 patients had recurrence. Parental satisfaction grade (PSG) was A in 26 cases (55.3%); B in 15 (31.9%); C in 3 (6.4%) and D in 3 (6.4%). The first follow-up was usually 1 week after surgery (median, 2 weeks). The incidence of post-surgery complications was 4% and all complications were minor.

Discussion/Conclusions: Assessment of the results achieved was subjective as it was not possible to quantify the amount of drooling precisely before/after surgery. Nevertheless, BS was found to be an easy and safe procedure as the low rate of complications demonstrates. It was also found to be an effective procedure; there were only 3 recurrences, and PSG in 87.2% of cases was either A or B, indicating a minimum improvement in drooling of 50%.

Key words

drooling - submandibulectomy - children - neurological disability

References

• 1 Boros I, Keszler P. Sialorrhea: hypersalivation and drooling. An underestimated problem in medical practice.  Fogorv Sz. 2006;  99 99-108
• 2 Harris S, Purdy A. Drooling and its management in cerebral palsy.  Dev Med Child Neurol. 1987;  29 805-814
• 3 Morales-Chávez MC, Nualart-Grollmus ZC, Silvestre-Donat FJ. Clinical prevalence of drooling in infant cerebral palsy.  Med Oral Patol Oral Cir Bucal. 2008;  13 E22-E26
• 4 Wong V, Sun JG, Wong W. Traditional Chinese medicine (tongue acupuncture) in children with drooling problems.  Pediatr Neurol. 2001;  25 47-54
• 5 Meningaud JP, Pitak-Arnnop P, Chikhani L. et al . Drooling of saliva: a review of the etiology and management options.  Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;  101 48-57
• 6 Bushara KO. Sialorrhea in amyotrophic lateral sclerosis: a hypothesis of a new treatment – botulinum toxin A injections of the parotid glands.  Med Hypotheses. 1997;  48 337-339
• 7 Fuster MA, Berini L, Gay C. Salivary gland application of botulinum toxin for the treatment of sialorrhea.  Med Oral Patol Oral Cir Bucal. 2007;  12 E511-E517
• 8 Witherow H, Lee N, George K. et al . The treatment of sialorrhoea/drooling using botulinum B toxin.  British Journal of Oral and Maxillofacial Surgery. 2008;  46 e32-e67
• 9 Guyot L, Duroure F, Richard O. et al . Submandibular gland endoscopic resection: a cadaveric study.  Int J Oral Maxillofac Surg. 2005;  34 407-410

Correspondence