THE USE OF THE SALIVAGRAM IN THE EVALUATION OF SEVERE AND CHRONIC ASPIRATION

Chronic salivary aspiration may be responsible for a significant perce ntage of pneumonia in the neurologically impaired child. The radionucl ide salivagram (RS), a simple investigative study, can document saliva ry aspiration as the source of pulmonary contamination. The purpose of this study was to determine if the results of the RS would accurately identify children with severe and chronic salivary aspiration who wou ld benefit from laryngotracheal separation (LTS). We reviewed 30 recor ds of children with chronic aspiration pneumonitis who underwent LTS b etween 1988 and 1996. We recorded the number of inpatient days require d for respiratory infections before and after LTS. This number was com pared with the number of inpatient days for respiratory infection from children (n = 27) who underwent the RS during a ten-month period but who were never referred for LTS. Fifteen children who underwent LTS ha d a preoperative RS. The RS documented salivary aspiration in 11 of th ese children. Aspiration was effectively controlled by LTS for this gr oup. There were three studies that failed to show either aspiration or progression of the Technetium 99m sulfur colloid (Tc 99m SC) into the esophagus. This finding was felt to represent significant swallowing dysfunction and, therefore, was also considered a positive finding. Th ere was a significant difference in the number of inpatient days for c hildren who had a negative RS and were never referred for LTS when com pared with the number of inpatient days for those children who had a p ositive RS and were referred for LTS. We feel that the RS is an effect ive tool to document salivary aspiration as the source of recurrent pn eumonia. A modification of the technique and interpretation of RS is s uggested. (C) 1997 Elsevier Science Ireland Ltd.