CHRONIC ASPIRATION IN CHILDREN - WHEN ARE BILATERAL SUBMANDIBULAR-GLAND EXCISION AND PAROTID DUCT LIGATION INDICATED

Objective: To assess the efficacy of bilateral submandibular gland exc ision ansi bilateral parotid duct ligation in treatment of chronic asp iration in neurologically impaired children. Design: Retrospective cha rt review and telephone follow-up interview. Setting: Tertiary care ce nter. Patients: All patients from 1986 through 1994 who underwent bila teral submandibular gland excision and bilateral parotid duct ligation and had evidence of at least 1 episode of aspiration pneumonia in the year prior to undergoing surgery. Main Outcome Measure: Two main outc omes measures were (1) the change in number of hospitalizations for pn eumonia and total number of lower respiratory tract infections between 1 year before and 1 year after surgical intervention and (2) telephon e assessment of patient outcome with respect to parental satisfaction, effect on quality of life, care requirements, amount of suctioning, a nd use of voice. Results: Sixteen patients aged 16 months to 18 years were included. After surgical intervention, there was a significant de crease in the mean (+/- SD) number of pneumonias (2.3 +/- 1.44 before surgery, 0.9 +/- 1.2 after surgery; P < .001) and hospitalizations (1. 2 +/- 0.8 before surgery, 0.4 +/- 0.8: after surgery; P < .005). Six p atients had a tracheostomy at the lime of surgery, and 1 required a tr acheostomy 2 years after surgery, No individual required laryngotrache al separation. Eleven families were able to be contacted by telephone. Caretakers reported that in 8 of 11 patients, quality of life was imp roved and care requirements decreased. Seven patients used voice for a t least some degree of communication. Three patients had postoperative complications involving the parotid glands; all resolved after furthe r therapy. Conclusion: Bilateral submandibular gland excision and bila teral parotid duct ligation reduce thr incidence of aspiration pneumon ias and hospitalization, and decrease overall care requirements in a s elect group neurologically impaired children. Because they are voice s paring, are efficacious, and have a low morbidity, they should be cons idered before laryngotracheal separation or tracheoesophageal diversio n.