Management of drooling in individuals with neurodisability: a surgical experience

From 1975 to 1 January 1999, 1103 neurologically involved patients (mean ag e 13.2 years; 686 males, 417 females) referred with problematic drooling, o r sialorrhea, were assessed at a pediatric rehabilitation center by a team consisting of an otolaryngologist, speech pathologist, and a dentist. The i nitial standard treatment for persistent sialorrhea (in the compliant or aw are patient) is oral-motor training. A group of 522 patients with persisten t significant drooling after a minimum of 6 months of oral-motor training, or profuse drooling in the presence of a low cognitive level, underwent sur gery, usually when over 6 years of age. From 1978 to 1 January 1998, the op eration of first choice was submandibular duct relocation (SDR), and was co mpleted in a total of 226 patients. Midway through 1988, sublingual gland e xcision was also completed at the time of submandibular duct relocation (SD RSGE); 249 of these procedures have been completed to January Ist 1999, Tho se patients who had SDRSGE had significantly fewer complications that requi red additional surgery than those that had SDR only. However, the impact of surgery on the drooling as evaluated in subsets of both groups (SDR n = 11 5, SDRSGE n = 106) was statistically similar. The study of 11 children with salivary gland radionuclitide scans to determine the effect of submandibul ar duct surgery on gland function was inconclusive. The pattern of oral-mot or function in 26 children studied after SDRSGE surgery suggested that thos e children with severe impairment of volitional motor function and profuse drooling tended to have a poorer outcome following surgery compared to thos e with milder impairments.