Surgical management of drooling: Clinical and caregiver satisfaction outcomes

Introduction: Various surgical techniques are used to manage problematic drooling. These include: (1) re-routing of the submandibular ducts/excision of the sublingual glands (group 1), (2) excision of the submandibular glands/parotid duct ligation (group 2), and (3) ligation of the parotid and submandibular ducts (group 3). Purpose: To compare the long-term effectiveness of three surgical techniques and to evaluate long-term caregiver satisfaction. Setting: Tertiary care children's hospital. Study design: 10 year retrospective chart review and telephone follow-up questionnaire. Methods: Demographic data, drooling severity, medical management and surgical outcomes using objective severity ratings were evaluated. Satisfaction scores were obtained by phone interview. Results: 33 patients, 19 mate and 14 female, age 1.1-27.6 years (mean 9.4 +/- 4.9) underwent surgery. Six patients were in group 1, 14 in group 2 and 13 patients in group 3. There was no difference in age, sex or severity of drooling among groups. Mean follow-up was 4.5 years (range 1.1-10 years). Post-operative anti-chotinergic use was most common in group 3 (53%) compared to 21% in group 2 and 33% in group 1. Overall caregiver satisfaction for each group was 83% for group 1, 79% for group 2, and 30% for group 3. Gradual return of drooling occurred in 8 of 13 (61%) patients in group 3 and resulted in dissatisfied caregivers. Conclusions: Although recent literature advocates four-duct ligation, our tong-term results do not appear favorable. Reasons for this failure and strategies for avoidance are discussed. (C) 2008 Elsevier Ireland Ltd. All rights reserved.