Four-duct ligation: a simple and effective treatment for chronic aspiration from sialorrhea.

OBJECTIVES

To determine the effectiveness of bilateral submandibular and parotid duct ligation on children with severe neuromuscular impairment and chronic aspiration of salivary secretions and to identify any predictable anatomical connections between the submandibular duct and sublingual glands.

DESIGN

Case series; retrospective anatomical study of adult cadaveric submandibular gland specimens.

SETTING

Academic tertiary referral medical center.

PATIENTS

Five children with severe neuromuscular impairment and recurrent aspiration pneumonitis.

INTERVENTION

The children underwent bilateral submandibular and parotid duct ligation. The oral cavities of 8 cadavers were dissected to identify anatomical connections between the submandibular duct and sublingual glands.

MAIN OUTCOME MEASURES

Incidence of postoperative aspiration pneumonitis; gross anatomical connections between the submandibular duct and sublingual gland in cadaveric specimens.

RESULTS

No postoperative airway obstruction, infection, or xerostomia was noted, and technetium scanning confirmed control of salivary secretions from major salivary glands. Caregivers noted diminished salivary secretions and no aspiration pneumonia.

CONCLUSIONS

This new, simple intraoral procedure controls aspiration pneumonitis with minimal surgical dissection and has less morbidity than procedures involving major salivary gland excision. Ranula formation, a common complication of submandibular duct transposition, is unlikely in this procedure because the sublingual ducts are not interrupted.