Formeister Eric J, Dahl John P, Rose Austin S
Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Int J Pediatr Otorhinolaryngol. 2014 Aug;78(8):1387-92. doi: 10.1016/j.ijporl.2014.06.005. Epub 2014 Jun 16.
Chronic sialorrhea is a common problem for pediatric patients with disorders that affect swallowing. While many patients are successfully treated with medical therapies such as Robinul and Scopolamine, a number of such children are not able to tolerate the side effects of these medications. In these cases, surgical treatments can include Botulinum toxin A (Botox) injections into the major salivary glands, sublingual or submandibular gland excision (SMGE), submandibular duct ligation, parotid duct ligation (PDL), or any combination of the above procedures. The purpose of this study is to report on the 10-year experience with the surgical management of chronic sialorrhea at one tertiary care institution, and compare the efficacy of open surgical procedures versus Botox injections for reduction in salivary flow.
A retrospective chart review identified 27 pediatric patients with chronic sialorrhea; 21 of whom underwent Botox injections and 15 of whom underwent surgical procedures. Preoperative and follow-up clinic notes were reviewed to determine the level and severity of drooling as well as the effectiveness of sialorrhea reduction, as assessed by the Teacher Drooling Scale (TDS).
42% of those receiving Botox injections reported a reduction in drooling, with the average pre- and post-Botox TDS of 4.3 and 3.9, respectively (p=0.02 by the Wilcoxon signed rank test). Nine of the patients receiving Botox injections (43%) required multiple injections, with an average duration of effect of 3.9 months, and 7 patients (33%) eventually required surgery. All of the children who underwent surgery (7 bilateral SMGE with PDL, 6 SMGE only, and 2 PDL only) experienced a reduction in drooling, with average pre- and post-operative TDS of 4.5 and 2.2, respectively. This reduction was significant by the Wilcoxon signed rank test (p=0.001).
The ten-year experience at our institution demonstrates the safety, efficacy and long-term control of drooling in the patients undergoing surgery for intractable sialorrhea.
慢性流涎是影响吞咽功能的儿科患者的常见问题。虽然许多患者通过如罗比尼罗和东莨菪碱等药物治疗取得了成功，但仍有一些儿童无法耐受这些药物的副作用。在这些情况下，手术治疗可包括向主要唾液腺注射A型肉毒杆菌毒素（肉毒素）、舌下或下颌下腺切除术（SMGE）、下颌下腺导管结扎、腮腺导管结扎（PDL）或上述任何手术的联合。本研究的目的是报告一家三级医疗机构对慢性流涎进行手术治疗的10年经验，并比较开放手术与肉毒素注射减少唾液分泌的疗效。
通过回顾性病历审查确定了27例慢性流涎的儿科患者；其中21例接受了肉毒素注射，15例接受了手术治疗。对术前和随访门诊记录进行审查，以确定流口水的程度和严重程度，以及通过教师流涎量表（TDS）评估的流涎减少效果。
42%接受肉毒素注射的患者报告流涎减少，肉毒素注射前后的平均TDS分别为4.3和3.9（威尔科克森符号秩检验，p = 0.02）。9例接受肉毒素注射的患者（43%）需要多次注射，平均起效持续时间为3.9个月，7例患者（33%）最终需要手术。所有接受手术的儿童（7例双侧SMGE联合PDL，6例仅SMGE，2例仅PDL）流涎均减少，术前和术后平均TDS分别为4.5和2.2。经威尔科克森符号秩检验，这种减少具有显著性（p = 0.001）。
我们机构的十年经验证明了手术治疗难治性流涎患者时，在控制流涎方面的安全性、有效性和长期效果。
