Khan Waqas U, Islam Alvi, Fu Ann, Blonski Diane C, Zaheer Salaha, McCann Catherine A, Joseph Melissa S, Perlin Rebecca, Khan Rajab, Campisi Paolo
Faculty of Health Sciences, School of Medicine, Trinity College Dublin, Dublin, Ireland.
Department of Pharmacology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
JAMA Otolaryngol Head Neck Surg. 2016 Mar;142(3):278-83. doi: 10.1001/jamaoto.2015.3592.
The 4-duct ligation procedure has appeal for its surgical simplicity and limited invasiveness in the management of pediatric sialorrhea. However, more information is required to understand the benefits, risks, success rates, and long-term effects of this intervention.
To report the clinical outcomes of the 4-duct ligation procedure in pediatric patients diagnosed as having sialorrhea and the associated complication rates and to characterize patient and caregiver satisfaction in a consecutive series.
DESIGN, SETTING, AND PARTICIPANTS: This investigation was a retrospective cohort study at an academic tertiary pediatric center and pediatric rehabilitation hospital. Patients included 38 children with neurological impairment who underwent a 4-duct salivary gland ligation (parotid and submandibular glands) between January 1, 2004, and July 31, 2012. The dates of the analysis were August 2013 through February 2015.
Posttreatment assessments included duration of effect, severity and frequency of drooling before and after the procedure, patient complications, caregiver satisfaction, caregiver recommendation of the procedure, and caregiver overall assessment of the child's quality of life. Clinical and outcome measures were collected before the procedure, 1 month after the procedure, 1 year after the procedure, and at the most recent follow-up (range, 3-8 years).
The study cohort comprised 38 participants. Their median age was 11 years (age range, 5-17 years), and 37% (14 of 38) were female. The mean (SD) duration of effect was 52.6 (20.4) months. Patients with previous sialorrhea management were more likely to demonstrate an improvement in their drooling frequency score at 1 year. Thirteen complications were documented in 12 patients. The most common complications were persistent facial swelling and aspiration pneumonia. Eighty percent (28 of 35) of caregivers reported an improvement in their child's drooling at 1 month, while 69% (25 of 36) and 71% (24 of 34) stated that there was an improvement at the 1-year follow-up and the most recent follow-up, respectively.
The 4-duct ligation procedure offers a simple, effective, and minimally invasive approach to the management of sialorrhea in children.
四导管结扎术因其手术操作简单且在小儿流涎症治疗中侵袭性有限而具有吸引力。然而，需要更多信息来了解该干预措施的益处、风险、成功率及长期影响。
报告四导管结扎术在诊断为流涎症的小儿患者中的临床结果及相关并发症发生率，并描述连续系列病例中患者及其照料者的满意度。
设计、地点和参与者：本研究为在一家学术性三级儿科中心和儿科康复医院开展的回顾性队列研究。患者包括38例神经功能障碍儿童，他们于2004年1月1日至2012年7月31日期间接受了四导管唾液腺结扎术（腮腺和下颌下腺）。分析日期为2013年8月至2015年2月。
治疗后评估包括效果持续时间、术前术后流口水的严重程度和频率、患者并发症、照料者满意度、照料者对该手术的推荐以及照料者对孩子生活质量的总体评估。临床和结局指标在手术前、手术后1个月、手术后1年以及最近一次随访（范围为3至8年）时收集。
研究队列包括38名参与者。他们的中位年龄为11岁（年龄范围为5至17岁），37%（38例中的14例）为女性。平均（标准差）效果持续时间为52.6（20.4）个月。既往有流涎症治疗史的患者在1年时流口水频率评分更有可能改善。12例患者记录了13种并发症。最常见的并发症是持续性面部肿胀和吸入性肺炎。80%（35例中的28例）的照料者报告其孩子在1个月时流口水情况有所改善，而分别有69%（36例中的25例）和71%（34例中的
