Kok Saskia E, Erasmus Corrie E, Scheffer Arthur R T, van Hulst Karen, Rovers Maroeska M, van den Hoogen Frank J A
Department of Otolaryngology-Head and Neck Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Department of Pediatric Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Clin Otolaryngol. 2018 Dec;43(6):1471-1477. doi: 10.1111/coa.13188. Epub 2018 Aug 9.
To evaluate the effectiveness of submandibular duct relocation (SMDR) in drooling children with neurological disorders.
Prospective cohort study.
Academic Outpatient Saliva Control Clinic.
Ninety-one children suffering from moderate to severe drooling.
Direct observational drooling quotient (DQ; 0-100) and caretaker Visual Analogue Scale (VAS; 0-100). Secondary outcome measures were drooling severity (DS) and frequency rating scales.
The DQ at baseline, 8 and 32 weeks postoperatively was 26.4, 12.3 and 10.8, respectively. VAS score decreased from 80.1 at baseline to 28.3 and 37.0 at 8 and 32 weeks after surgery. Median DS at baseline, 8 and 32 weeks was 5, 3 and 4, whereas the drooling frequency median scores were 4, 2 and 2, respectively. Five children required prolonged intubation due to transient floor of the mouth swelling, two of whom developed a ventilator-associated pneumonia. Another child developed atelectasis with postoperative pneumonia. Two more children needed tube feeding because of postoperative eating difficulties for 3 days or suprapubic catheterisation for urinary retention. Children aged 12 years or older (OR = 3.41; P = 0.03) and those with adequate stability and position of the head (OR = 2.84; P = 0.09) appeared to benefit most from treatment.
Submandibular duct relocation combined with excision of the sublingual glands appears to be relatively safe and effective in diminishing visible drooling in children with neurological disorders, particularly in children aged 12 years and older and those without a forward head posture.
评估下颌下腺导管重定位术（SMDR）对患有神经功能障碍的流涎儿童的疗效。
前瞻性队列研究。
学术性门诊唾液控制诊所。
91名患有中度至重度流涎的儿童。
直接观察流涎商数（DQ；0 - 100）和照料者视觉模拟量表（VAS；0 - 100）。次要观察指标为流涎严重程度（DS）和频率评定量表。
基线时、术后8周和32周的DQ分别为26.4、12.3和10.8。VAS评分从基线时的80.1降至术后8周和32周时的28.3和37.0。基线时、8周和32周的DS中位数分别为5、3和4，而流涎频率中位数分别为4、2和2。5名儿童因口底短暂肿胀需要延长插管时间，其中2名发生呼吸机相关性肺炎。另1名儿童发生肺不张合并术后肺炎。另有2名儿童因术后进食困难3天需要鼻饲或因尿潴留需要耻骨上膀胱造瘘。12岁及以上儿童（OR = 3.41；P = 0.03）以及头部稳定性和位置合适的儿童（OR = 2.84；P = 0.09）似乎从治疗中获益最大。
下颌下腺导管重定位术联合舌下腺切除术在减少神经功能障碍儿童的可见流涎方面似乎相对安全有效，尤其是12岁及以上儿童和无前倾头位的儿童。
