Delsing Corinne P A, Bekkers Stijn, van Hulst Karen, Erasmus Corrie E, van den Hoogen Frank J A
Radboud University Medical Centre Nijmegen, Institute for Health Sciences, Department of Otorhinolaryngology-Head and Neck Surgery, the Netherlands.
Radboud University Medical Centre Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, the Netherlands.
Int J Pediatr Otorhinolaryngol. 2019 Aug;123:132-137. doi: 10.1016/j.ijporl.2019.04.036. Epub 2019 Apr 30.
To evaluate if drooling recurrence after surgery of the submandibular ducts is due to surgical failure or other variables.
Historic cohort with prospective collected data of all patients with severe drooling who underwent unsuccessful submandibular duct surgery with subsequent re-intervention between 2003 and 2018. A reference cohort was used for comparison of clinical variables.
Six males and 4 females were included (cerebral palsy n = 8, neurodevelopmental disorders n = 2). All patients underwent submandibular gland surgery as a primary intervention (duct ligation n = 8, submandibular duct relocation n = 2) followed by re-intervention (submandibular gland excision n = 7, parotid duct ligation n = 3). One patient underwent tertiary surgery (parotid duct ligation after re-intervention by submandibular gland excision). Three patients were successful after re-intervention. No difference was found between both re-intervention techniques. There was significantly more severe dental malocclusion (50% vs. 21%, P value = 0.047) and severe speech disorders (80% vs. 42%, P value = 0.042) in the current cohort when compared to the reference cohort.
Recurrence of drooling surgery is most likely not caused by surgical failure of the primary intervention, because re-intervention (submandibular gland excision) did not lead to more success. Dysarthria and dental malocclusion might negatively influence treatment outcome.
评估下颌下腺导管手术后流涎复发是由于手术失败还是其他因素。
对2003年至2018年间所有严重流涎且下颌下腺导管手术失败并随后接受再次干预的患者进行回顾性队列研究，前瞻性收集其数据。使用一个对照队列比较临床变量。
纳入6名男性和4名女性（脑瘫患者8例，神经发育障碍患者2例）。所有患者均首先接受了下颌下腺手术（导管结扎8例，下颌下腺导管重新定位2例），随后接受再次干预（下颌下腺切除7例，腮腺导管结扎3例）。1例患者接受了三次手术（在经下颌下腺切除进行再次干预后行腮腺导管结扎）。3例患者再次干预后成功。两种再次干预技术之间未发现差异。与对照队列相比，当前队列中严重牙合畸形（50%对21%，P值=0.047）和严重言语障碍（80%对42%，P值=0.042）明显更多。
流涎手术后复发很可能不是由初次干预的手术失败引起的，因为再次干预（下颌下腺切除）并未带来更多成功。构音障碍和牙合畸形可能会对治疗结果产生负面影响。
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