Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
Dev Med Child Neurol. 2020 Jul;62(7):861-867. doi: 10.1111/dmcn.14510. Epub 2020 Mar 9.
To assess: (1) the effect on drooling of bilateral submandibular duct ligation as surgical therapy after the administration of submandibular botulinum neurotoxin A (BoNT-A) for excessive drooling and (2) the predictive value of treatment success with BoNT-A on treatment success after bilateral submandibular duct ligation.
This was a within-participant retrospective observational study in which 29 children with severe drooling (15 males, 14 females) received BoNT-A treatment at a mean age of 9 years 6 months (SD 2y 5mo), followed by bilateral submandibular duct ligation at a mean age of 10 years 11 months (SD 2y 4mo). Fifteen children were diagnosed with cerebral palsy (CP), with 12 children classified in Gross Motor Function Classification System levels IV and V. The 14 children without CP had non-progressive developmental disorders. The primary drooling severity outcomes were the Visual Analogue Scale (VAS; subjective assessment) and drooling quotient (objective assessment). Measurements were taken before each intervention and again at 8 and 32 weeks.
The VAS was significantly lower after bilateral submandibular duct ligation at follow-up compared to BoNT-A treatment (mean difference -33, p≤0.001; 95% confidence interval [CI]=-43.3 to -22.9). The mean drooling quotient did not significantly differ between BoNT-A treatment and bilateral submandibular duct ligation at follow-up (3.3, p=0.457; 95% CI=-4.35 to 9.62) or between 8 and 32 weeks (4.7, p=0.188; 95% CI=-2.31 to 11.65).
BoNT-A treatment and bilateral submandibular duct ligation are both effective treatment modalities for drooling. At 32-week follow-up, subjective drooling severity after bilateral submandibular duct ligation was significantly lower compared to previous BoNT-A injections in participants. However, treatment success with BoNT-A is no precursor to achieving success with bilateral submandibular duct ligation.
Bilateral submandibular duct ligation is an effective therapy for drooling after treatment with botulinum neurotoxin A (BoNT-A). Treatment success with BoNT-A is not a predictor of successful therapy with bilateral submandibular duct ligation.
评估（1）在接受下颌下腺肉毒毒素 A（BoNT-A）治疗后，双侧下颌下腺导管结扎术作为治疗流涎的手术治疗的效果；（2）BoNT-A 治疗成功对双侧下颌下腺导管结扎术治疗成功的预测价值。
这是一项参与者内回顾性观察研究，29 名严重流涎儿童（15 名男性，14 名女性）在平均 9 岁 6 个月（SD 2y 5mo）时接受 BoNT-A 治疗，随后在平均 10 岁 11 个月（SD 2y 4mo）时接受双侧下颌下腺导管结扎术。15 名儿童被诊断为脑瘫（CP），其中 12 名儿童被归类为运动功能分级系统（GMFCS）IV 和 V 级。14 名无 CP 的儿童患有进行性发育障碍。主要流涎严重程度的结果是视觉模拟量表（VAS；主观评估）和流涎商（客观评估）。在每次干预前和 8 周和 32 周时进行测量。
与 BoNT-A 治疗相比，双侧下颌下腺导管结扎术在随访时的 VAS 明显降低（平均差异-33，p≤0.001；95%置信区间[CI]=-43.3 至-22.9）。在随访时，BoNT-A 治疗和双侧下颌下腺导管结扎术之间的平均流涎商无显著差异（3.3，p=0.457；95%CI=-4.35 至 9.62）或 8 至 32 周之间（4.7，p=0.188；95%CI=-2.31 至 11.65）。
BoNT-A 治疗和双侧下颌下腺导管结扎术都是治疗流涎的有效方法。在 32 周随访时，与之前的 BoNT-A 注射相比，双侧下颌下腺导管结扎术后主观流涎严重程度明显降低。然而，BoNT-A 治疗的成功并不是双侧下颌下腺导管结扎术成功的前兆。
双侧下颌下腺导管结扎术是 BoNT-A 治疗后流涎的有效治疗方法。BoNT-A 治疗的成功不是双侧下颌下腺导管结扎术成功的预测因素。
