Weitzman Rachel E, Kawai Kosuke, Nuss Roger, Hughes Amy
Otolaryngology, Harvard Medical School, Boston, USA.
Otolaryngology, Boston Children's Hospital, Boston, USA.
Cureus. 2020 May 1;12(5):e7916. doi: 10.7759/cureus.7916.
Background Sialorrhea is a common comorbidity among children with neurologic disorders. Botulinum toxin injections and surgical procedures are recommended for the management of pathological sialorrhea in patients who fail conservative management or with concerns for salivary aspiration. The following review evaluates outcomes following botulinum toxin injections and surgical interventions for sialorrhea over a 10-year period with a focus on treatment options and outcomes for patients with anterior and posterior drooling. Methods The study included all patients less than 25 years of age who underwent a procedure for drooling (Current Procedural Terminology (CPT) codes 42440, 42450, 42509, 42510, 64611 matched with the International Classification of Diseases (ICD)-9 and ICD-10 codes 527.7 and K11.7) from January 1, 2006 to December 31, 2015. A chart review collected demographics, drooling medication use, and type of drooling (anterior, posterior, both). Outcome variables included pre- and post-procedure number of bibs, parent-reported outcomes, post-intervention drooling medication requirement, post-procedure length of stay, and complications. Results Seventy-one patients were included in our analysis, with 88 total procedures performed. The average age at first intervention was 8.9 years; 43 patients were male and 40 patients had cerebral palsy. Thirty-one patients experienced posterior drooling or anterior/posterior drooling. These patients were more likely to undergo surgery as the first invasive intervention. The most commonly performed interventions were botulinum toxin injections (28 patients, 39%) and sublingual gland excision (SLGE) with submandibular duct ligation (SMDL) (36 patients, 51%). Improvement following injections was noted in 56% of patients versus 73% of patients following any surgical intervention. Conclusion Management of drooling is complex with 18 different procedures performed over 10 years. Surgical interventions, specifically SLGE with SMDL and submandibular gland excision (SMGE), result in substantial improvement; these are commonly performed as the first intervention in patients with posterior drooling. By reviewing our experience, we hope to guide management decisions and help manage patient and caregiver expectations.
流涎是神经功能障碍患儿常见的合并症。对于保守治疗无效或存在唾液误吸风险的患者，推荐使用肉毒杆菌毒素注射和手术治疗病理性流涎。以下综述评估了10年间肉毒杆菌毒素注射和手术干预治疗流涎的效果，重点关注前后流涎患者的治疗选择和结果。方法：该研究纳入了2006年1月1日至2015年12月31日期间所有接受流涎治疗（当前操作术语（CPT）代码42440、42450、42509、42510、64611，与国际疾病分类（ICD）-9和ICD-10代码527.7和K11.7匹配）的25岁以下患者。通过病历回顾收集人口统计学资料、流涎用药情况和流涎类型（前、后、双侧）。结果变量包括术前和术后围兜使用数量、家长报告的结果、干预后流涎用药需求、术后住院时间和并发症。结果：我们的分析纳入了71例患者，共进行了88次手术。首次干预的平均年龄为8.9岁；43例为男性，40例患有脑瘫。31例患者出现后流涎或前后流涎。这些患者更有可能接受手术作为首次侵入性干预。最常进行的干预措施是肉毒杆菌毒素注射（28例患者，39%）和舌下腺切除术（SLGE）联合下颌下腺导管结扎术（SMDL）（36例患者，51%）。56%的注射患者和73%的任何手术干预患者出现改善。结论：流涎的治疗很复杂，10年间进行了18种不同的手术。手术干预，特别是SLGE联合SMDL和下颌下腺切除术（SMGE），可带来显著改善；这些手术通常作为后流涎患者的首次干预措施。通过回顾我们的经验，我们希望指导治疗决策，并帮助管理患者和护理人员的期望。
