State University of New York, Brooklyn, New York, USA.
Otolaryngol Head Neck Surg. 2021 Oct;165(4):507-518. doi: 10.1177/0194599820985165. Epub 2021 Jan 26.
Chronic sialorrhea commonly occurs in patients with neurodevelopmental disorders. While conservative management can provide sufficient symptom control, surgical intervention is often required. One of the most common procedures utilized is submandibular gland excision (SMGE), with or without parotid duct ligation or rerouting (PDL or PDR). This study aims to compare these surgical approaches and their outcomes.
PubMed, Web of Science, and Embase.
This systematic review includes studies of patients with chronic sialorrhea treated with SMGE alone or SMGE plus PDR or PDL and reports on postintervention outcomes and complications. Two independent investigators assessed study eligibility, rated quality, and extracted data for analysis. A random effects model was used for meta-analysis of pooled data.
Of 3186 studies identified, 21 met inclusion criteria, with 708 patients: 103 underwent SMGE alone (15%); 299 (42%), SMGE and PDL; and 306 (43%), SMGE plus PDR. Overall, a majority of patients had significant improvement, with very good to excellent control of symptoms after surgery: SMGE, 82% (95% CI, 73%-89%); SMGE and PDL, 79% (95% CI, 73%-85%); and SMGE and PDR, 85% (95% CI, 75%-92%). Importantly, there was no significant difference in outcomes with the addition of PDL or PDR. Reported complications included sialocele, parotitis, dental caries, and dry mouth.
Our systematic review identified consistent positive outcomes with SMGE for patients with chronic sialorrhea but no additional benefit when PDR or PDL was performed as a concurrent procedure.
慢性涎液过多症常发生于神经发育障碍患者。虽然保守治疗可充分控制症状，但往往需要手术干预。最常用的手术之一是颌下腺切除术（SMGE），可联合或不联合腮腺导管结扎或改道术（PDL 或 PDR）。本研究旨在比较这些手术方法及其结果。
PubMed、Web of Science 和 Embase。
本系统评价纳入了单独接受 SMGE 或 SMGE 联合 PDR 或 PDL 治疗的慢性涎液过多症患者的研究，并报告了干预后结局和并发症。两名独立的研究者评估了研究的纳入标准、质量评分，并提取数据进行分析。采用随机效应模型对汇总数据进行荟萃分析。
在 3186 项研究中，有 21 项符合纳入标准，涉及 708 例患者：103 例患者仅接受 SMGE（15%）；299 例（42%）接受 SMGE 和 PDL；306 例（43%）接受 SMGE 加 PDR。总体而言，大多数患者术后症状显著改善，且术后症状控制非常好或极好：SMGE 组为 82%（95%CI，73%-89%）；SMGE 和 PDL 组为 79%（95%CI，73%-85%）；SMGE 和 PDR 组为 85%（95%CI，75%-92%）。重要的是，同时行 PDL 或 PDR 并不能提高疗效。报告的并发症包括涎瘘、腮腺炎、龋齿和口干。
本系统评价发现，SMGE 治疗慢性涎液过多症患者的效果一致为阳性，但当联合行 PDR 或 PDL 时并不能带来额外获益。
