Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Pediatric Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands.
Dev Med Child Neurol. 2021 Nov;63(11):1351-1359. doi: 10.1111/dmcn.14924. Epub 2021 May 16.
To compare the effect of bilateral submandibular duct ligation and botulinum neurotoxin A (BoNT-A) on drooling severity and its impact on daily life and care in children and adolescents with moderate-to-severe drooling.
This was a randomized, interventional, controlled trial in which 53 children and adolescents (31 males, 22 females, mean age 11y, range 8-22y, SD 2y 10mo) with cerebral palsy (58.5%) or other non-progressive developmental disorders (41.5%) were randomized to BoNT-A (n=26) or bilateral submandibular duct ligation (n=27). A parent questionnaire on the severity of drooling in specific positions and daily activities and the impact of drooling on daily life and care was filled out at baseline and 8 and 32 weeks posttreatment.
Both BoNT-A and bilateral submandibular duct ligation had a positive effect on daily care, damage to electronic equipment and/or furniture, social interactions, and self-esteem. However, bilateral submandibular duct ligation had a significant greater and longer-lasting short- (8wks) and medium-term (32wks) effect on daily care, reducing damage to electronic devices, and improving social interactions and satisfaction with life in general.
This randomized controlled trial confirms reduced drooling by both BoNT-A and bilateral submandibular duct ligation, but provides new evidence on improved well-being through a reduction in drooling. Even though there is a greater risk of complications and morbidity after bilateral submandibular duct ligation, compared to BoNT-A there was a significantly greater and longer-lasting positive effect on most outcomes. What this paper adds Bilateral botulinum neurotoxin A (BoNT-A) and submandibular duct ligation had a positive effect on the well-being of individuals with moderate-to-severe drooling. Bilateral submandibular duct ligation had a greater effect on the impact of drooling during daily care than BoNT-A. Bilateral submandibular duct ligation reduced damage to electronic devices and improved social interactions and satisfaction with life.
比较双侧下颌下腺导管结扎术和肉毒毒素 A（BoNT-A）对中重度流涎儿童和青少年流涎严重程度及其对日常生活和护理的影响。
这是一项随机、干预性、对照试验，纳入了 53 名患有脑瘫（58.5%）或其他非进行性发育障碍（41.5%）的儿童和青少年（31 名男性，22 名女性；平均年龄 11 岁，范围 8-22 岁，标准差 2 岁 10 个月），并将其随机分为 BoNT-A 组（n=26）或双侧下颌下腺导管结扎术组（n=27）。在基线时以及治疗后 8 周和 32 周时，由家长填写一份关于特定体位和日常活动时流涎严重程度以及流涎对日常生活和护理影响的问卷。
BoNT-A 和双侧下颌下腺导管结扎术均对日常护理、电子设备和/或家具损坏、社会交往和自尊产生积极影响。然而，双侧下颌下腺导管结扎术在短期（8 周）和中期（32 周）对日常护理、减少电子设备损坏以及改善社会交往和总体生活满意度方面具有更显著且更持久的效果。
本随机对照试验证实 BoNT-A 和双侧下颌下腺导管结扎术均可减少流涎，但提供了新的证据表明通过减少流涎可提高幸福感。尽管与 BoNT-A 相比，双侧下颌下腺导管结扎术的并发症和发病率风险更高，但在大多数结局上，其效果更显著且更持久。本文新获信息双侧 BoNT-A 和下颌下腺导管结扎术均可改善中重度流涎患者的幸福感。与 BoNT-A 相比，双侧下颌下腺导管结扎术对流涎对日常护理影响的改善作用更大。双侧下颌下腺导管结扎术减少了电子设备损坏，并改善了社会交往和生活满意度。
