School of Dentistry, Federal University of Juiz de Fora, Rua José Lourenço Kelmer, São Pedro, Juiz de Fora, Minas Gerais, Brazil.
Department of Stomatology, School of Dentistry, University of São Paulo, Av. Professor Lineu Prestes, 2227, Butantã, São Paulo, Brazil.
Br J Oral Maxillofac Surg. 2022 Jun;60(5):e691-e701. doi: 10.1016/j.bjoms.2021.10.010. Epub 2021 Oct 30.
Different therapeutic methods for chronic drooling in paediatric patients with neurological problems have been described in the scientific literature. However, there is no consensus on the ideal strategy of treatment. The aim of this study was to compare botulinum toxin injection therapy and surgical modalities to control drooling in paediatric patients with neurological disorders. A systematic literature search was conducted on nine electronic databases for publications until April 2020. Six articles were included with a total sample of 209 patients, 67.4% (n = 141) of whom had cerebral palsy. All studies used injections of botulinum toxin type A with application to the submandibular and/or parotid salivary glands. The surgical treatments were duct ligation in the parotid and/or submandibular salivary glands, duct relocation in the submandibular salivary glands, and glandular excision of the submandibular and sublingual salivary glands. There were complications in only 16.1% (n = 27) of the sample (11 cases due to botulinum toxin application and 16 due to surgery). Drooling control was assessed by objective and subjective measures. Although surgical procedures presented a higher risk of adverse effects than botulinum toxin type A in all the studies and measurements performed, they presented larger and longer-lasting positive effects on drooling. We suggest bilateral submandibular duct relocation with bilateral sublingual gland excision or isolated bilateral submandibular duct ligation, which were the surgical techniques with the largest samples in this review. Nevertheless, further studies are necessary to compare samples with botulinum toxin type A and surgical treatment.
在科学文献中已经描述了针对患有神经问题的儿科患者慢性流涎的不同治疗方法。然而，对于理想的治疗策略尚未达成共识。本研究旨在比较肉毒杆菌毒素注射疗法和手术方式对控制神经障碍儿科患者流涎的效果。对 9 个电子数据库进行了系统的文献检索，以获取截至 2020 年 4 月的出版物。纳入了 6 篇文章，共纳入 209 例患者，其中 67.4%（n=141）患有脑瘫。所有研究均使用 A 型肉毒毒素注射，应用于下颌下和/或腮腺唾液腺。手术治疗包括腮腺和/或下颌下唾液腺导管结扎、下颌下唾液腺导管再定位和下颌下和舌下唾液腺切除术。仅 16.1%（n=27）的样本出现并发症（11 例与肉毒毒素应用有关，16 例与手术有关）。流涎控制通过客观和主观措施进行评估。尽管在所有研究和进行的测量中，手术比肉毒毒素 A 具有更高的不良反应风险，但它们对流涎的控制效果更大且持续时间更长。我们建议双侧下颌下腺导管再定位联合双侧舌下腺切除术或单纯双侧下颌下腺导管结扎，这是本综述中样本量最大的手术技术。然而，仍需要进一步的研究来比较肉毒毒素 A 和手术治疗的样本。
