Major salivary duct clipping for control problems in developmentally challenged children

Abstract

Objectives: To introduce a technical modification for interruption of the parotid and submandibular salivary ducts and to demonstrate the technique's effectiveness and effect on quality of life.

Design: Retrospective, uncontrolled, consecutive case series.

Setting: A tertiary care pediatric otolaryngology practice.

Patients: Eighteen drooling and aspirating children.

Intervention: Transoral interruption of parotid and submandibular ducts using vascular clips.

Main outcome measures: Manifestations of poor saliva control (visible drooling, number of shirts and bibs used, choking episodes, embarrassment, and incidence of salivary aspiration), Glasgow Children's Benefit Inventory scores (possible score range, - 100 to + 100), and complications.

Results: Eighteen patients (10 boys and 8 girls) were treated in 14 months. Patient age ranged from 2 to 14 years. Follow-up ranged from 3 to 18 months. No complications occurred. Nine patients had no drooling at all after surgery. There was a significant reduction in the number of bibs and shirts used (P < .001). Regarding measures indicating circumoral skin problems, embarrassment, choking episodes, and aspiration pneumonia, all the patients had significant improvements after surgery. The mean Glasgow Children's Benefit Inventory score was 33.2.

Conclusions: Salivary duct clipping is an efficient and safe method of controlling saliva in neurologically challenged children. The operation positively affects the children's quality of life.