The best surgical option to treat drooling in neurodisabilitiesis still under debate. The aim of this study is to describe the technique of subtotal functional sialoadenectomy (SFS) (i.e. four-duct ligation (4-DL)together with bilateral sublingual gland excision) and its long-term outcomes, in comparison with 4-DL.
Retrospective observational cohortstudy SETTING: Unit of Pediatric Surgery of Bambino Gesù Children’s Hospital (Rome) PARTICIPANTS: 75 patients surgically treated for drooling between 2002 and 2012, with at least five years of follow-up, divided into two groups: 4-DL group(19 patients) underwent four-duct ligation, and SFS group (56 patients) underwent subtotal functional sialoadenectomy MAIN OUTCOME MEASURES: Primary end points werethe evaluation of drooling improvement after surgery(parameters: drooling frequency and severity scale, DSFS; n° bibs/day;n° shirts/day; n° pneumonia/year; use of antidrooling drugs),and the comparison between two different surgical techniques RESULTS: Median age at surgery was 10 years(1-35). Long-term outcomes showed significant improvement in DSFS and in n° shirts/day in both groups.Significantly better results were found in SFS group than in4-DL group as far as DSFS (P value 0.045), n° bibs/day (P value 0.041), n° shirts/day (P value 0.032) is concerned. Reoperation rate for recurrence was 42% in 4-DL group and 0% in SFS group (P value < 0.0001). Six patients (8%; 2 in 4-DL group, 4 in SFS group) experienced perioperative complications, whilst 4 patients (5%; 2 in 4-DL group, 2 in SFS group) recorded long-term complications, with no difference between groups neitherneed for surgical treatment. No surgery-related mortality was recorded.
In our experience, subtotal functional sialoadenectomyensured significantly greater long-term effectsthan four-duct ligation for drooling treatment in neurologically impaired child, with equal complication rate.

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