Long-term effects of submandibular gland excision on drooling in children with neurodevelopmental disorders: A cross-sectional study.

AIM: Submandibular gland excision (SMGE) is suitable for the management of drooling in patients with non-progressive neurodisabilities. We aimed to investigate the long-term effects of SMGE. METHOD: Patients who had SMGE between 2007 and 2018 were included. Main outcomes were a Visual Analogue Scale (VAS), Drooling Severity (DS), and Drooling Frequency (DF) collected at baseline, 8 weeks, 32 weeks and with a median of 313 weeks after SMGE (long-term). Secondary outcomes were satisfaction with the procedure, Drooling Quotient (DQ) and adverse events (AEs). RESULTS: We included thirty-five patients in the long-term analysis with a mean age of 14.5 years. A baseline VAS score of 80.4 was found, which improved on the long-term (mean difference -21.8, t(26) = 4.636, p < 0.0005)). DS and DF decreased significantly at the long-term compared to baseline (Z = -4.361, p < 0.0001 for DS, Z = -3.065, p = 0.002 for DF). Twenty-three out of 35 (66%) patients would recommend the procedure to peers. INTERPRETATION: This study indicates a long-term stable effect on drooling after SMGE in patients with anterior drooling. Recurrence of drooling occurs due to unknown reasons, nevertheless most caregivers and/or patients are still satisfied and would recommend the procedure to others.

[Sensory impairments and dementia]. / Zintuiglijke beperkingen en dementie.

In recent years, research has consistently reported an association between hearing- and vision loss and mental health outcomes. Whether treating these condition in elders improves cognition has been addressed by several studies. Observational data suggest that treatment positively impacts cognition, even though more research is needed. Nevertheless, because hearing loss is suspected to account for 9% of dementia cases, and also because these factors are one of the few potentially modifiable factors from a dementia prevention perspective, the need to stimulate research to have clearer knowledge about the benefits of treating hearing and/or vision loss on cognitive outcomes is urgent.

Unsuccessful submandibular duct surgery for anterior drooling: Surgical failure or parotid gland salivation?

OBJECTIVES: To evaluate if drooling recurrence after surgery of the submandibular ducts is due to surgical failure or other variables. METHODS: Historic cohort with prospective collected data of all patients with severe drooling who underwent unsuccessful submandibular duct surgery with subsequent re-intervention between 2003 and 2018. A reference cohort was used for comparison of clinical variables. RESULTS: Six males and 4 females were included (cerebral palsy n = 8, neurodevelopmental disorders n = 2). All patients underwent submandibular gland surgery as a primary intervention (duct ligation n = 8, submandibular duct relocation n = 2) followed by re-intervention (submandibular gland excision n = 7, parotid duct ligation n = 3). One patient underwent tertiary surgery (parotid duct ligation after re-intervention by submandibular gland excision). Three patients were successful after re-intervention. No difference was found between both re-intervention techniques. There was significantly more severe dental malocclusion (50% vs. 21%, P value = 0.047) and severe speech disorders (80% vs. 42%, P value = 0.042) in the current cohort when compared to the reference cohort. CONCLUSION: Recurrence of drooling surgery is most likely not caused by surgical failure of the primary intervention, because re-intervention (submandibular gland excision) did not lead to more success. Dysarthria and dental malocclusion might negatively influence treatment outcome.

Bilateral transcervical submandibular gland excision for drooling: A study of the mature scar and long-term effects.

AIM: Several surgical techniques are available to treat drooling in neurologically disabled children and adolescents, with bilateral submandibular gland excision being the only transcervical procedure. External scars can be a reason to decline for this surgical approach. We investigated which factors influenced caregiver satisfaction by evaluating the long-term scar in relation to treatment outcome. METHODS: We identified a historical cohort, in which all neurologically disabled patients who underwent bilateral submandibular gland excision for drooling between January 2009 and December 2013 were identified (n = 41). The Patient and Observer Scar Assessment Scale (POSAS) was used to evaluate observer and clinician satisfaction. All included patients were contacted by telephone and completed a digital questionnaire that included digital images of the scars. RESULTS: Of the caregivers that responded the questionnaire 76% (19/25) were satisfied with the overall outcome. Twenty-four (96%) caregivers considered the scars acceptable. Caregiver satisfaction was not correlated to the appearance of scars, but was significantly correlated with the decrease in drooling severity on a visual analogue scale (p = 0.035) and decrease in lower respiratory tract infections (p = 0.042). INTERPRETATION: The appearance of scars does not influence satisfaction after bilateral submandibular gland excision for drooling. As expected, satisfaction is correlated to the treatment outcome.

[The treatment of drooling in children]. / De behandeling van kwijlen bij kinderen.

Undesirable drooling in children is an underexposed problem and difficult to treat, although there are multiple treatment options. A multidisciplinary approach is preferable for the examination and treatment of patients with drooling. The injection of botulinum toxin is the most frequently performed treatment for children who drool, but the effects are temporary. If drooling persists despite conservative treatment, surgical interventions performed by an otolaryngologist may be considered and may offer a more definitive solution.

[Cranial nerve palsy caused by tumours of the head and neck]. / Hersenzenuwuitval door hoofd-halstumoren.

Cranial nerve palsy is a diagnostic guiding symptom, but often goes unrecognized. The differential diagnosis includes a variety of diseases, including malignant tumours of the head and neck. Here we describe three cases of cranial nerve palsy. In two of the cases the palsy was recognized following physical examination; this altered the differential diagnosis and work-up plan. In the third case the patient initially presented with cranial nerve palsy, and this case indicates the importance of the addition of diagnostic imaging. When a patient presents with cranial nerve pathology, physical examination has to be performed, searching for an underlying cause. And vice versa: if a patient presents with vague symptoms or a lump in the head and neck area, examination of the cranial nerves should be kept in mind. If oncology is suspected, the patient should be referred to an otolaryngologist at a head and neck oncology centre.