Approach to the patients with sialorrhea and treatment management

APPROACH TO THE PATIENTS WITH SIALORRHEA AND TREATMENT MANAGEMENT Hassouna H, Approach to the Patients with Sialorrhea and Treatment Management, Bezmialem Vakıf University, Medical Faculty, Department of Otorhinolaryngology, Thesis for specialty in Medicine, Istanbul, 2016. Objective: Sialorrhea (drooling) is the uncontrolled and continuous release of saliva, and may be due to a range of causes. The aim of this study is to evaluate the effectiveness of bilateral submandibular duct rerouting and sublingual gland excision combined with parotid gland botulinum toxin type-A injection. Study Design: Retrospective study. Patients & Methods: This study was conducted in 13 paediatric sialorrhea patients who underwent bilateral submandibular duct rerouting and sublingual gland excision combined with parotid gland botulinum toxin type-A injection from 2012 to 2016 in Bezmialem Vakıf University, Medical Faculty, Department of Otorhinolaryngology. Patients were evaluated preoperatively and postoperatively at the third month. Degree of sialorrhea was assessed by The Drooling Frequency And Severity Scale (Thomas-Stonell and Greenburg classification), Teacher Drooling Scale, number of bibs or changed clothes per day and saliva wiping number per hour. Statistical analysis was performed using SPSS (Statistical Package for Social Sciences) for windows 16.0. Wilcoxon Singed-Rank tests were used to compare preoperative and postoperative measurements. The significance level was set at 0.05. Results: In all categories statistically significant differences (p=0.002) were found between preoperative and postoperative mean values over six months. One patient (%7.6) underwent urgent intervention because of postoperative hemorrhage. The postoperative result of method was successful in 12 patients (92,3) over all categories. However in one patient (%7,6) there was no changes in any category. Conclusion: Sialorrhea is a complex disorder benefiting by multidisciplinary approach. Surgical interventions are submandibular and/or parotid duct rerouting that diverts salivary flow or duct ligation, submandibular gland excision, tympanic neurectomy with or without chorda tympani section which decreases salivary secretion. Bilateral submandibular duct rerouting and sublingual gland excision combined with botulinum toxin type-A injection into the parotid gland is an effective and minimally invasive treatment with high parental satisfactory results. Key words: Sialorrhea, drooling, salivation, botulinum toxin, surgery, treatment, cerebral palsy, submandibular duct rerouting.