title: Success and complications of four-duct ligation for sialorrhea.
abstract: OBJECTIVE
  Sialorrhea can have a significant negative effect on quality of life, impeding social interactions and severely limiting employment opportunities. Many surgical options to control sialorrhea have been reported. One of the newest procedures is combined ligation of the submandibular and parotid ducts, reported only once in the literature in one series of five patients to date. We have compared results in our first 21 patients undergoing this procedure with results reported in the literature for other procedures to treat sialorrhea.
  
  
  METHODS
  We retrospectively reviewed medical records of all 21 children we treated with four-duct ligation, a relatively simple intraoral procedure to control sialorrhea, between August 1999 and September 2000 and contacted primary caregivers by telephone to answer a questionnaire regarding objective and subjective results of surgery. Surgery was considered successful when caregivers rated patients as 'much better' or 'better' after surgery.
  
  
  RESULTS
  Follow-up was completed in all 21 of the patients 1-14 months after surgery. The success rate of four-duct ligation ('much better' or 'better' after surgery) was 81%, and no patient's sialorrhea problem was worse after surgery. Major complications occurred in two (10%) of the patients (one ranula and one case of sialoadenitis), which were both successfully treated surgically. Minor complications occurred in four (19%) of the patients, tongue swelling that prolonged hospitalization, a ranula that resolved, and prolonged submandibular gland swelling that resolved (two cases). More than half of patients were discharged the day of or the day after surgery.
  
  
  CONCLUSIONS
  Four-duct ligation should be considered when surgery is indicated to treat sialorrhea.
authors.affiliation: Department of Pediatric Otolaryngology, Children's Hospital of Alabama, 1600 Seventh Avenue South ACC320, Birmingham, AL 35233, USA.
authors.forename: W Peyton
authors.initials: WP
authors.lastname: Shirley
authors.forename: J Scott
authors.initials: JS
authors.lastname: Hill
authors.forename: Audie L
authors.initials: AL
authors.lastname: Woolley
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Wiatrak
mesh_terms: D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008026:Ligation / Q000295:instrumentation; D011183:Postoperative Complications; D012189:Retrospective Studies; D012798:Sialorrhea / Q000534:rehabilitation / Q000601:surgery*; D016896:Treatment Outcome