title: Prospective analysis of the outcome of surgical management of drooling in the pediatric population: a 10-year experience.
abstract: BACKGROUND
  Sialorrhea is a common problem in the neurologically impaired pediatric patient and surgery is the mainstay of treatment for severely affected patients refractory to conservative or medical treatment.
  
  
  METHODS
  The results of the surgical protocol used since 1993 at the Royal Children's Hospital in Melbourne, Australia, are reported. Seventy-two patients underwent bilateral submandibular duct transposition combined with bilateral sublingual gland excision. Patients were analyzed prospectively and reviewed at 1, 6, and 12 months, then at 2 and 5 years postoperatively.
  
  
  RESULTS
  Of 67 patients with 2 years of complete follow-up, the median score for the frequency of drooling fell from 4.0 to 2.9 (p < 0.001) and the median severity-of-drooling score decreased from 4.8 to 3.0 (p < 0.001). There was a fall in the number of clothing/bib changes from a median of four per day to zero (p < 0.0001). Of 41 patients followed to 5 years, both the median frequency and severity of drooling scores remained at 3. Overall the majority of patients benefited from surgery. Thirteen patients (18 percent) experienced complications which were major in 9 percent.
  
  
  CONCLUSIONS
  We have found bilateral sublingual gland excision in combination with bilateral submandibular duct transposition to be superior to bilateral submandibular duct transposition plus parotid duct ligation. The surgical treatment of sialorrhea continues to be a rewarding experience for our multidisciplinary team.
authors.affiliation: Department of Plastic and Maxillofacial, Royal Children's Hospital, Melbourne, Australia.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Greensmith
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Johnstone
authors.forename: Susan M
authors.initials: SM
authors.lastname: Reid
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Hazard
authors.forename: Hilary M
authors.initials: HM
authors.lastname: Johnson
authors.forename: Dinah S
authors.initials: DS
authors.lastname: Reddihough
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D019647:Oral Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011446:Prospective Studies; D012798:Sialorrhea / Q000601:surgery*; D013361:Sublingual Gland / Q000601:surgery*; D013363:Submandibular Gland / Q000601:surgery*; D016896:Treatment Outcome