title: Botulinum toxin versus submandibular duct relocation for severe drooling.
abstract: OBJECTIVE
  Botulinum neurotoxin type A (BoNT-A) has been described as an effective intervention for drooling and is being increasingly adopted. However, its effectiveness compared with established treatments is still unknown. We undertook a within-participants observational study to examine this.
  
  
  METHODS
  An historic cohort was formed of 19 children and young adults (10 males, nine females) with severe drooling who underwent BoNT-A injections followed by surgical re-routing of the submandibular duct at least 6 months later. Mean age at time of admission was 11 years 5 months (range 5-17 y) and mean age at the time of surgery was 14 years (range 6-23 y). Fifteen children were diagnosed with bilateral cerebral palsy (CP), three with unilateral CP, and one with non-progressive developmental delay. Gross Motor Function Classification System levels were the following: level I, n=1; level II, n=2; level III, n=7; level IV, n=6; and level V, n=3). The primary outcome was the drooling quotient, which was assessed before each intervention and 8 and 32 weeks thereafter. A multivariate analysis of variance of repeated measures was performed, with the measurement points as the within-participant variables.
  
  
  RESULTS
  The drooling quotient was reduced to a greater extent after surgery than after BoNT-A administration (p=0.001). Compared with a baseline value of 28, the mean drooling quotient 8 weeks after surgery was 10, and 32 weeks after surgery was 4 (p<0.001). Among the group treated with BoNT-A, the drooling quotient showed a significant reduction from a baseline value of 30 to 18 after 8 weeks (p=0.02), and a continued but diminished effect after 32 weeks (drooling quotient 22; p=0.05).
  
  
  CONCLUSIONS
  Both interventions are effective, but surgery provides a larger and longer-lasting effect.
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands. a.scheffer@kno.umcn.nl
authors.forename: Arthur R T
authors.initials: AR
authors.lastname: Scheffer
authors.forename: Corrie
authors.initials: C
authors.lastname: Erasmus
authors.forename: Karen
authors.initials: K
authors.lastname: VAN Hulst
authors.forename: Jacques
authors.initials: J
authors.lastname: VAN Limbeek
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Rotteveel
authors.forename: Peter H
authors.initials: PH
authors.lastname: Jongerius
authors.forename: Frank J A
authors.initials: FJ
authors.lastname: van den Hoogen
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009498:Neurotoxins / Q000494:pharmacology / Q000627:therapeutic use*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012798:Sialorrhea / Q000188:drug therapy* / Q000601:surgery*; D013363:Submandibular Gland / Q000187:drug effects / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009498:Neurotoxins; D019274:Botulinum Toxins, Type A