title: Four-Duct Ligation for the Treatment of Sialorrhea in Children.
abstract: OBJECTIVE
  The 4-duct ligation procedure has appeal for its surgical simplicity and limited invasiveness in the management of pediatric sialorrhea. However, more information is required to understand the benefits, risks, success rates, and long-term effects of this intervention.
  
  
  OBJECTIVE
  To report the clinical outcomes of the 4-duct ligation procedure in pediatric patients diagnosed as having sialorrhea and the associated complication rates and to characterize patient and caregiver satisfaction in a consecutive series.
  
  
  METHODS
  This investigation was a retrospective cohort study at an academic tertiary pediatric center and pediatric rehabilitation hospital. Patients included 38 children with neurological impairment who underwent a 4-duct salivary gland ligation (parotid and submandibular glands) between January 1, 2004, and July 31, 2012. The dates of the analysis were August 2013 through February 2015.
  
  
  METHODS
  Posttreatment assessments included duration of effect, severity and frequency of drooling before and after the procedure, patient complications, caregiver satisfaction, caregiver recommendation of the procedure, and caregiver overall assessment of the child's quality of life. Clinical and outcome measures were collected before the procedure, 1 month after the procedure, 1 year after the procedure, and at the most recent follow-up (range, 3-8 years).
  
  
  RESULTS
  The study cohort comprised 38 participants. Their median age was 11 years (age range, 5-17 years), and 37% (14 of 38) were female. The mean (SD) duration of effect was 52.6 (20.4) months. Patients with previous sialorrhea management were more likely to demonstrate an improvement in their drooling frequency score at 1 year. Thirteen complications were documented in 12 patients. The most common complications were persistent facial swelling and aspiration pneumonia. Eighty percent (28 of 35) of caregivers reported an improvement in their child's drooling at 1 month, while 69% (25 of 36) and 71% (24 of 34) stated that there was an improvement at the 1-year follow-up and the most recent follow-up, respectively.
  
  
  CONCLUSIONS
  The 4-duct ligation procedure offers a simple, effective, and minimally invasive approach to the management of sialorrhea in children.
authors: Faculty of Health Sciences, School of Medicine, Trinity College Dublin, Dublin, Ireland.
authors: Waqas U
authors: WU
authors: Khan
authors: Department of Pharmacology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors: Alvi
authors: A
authors: Islam
authors: Department of Occupational Therapy, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.
authors: Ann
authors: A
authors: Fu
authors: Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors: Diane C
authors: DC
authors: Blonski
authors: Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada.
authors: Salaha
authors: S
authors: Zaheer
authors: Cleft Lip and Palate/Craniofacial Service, Child Development Program, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.
authors: Catherine A
authors: CA
authors: McCann
authors: Cleft Lip and Palate/Craniofacial Service, Child Development Program, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.
authors: Melissa S
authors: MS
authors: Joseph
authors: Cleft Lip and Palate/Craniofacial Service, Child Development Program, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.
authors: Rebecca
authors: R
authors: Perlin
authors: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors: Rajab
authors: R
authors: Khan
authors: Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada.
authors: Paolo
authors: P
authors: Campisi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation / Q000379:methods; D008297:Male; D019647:Oral Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D018987:Salivary Ducts / Q000601:surgery*; D012798:Sialorrhea / Q000601:surgery*; D016896:Treatment Outcome