title: [Submandibular gland resection for the management of sialorrhea in paediatric patients with cerebral palsy and unresponsive to type A botullinum toxin. Pilot study].
abstract: BACKGROUND
  Sialorrhoea has a prevalence of between 10% and 58% in patients with cerebral palsy. Amongst the invasive treatments, botulinum toxin-A injections in submandibular and parotid glands and various surgical techniques are worth mentioning. There are no studies in Mexico on the usefulness of surgery to manage sialorrhoea.
  
  
  OBJECTIVE
  To evaluate the usefulness of submandibular gland resection in improving sialorrhoea in patients with cerebral palsy and with a poor response to botulinum toxin.
  
  
  METHODS
  Experimental, clinical, self-controlled, prospective trial was conducted to evaluate the grade of sialorrhoea before surgery, and 8, 16 and 24 weeks after. Statistical analysis was performed using a non-parametric repetitive measure assessment, considering a p < 0.05 as significant. Complications and changes in salivary composition were evaluated.
  
  
  RESULTS
  Surgery was performed on 3 patients with severe sialorrhoea, and 2 with profuse sialorrhoea, with mean age of 10.8 years. The frequency and severity of sialorrhoea improved in the 5 patients, with mean of 76.7 and 87.5% improvement, respectively. The best results were seen after 6 months of surgery, with a statistically significant difference between the preoperative stage and 6 months after the procedure (p = 0.0039, 95% CI). No significant differences were observed in complications, increase in periodontal disease or cavities, or salivary composition.
  
  
  CONCLUSIONS
  Submandibular gland resection is an effective technique for sialorrhoea control in paediatric patients with cerebral palsy, with a reduction in salivary flow greater than 80%. It has a low chance of producing complications compared to other techniques. It led to an obvious decrease in sialorrhoea without the need to involve other salivary glands in the procedure.
authors.affiliation: Otorrinolaringología y Cirugía de Cabeza y Cuello, Instituto Nacional de Rehabilitación, Ciudad de México, México.
authors.forename: Mario Sabas
authors.initials: MS
authors.lastname: Hernández-Palestina
authors.affiliation: Otorrinolaringología y Cirugía de Cabeza y Cuello, Instituto Nacional de Rehabilitación, Ciudad de México, México. Electronic address: juancarloscisneros@me.com.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Cisneros-Lesser
authors.affiliation: Servicio de Rehabilitación Pediátrica, Instituto Nacional de Rehabilitación, Ciudad de México, México.
authors.forename: María Elena
authors.initials: ME
authors.lastname: Arellano-Saldaña
authors.affiliation: Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, México.
authors.forename: Said Estibeyesbo
authors.initials: SE
authors.lastname: Plascencia-Nieto
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000494:pharmacology / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000150:complications; D002648:Child; D004351:Drug Resistance; D006801:Humans; D010865:Pilot Projects; D011446:Prospective Studies; D012720:Severity of Illness Index; D012798:Sialorrhea / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D013363:Submandibular Gland / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin; Cerebral palsy; Glándulas salivales; Parálisis cerebral; Salivary glands; Sialorrea; Sialorrhoea; Toxina botulínica