title: Bilateral transcervical submandibular gland excision for drooling: A study of the mature scar and long-term effects.
abstract: OBJECTIVE
  Several surgical techniques are available to treat drooling in neurologically disabled children and adolescents, with bilateral submandibular gland excision being the only transcervical procedure. External scars can be a reason to decline for this surgical approach. We investigated which factors influenced caregiver satisfaction by evaluating the long-term scar in relation to treatment outcome.
  
  
  METHODS
  We identified a historical cohort, in which all neurologically disabled patients who underwent bilateral submandibular gland excision for drooling between January 2009 and December 2013 were identified (n = 41). The Patient and Observer Scar Assessment Scale (POSAS) was used to evaluate observer and clinician satisfaction. All included patients were contacted by telephone and completed a digital questionnaire that included digital images of the scars.
  
  
  RESULTS
  Of the caregivers that responded the questionnaire 76% (19/25) were satisfied with the overall outcome. Twenty-four (96%) caregivers considered the scars acceptable. Caregiver satisfaction was not correlated to the appearance of scars, but was significantly correlated with the decrease in drooling severity on a visual analogue scale (p = 0.035) and decrease in lower respiratory tract infections (p = 0.042).
  
  
  CONCLUSIONS
  The appearance of scars does not influence satisfaction after bilateral submandibular gland excision for drooling. As expected, satisfaction is correlated to the treatment outcome.
authors.affiliation: Radboud University Medical Centre Nijmegen, Radboud Institute for Health Sciences, Department of Otorhinolaryngology and Head and Neck Surgery, The Netherlands. Electronic address: Corinne.Delsing@radboudumc.nl.
authors.forename: Corinne P A
authors.initials: CP
authors.lastname: Delsing
authors.affiliation: Radboud University Medical Centre Nijmegen, Radboud Institute for Health Sciences, Department of Otorhinolaryngology and Head and Neck Surgery, The Netherlands.
authors.forename: Tieneke
authors.initials: T
authors.lastname: Viergever
authors.affiliation: Radboud University Medical Centre Nijmegen, Radboud Institute for Health Sciences, Department of Otorhinolaryngology and Head and Neck Surgery, The Netherlands.
authors.forename: Jimmie
authors.initials: J
authors.lastname: Honings
authors.affiliation: Radboud University Medical Centre Nijmegen, Radboud Institute for Health Sciences, Department of Otorhinolaryngology and Head and Neck Surgery, The Netherlands.
authors.forename: Frank J A
authors.initials: FJ
authors.lastname: van den Hoogen
mesh_terms: D000293:Adolescent; D017028:Caregivers; D002648:Child; D002921:Cicatrix; D005260:Female; D006801:Humans; D008297:Male; D012798:Sialorrhea / Q000601:surgery*; D013363:Submandibular Gland / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Cerebral palsy; Drooling; Mental retardation; Surgery