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When Are Bilateral Submandibular Gland Excision and Parotid Duct Ligation Indicated?

Mark E. Gerber, MD; Michael D. Gaugler, MD; Charles M. Myer, III, MD; Robin T. Cotton, MD

Arch Otolaryngol Head Neck Surg. 1996;122(12):1368-1371.

Abstract
Objective
To assess the efficacy of bilateral submandibular gland excision and bilateral parotid duct ligation in treatment of chronic aspiration in neurologically impaired children.

Design
Retrospective chart review and telephone follow-up interview.

Setting
Tertiary care center.

Patients
All patients from 1986 through 1994 who underwent bilateral submandibular gland excision and bilateral parotid duct ligation and had evidence of at least 1 episode of aspiration pneumonia in the year prior to undergoing surgery.

Main Outcome Measure
Two main outcomes measures were (1) the change in number of hospitalizations for pneumonia and total number of lower respiratory tract infections between 1 year before and 1 year after surgical intervention and (2) telephone assessment of patient outcome with respect to parental satisfaction, effect on quality of life, care requirements, amount of suctioning, and use of voice.

Results
Sixteen patients aged 16 months to 18 years were included. After surgical intervention, there was a significant decrease in the mean (±SD) number of pneumonias (2.3±1.44 before surgery, 0.9±1.2 after surgery; P<.001) and hospitalizations (1.2±0.8 before surgery, 0.4±0.8 after surgery; P<.005). Six patients had a tracheostomy at the time of surgery, and 1 required a tracheostomy 2 years after surgery. No individual required laryngotracheal separation. Eleven families were able to be contacted by telephone. Caretakers reported that in 8 of 11 patients, quality of life was improved and care requirements decreased. Seven patients used voice for at least some degree of communication. Three patients had postoperative complications involving the parotid glands; all resolved after further therapy.

Conclusion
Bilateral submandibular gland excision and bilateral parotid duct ligation reduce the incidence of aspiration pneumonias and hospitalization, and decrease overall care requirements in a select group of neurologically impaired children. Because they are voice sparing, are efficacious, and have a low morbidity, they should be considered before laryngotracheal separation or tracheoesophageal diversion.

Arch Otolaryngol Head Neck Surg. 1996;122:1368-1371

Author Affiliations
From the Department of Pediatric Otolaryngology and Maxillofacial Surgery, Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.

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