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Major Salivary Duct Clipping for Control Problems in Developmentally Challenged Children
Hamdy El-Hakim, FRCS(Edin), FRCS(ORL-HNS);
Susan Richards, RN, BScN, MN(c);
Mahilravi Samuel Thevasagayam, FRCS(Edin), FRCS(ORL-HNS)
Arch Otolaryngol Head Neck Surg. 2008;134(5):470-474.
Objectives To introduce a technical modification for interruption of the parotid and submandibular salivary ducts and to demonstrate the technique's effectiveness and effect on quality of life.
Design Retrospective, uncontrolled, consecutive case series.
Setting A tertiary care pediatric otolaryngologypractice.
Patients Eighteen drooling and aspirating children.
Intervention Transoral interruption of parotid and submandibular ducts using vascular clips.
Main Outcome Measures Manifestations of poor saliva control (visible drooling, number of shirts and bibs used, choking episodes, embarrassment, and incidence of salivary aspiration), Glasgow Children's Benefit Inventory scores (possible score range, – 100 to + 100), and complications.
Results Eighteen patients (10 boys and 8 girls) were treated in 14 months. Patient age ranged from 2 to 14 years. Follow-up ranged from 3 to 18 months. No complications occurred. Nine patients had no drooling at all after surgery. There was a significant reduction in the number of bibs and shirts used (P < .001). Regarding measures indicating circumoral skin problems, embarrassment, choking episodes, and aspiration pneumonia, all the patients had significant improvements after surgery. The mean Glasgow Children's Benefit Inventory score was 33.2.
Conclusions Salivary duct clipping is an efficient and safe method of controlling saliva in neurologically challenged children. The operation positively affects the children's quality of life.
Author Affiliations: Pediatric Otolaryngology (Division of Pediatric Surgery), Department of Pediatrics, and Division of Otolaryngology, The Stollery Children's Hospital, The University of Alberta Hospitals, Edmonton, Alberta, Canada.
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