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A Meta-analysis

Jeremy Reed, MD, MPH; Carolyn K. Mans, MD; Scott E. Brietzke, MD, MPH

Arch Otolaryngol Head Neck Surg. 2009;135(9):924-931.

Objective  To review and assess the current published literature regarding the efficacy of surgical management of sialorrhea in pediatric patients.

Data Sources  The MEDLINE database was systematically reviewed for articles reporting on the use of surgical procedures to treat sialorrhea published from January 1, 1963, to November 30, 2008.

Study Selection  Inclusion criteria included presence of data on the success of surgical treatment of sialorrhea, English language, sample size greater than 5, and presentation of extractable data regarding the subjective success of surgical management of sialorrhea.

Data Extraction  Data regarding demographic characteristics of study participants, follow-up duration, subjective success rates, and number and type of complications were extracted by blinded reviewers.

Data Synthesis  A total of 325 studies were identified on initial search. Abstract review reduced the sample to 46. Cross-referencing yielded an additional 4 articles, resulting in the final sample of 50 articles. Forty-seven studies were case series (Centre for Evidence-Based Medicine level 4 evidence), 2 were cohort studies (level 2), and 1 was a prospective cohort study (level 1b). Median sample size was 18 (range, 5-181), and median follow-up duration was 8.1 months (range, 0.1-50 months). Subjective success was reported in more than 50% of patients in 49 of 50 studies. Random-effects modeling estimated the overall subjective success rate for all procedures to be 81.6% (95% confidence interval, 77.5%-85.7%; P < .001). Bilateral submandibular gland excision and parotid duct rerouting appeared to have the highest subjective success rates at 87.8% (k = 8 studies; 95% confidence interval, 80.5%-95.1%; P <.001), and 4-duct ligation was the lowest at 64.1% (4 studies; 27.6%-100%; P = .001).

Conclusions  Most evidence regarding surgical outcomes of sialorrhea management is low quality and heterogeneous. Despite this, most patients experience a subjective improvement following surgical treatment.

Author Affiliations: Department of Otolaryngology, Walter Reed Army Medical Center, Washington, DC.

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