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Abstract：
Background Sialorrhea is a common comorbidity among children with neurologic disorders. Botulinum toxin injections and surgical procedures are recommended for the management of pathological sialorrhea in patients who fail conservative management or with concerns for salivary aspiration. The following review evaluates outcomes following botulinum toxin injections and surgical interventions for sialorrhea over a 10-year period with a focus on treatment options and outcomes for patients with anterior and posterior drooling. Methods The study included all patients less than 25 years of age who underwent a procedure for drooling (Current Procedural Terminology (CPT) codes 42440, 42450, 42509, 42510, 64611 matched with the International Classification of Diseases (ICD)-9 and ICD-10 codes 527.7 and K11.7) from January 1, 2006 to December 31, 2015. A chart review collected demographics, drooling medication use, and type of drooling (anterior, posterior, both). Outcome variables included pre- and post-procedure number of bibs, parent-reported outcomes, post-intervention drooling medication requirement, post-procedure length of stay, and complications. Results Seventy-one patients were included in our analysis, with 88 total procedures performed. The average age at first intervention was 8.9 years; 43 patients were male and 40 patients had cerebral palsy. Thirty-one patients experienced posterior drooling or anterior/posterior drooling. These patients were more likely to undergo surgery as the first invasive intervention. The most commonly performed interventions were botulinum toxin injections (28 patients, 39%) and sublingual gland excision (SLGE) with submandibular duct ligation (SMDL) (36 patients, 51%). Improvement following injections was noted in 56% of patients versus 73% of patients following any surgical intervention. Conclusion Management of drooling is complex with 18 different procedures performed over 10 years. Surgical interventions, specifically SLGE with SMDL and submandibular gland excision (SMGE), result in substantial improvement; these are commonly performed as the first intervention in patients with posterior drooling. By reviewing our experience, we hope to guide management decisions and help manage patient and caregiver expectations.
摘要：
背景泪流是患有神经系统疾病的儿童中常见的合并症。对于保守治疗失败或担心唾液吸入的患者，建议注射肉毒杆菌毒素和外科手术来治疗病理性流涕。以下综述评估了10年期间肉毒杆菌毒素注射和手术干预后的结果，重点是前后流口水患者的治疗选择和结果。方法该研究包括2006年1月1日至2015年12月31日接受流口水手术（与国际疾病分类（ICD）-9和ICD-10代码527.7和K11.7相匹配的当前程序术语（CPT）代码42440、42450、42509、42510、64611）的所有年龄小于25岁的患者。图表审查收集了人口统计数据，流口水的药物使用，和流口水的类型(前，后部,both).结果变量包括术前和术后的围兜数量，父母报告的结果，干预后流口水的药物需求，术后住院时间,和并发症。结果71例患者被纳入我们的分析，总共执行了88个程序。首次干预的平均年龄为8.9岁；43例患者为男性，40例患者患有脑瘫。31例患者出现后流口水或前/后流口水。这些患者更有可能接受手术作为第一次侵入性干预。最常见的干预措施是肉毒杆菌毒素注射(28例患者，39％）和舌下腺切除术（SLGE）下颌下导管结扎术（SMDL）（36例，51%）。在56％的患者中观察到注射后的改善，而在任何手术干预后的患者中为73％。结论流口水的管理是复杂的，在10年内执行了18种不同的程序。手术干预,特别是SLGE与SMDL和颌下腺切除术（SMGE），导致实质性改善；这些通常作为后流口水患者的首次干预措施进行。通过回顾我们的经验，我们希望指导管理决策，并帮助管理患者和护理人员的期望。
