98 CHAPTER 4 In summary, age, poor posture, and a VSSD are simply determined in a multidisciplinary, pre-operative setting. The formula to calculate the probability of 2-DL treatment success is helpful when providing patient-specific pre-operative information. Clinicians should be attentive to the modest individual effect sizes of the clinical variables. Furthermore, when considering this vulnerable patient population, the predictors inform, but never replace individual care. Moreover, because the data were not externally validated, clinicians in other institutions should be attentive to patient’s specific history when using the formula for surgical decision making. Additionally, we advocate that drooling should be treated in a multidisciplinary approach that includes a (child) neurologist, ENT-surgeon, and a speech and language therapist who evaluates speech but also other aspects of oral motor function. We identified the same predictors for both definitions of treatment success (objective and ‘combined’ treatment success). We feel it is of more clinical value to evaluate the subjective as well as the objective effects of treatment. Going forward, we therefore intend to use combined treatment success as an outcome in future research.8 2-DL seems to be an effective treatment strategy for anterior drooling up to 32 weeks (10,1% decrease to baseline) that is only slightly less effective when compared to SMDR and SMGE at 8 weeks (15,6% resp 23.6%) .17,2 Moreover, 2-DL is a relatively short procedure (24 minutes surgical time vs. 93 minutes in SMDR) that is performed in a day case setting with low (4%) risk for SAE related to the intervention (there were only two SAE related to the intervention which included direct postoperative admission due to nausea, and surgical re-intervention due to bilateral ranula formation) compared to 8% after SMDR and SMGE.17,2 Future studies should investigate the position of 2-DL when compared to SMGE and SMDR. Strengths and limitations The strengths of this study include the measurements of both objective and subjective outcomes that were obtained in a prospective setting. Themeasurements
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