109 Surgery vs botulinum for the impact of drooling on daily life in children with neurodevelopmental disabilities: a randomized controlled trial 5 treatment success after SMDR and SMGE.8-12 Here, treatment success was defined as a ≥50% reduction in drooling quotient and/or caregiver’s score on a Visual Analog Scale. There was a slightly greater risk for complications and morbidity after 2-DL compared to BoNT-A.5 The cost-effectiveness analysis revealed that BoNT-A is less expensive per percentage of success than two-duct ligation. The additional cost of two-duct ligation over BoNT-A is, however, offset by greater treatment success. Costs of both procedures would be equal after ~ 1.5 BoNT-A injections.13 During this RCT, additional information was collected on the impact of drooling on the well-being and daily care. The aim of this paper was to report the effect of BoNT-A and 2-DL on drooling severity and its impact on daily life and care, damage to electronics and/or furniture, social interaction and self-esteem in children with neurodevelopmental disabilities and moderate to severe drooling. METHODS Study design This RCT was conducted in the Radboud University Medical Center Nijmegen, The Netherlands between April 2012 and August 2017. Patients were randomly allocated to treatment with BoNT-A or 2-DL. There was partial blinding for treatment allocation. Investigators measuring objective outcomes were masked, whereas patients and caregivers were not blinded for treatment allocation. For a detailed description of the study design see Bekkers et al.5 Participants Patients were recruited at the regular outpatient Saliva Control clinic of the Radboud University Medical Center where these children and adolescents were assessed. The multidisciplinary team includes a pediatric neurologist, a pediatric speech-language therapist, and a rehabilitation specialist, a psychologist and an Ear- Nose- and Throat surgeon upon consultation. All eligible patients underwent oral motor therapy to optimize swallow-, and mouth closure skills before inclusion.. The study was considered for all children and adolescents whose conservative
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