110 CHAPTER 5 treatment (speech and language therapy or behavioural therapy) had failed or was not expected to provide a substantial relief, were aged 8 years or older (when there is low chance that children would still ‘outgrow’ drooling), diagnosed with CP or any other non-progressive neurodevelopmental disorder and reported with moderate or severe drooling (defined as Drooling Frequency score ≥3 or Drooling Severity score ≥2).14 Interventions Both BoNT-A injections and 2-DL were performed in an outpatient setting. BoNT-A (Onabotulinum toxin A; Allergan, Nieuwegein, the Netherlands) was administered to the submandibular glands under general anaesthesia, fractioning 25U in 0.9% saline over each submandibular gland using a 25-gauge needle and ultrasound guidance. Patients were treated under general anaesthesia and ultrasound guidance to decrease the risk of negative effects in case of extra glandular BoNT-A.. In participants with preceding BoNT-A treatment, BoNT-A injections or 2-DL were performed at least 6 months after the last injection to prevent a carry-over effect. The 2-DL was also performed under general anesthesia. The submandibular ducts were traced, dissected and ligated, applying two metal vascular clips to each duct. Intraoral absorbable sutures closed the incision.5 All 2-DL patients received amoxicillin/clavulanic acid and paracetamol + diclofenac for respectively 7 and 5 days. Outcome measures A questionnaire was filled out by one of the parents or caregivers (hereafter referred to as caregivers) during the baseline measurement and 8 and 32 weeks post-treatment (see appendix). Drooling severity in 13 specific positions and daily activities (e.g. sitting, eating, relaxing etc. See appendix) and the impact of drooling on daily care, the child’s social interaction, and self-esteem were scored by the caregivers in the questionnaire. Caregivers were also asked the average number of times during the past two weeks they had to wipe the chin per hour, encourage to swallow per hour, and to change bibs per day. Moreover, the questionnaire included a question whether there occurred damage to furniture and/or electronics
RkJQdWJsaXNoZXIy MjY0ODMw