151 The medium to long-term effects of two-duct ligation for excessive drooling in neurodisabilities, a cross-sectional study 7 INTRODUCTION Persistent excessive drooling is a frequent problem for children with neurodevelopmental disabilities.1-4 Invasive treatment for this condition comprises intraglandular injectionswithbotulinumneurotoxintypeA(BoNT-A),which iseffective in 54% of the children measured at 8 weeks after injection in the submandibular gland.4-7 Submandibular gland excision (SMGE) and submandibular duct relocation (SMDR) are effective in the majority of patients, but also have disadvantages.8,7,9 For SMGE these include admission, visible scars and risk of nerve injury, whereas SMDR involves a more technically challenging procedure with intensive care admission and several days of hospitalization, that is contra-indicated in posterior drooling.8,7,9 A less invasive, simpler treatment option is two-duct ligation (2-DL), which encompasses the clipping of the submandibular ducts in an outpatient setting. A recent randomized clinical trial showed that 2-DL is significantly more effective than submandibular BoNT-A. However, 26% of patients recurred in the period between week 8 and 32 weeks after surgery.8,10 Recurrence after 2-DL varies from 0% to 58%.9,11 To date, studies that focus on the long-term effect of 2-DL are scarce, so it remains unclear whether the decrease in effect progresses in the long-term. The present study aims to investigate the longterm effectiveness of 2-DL on anterior drooling. MATERIAL AND METHODS Study design and data sources This is a retrospective cohort study for patients who underwent two duct ligation (2-DL) to reduce anterior drooling. The study aims to evaluate the medium to longterm effectiveness of 2-DL. The follow-up data from 1 to 12 years in this chapter is from now on indicated by the long-term data expect for the subgroup analysis. In this article’s subgroup analysis the long-term data is divided into follow-up from
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