171 Unsuccessful submandibular duct surgery for anterior drooling: Surgical failure or parotid gland salivation? 8 METHODS A historic cohort was collected of all patients undergoing a secondary surgical procedure for anterior drooling between 2003-2018 at the Radboud University Medical Centre. At our clinic SMGE and PDL are considered when anterior drooling is refractory to primary submandibular duct surgery. Decision making between these two techniques is based on the expert opinion of our multidisciplinary ‘Saliva Control Team’, which consist of an ENT-surgeon, pediatric neurologist, rehabilitation specialist, psychologist and speech language therapist. Changes in saliva composition (serous/mucous) and severity of drooling at rest and during activity were used in the surgical decision making. More specifically, in case of mucous saliva and drooling during the resting situation, SMGE was performed as a re-intervention. On the contrary, PDL was performed when parotid gland salivation seemed to be the major problem (serous composition of saliva, drooling during activity/eating). Surgical outcomes were collected prospectively. Demographics, diagnosis, underlying conditions and procedure(s) were obtained using clinical records from the outpatient clinic. To evaluate the potential contribution of other clinical variables, demographics and clinical variables potentially related to treatment failure (developmental age, head posture, degree of mobility, a degree of dental malocclusion23, lip seal, Treatment Outcome Measure for dysarthria [TOMDysarthria24], Dysphagia Disorder Survey [DSS-Dysphagia]25) were compared to a reference cohort of 122 children with CP undergoing a first submandibular BoNT-A injection.20 We excluded patients (n=4) with missing follow-up data. The research was approved by our local ethics committee. All patient gave their informed consent for participation and publication of the results. Outcome measures The Thomas-Stonell and Greenberg classification26, which consists of a drooling severity and frequency scale, and a score on a visual analogue scale (VAS) (0: no drooling, 100: excessive drooling) for the drooling severity over the prior 2-week period were recorded as subjective outcome measures. The drooling quotient (DQ)
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