175 Unsuccessful submandibular duct surgery for anterior drooling: Surgical failure or parotid gland salivation? 8 Table 1 GMFCS (Gross Motor Function Classification Scale level descriptions; I: reduced speed, balance and coordination; II: limitations walking on uneven surfaces and inclines, and in crowds or confined spaced; III: walking indoors or outdoors on a level surface with assistance, wheelchair as needed; IV: reliance on wheelchair; V: no means of independent mobility).CP: cerebral palsy. 1PDL: unilateral parotid duct ligation, 2PDL: bilateral parotid duct ligation, SMDR: submandibular duct rerouting, 2DL: bilateral submandibular duct ligation, SMGE: submandibular gland excision. GERD: gastroesophageal reflux disease. BoNT-A: Botulinum neurotoxin type A injections of the bilateral submandibular glands (SMG) or bilateral parotid glands (PGL). Table 2. Clinical characteristics Current cohort (n = 10) Reference cohort (n = 122) P value GMFCS level IV-V, n (%) 7 (70) 77 (63) 0.75 Developmental age <4 y, n (%) 6 (60) 63 (52) 0.75 Anteflexion, n (%) 3 (38) [n = 8] 65 (53) 0.48 Dental malocclusion, n (%) 5 (50) 25 (21) 0.047* Incomplete lip seal, n (%) 7 (70) 74 (61) 0.74 No voluntary tongue control, n (%) 6 (60) 43 (35) 0.17 Tongue protrusion, n (%) 5 (56) [n = 9] 38 (31) 0.15 Severe speech disorder, n (%) 8 (80) 51 (42) 0.042* DSS-Dysphagia, n (%) 4 (40) 20 (16) 0.083 Table 2 Fisher’s exact test is used when expected cell count is less than 5. * = P value < 0.05; GMFCS = Gross Motor Function Classification System; GMFCS I – III is classified as Ambulant; GMFCS IV –V is classified as Non-ambulant; Developmental age <4 years vs. >4 years; Anteflexion = anteflexion head posture; Dental malocclusion = impossible-clearly different vs. slightly divergent-normal; Incomplete lip seal = impossible-clearly different vs. slightly divergent-normal; Tongue protrusion: Permanent – often vs. sometimes – never; Severe speech disorder is classified as no speech, anarthria or very severe dysarthria; DSS-Dysphagia = Dysphagia Disorder Survey (Dutch version): very serious-serious vs. moderate-mild-minimal-no dysphagia. After primary surgery with DL the DQ initially decreased in all patients at 8-weeks follow-up, on average reducing to 18.0 (12.7) from a mean baseline value of 41.4 (15.7), but increased back to 33.3 (14.9) after 32 weeks, which was the reason for re-intervention. A same pattern was observed for the VAS scores, as shown in Figure 1A.
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