181 Unsuccessful submandibular duct surgery for anterior drooling: Surgical failure or parotid gland salivation? 8 In sum, recurrence of drooling is most likely not caused by surgical failure, and it is not likely that recurrence is solely caused by increased parotid gland salivation. The latter could not be conclusively ruled out based on our data, as stated earlier by our research group ‘non-responders might constitute a group of clinically different children that suffer from more parotid activity’.30 Bilateral submandibular gland excision or unilateral parotid duct ligation are both not beneficial for anterior drooling after primary surgery on the submandibular glands in this cohort. However, we did find a good result from bilateral submandibular gland excision combined with bilateral parotid duct ligation. Further research about this intervention should be encouraged, but handled with care because of the postoperative risk of xerostomia and the beneficial aspects of saliva (bolus forming, dental health, immunity) in this extremely vulnerable population. Dysarthria and dental malocclusion might negatively influence treatment outcome, but future research is needed to identify clinical variables that could influence drooling and therapy outcome in a patient centered way. Acknowledgment This study is funded by the JKF kinderfonds.
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