186 GENERAL DISCUSSION DISCUSSION AND CONCLUSION Goal and main findings of the thesis The goal of any intervention to treat drooling is a reduction of the visible spill of saliva or a decrease in posterior drooling to improve the child’s quality of life and make caregivers’ lives easier. There is currently no consensus about the hierarchy of interventions for drooling. The primary goal of this thesis was to evaluate 2-DL to determine its current place in drooling treatment in the Netherlands. 2-DL in literature This thesis demonstrated that 2-DL is an effective treatment for drooling in most patients in both short and medium-term follow-up. However, a certain degree of recurrence is seen in medium to long-term follow-up, although there is still a significant subjective drooling reduction in long-term follow-up. 2-DL resulted in a significant drooling reduction which relieved the impact of drooling on daily life and care, damage to electrical devices, and social interaction. Notably, even though patient characteristics did not allow formal statistical analyses, caregivers reported improvement of self-esteem after treatment with 2-DL. An earlier paper reported by our research team showed no recurrence in 15 patients eight months after 2-DL. By contrast, another study by Martin et al. found recurrence in 58% out of 12 patients after a median of 16 months follow-up. Of these 12, two required reinterventions (SMGE or bilateral submandibular BoNT-A). The mean subjective drooling score in the latter study changed from 8.8 (out of 10) preoperatively to 5.5 postoperatively.52 These results resemble the results in this thesis, where subsequent treatment was performed in 33% of patients (14 out of 42 patients), and VAS decreased from 82 (out of 100) to 53 after a mean of 5.2 years in patients not requiring reintervention. The amount of complications in this thesis seems to be relatively high compared to former research that reported only postoperative swelling after 2-DL. The difference might be due to the formal prospective follow-up in this thesis which included a
RkJQdWJsaXNoZXIy MjY0ODMw