207 Secondary outcomes The following five variables will be collected as standard care, although these are not among the current study outcomes. 1. Visual Analog Scale for the severity of drooling 2. Drooling Quotient 3. Treatment effect 4. Drooling Severity Scale 5. Drooling Frequency Scale 6. Surgical time 7. Suitability for an out-patient setting. Tertiary outcome Determining the bacterial composition in saliva samples using 16S rRNA Illumina sequencing and monitoring potential changes in disease-associated species. The relative abundance of bacteria in saliva at baseline (before surgery) will be compared to samples 8 and 32 weeks after surgery. Procedure E-2DL is performed under general anesthesia. To prevent excessive post-operative swelling patients receive 1,5 mg / kilogram Di-Adreson-F aquosum per-operatively. Patients receive 30mg / kilogram cefazoline intravenously before the procedure. The floor of the mouth is infiltrated with 1% lidocaine with 1:100.000 epinephrine, and incised parallel to the frenulum. After identification of the duct, it is dissected for 1 to 2 cm. The submandibular duct is then cannulated by a 0.025 inch flexible cannula. To fixate the cannula, the duct that includes the cannula is tied with a polyglactin 910 wire. Dehydrated ethanol (EtOH) 96% is diluted with water-soluble contrast (Iomeron 300) in ratio 4:1 and an estimated 1 – 1.5mL of the solution (EtOH – Iomeron 300) is injected into the duct under digital subtraction sialography (DSS) in order to control for extravasation from the gland capsule.86 The maximum amount of Ethanol 96% is 4 mL per gland. The submandibular duct is then ligated using a disposable stapler, applying two vascular clips per duct. The incision is closed with
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