222 SUMMARY sparse, and to date, there is little evidence why some respond well while others are non-responders. Chapter 4 aims to find predictors for treatment success and study the effectiveness of 2-duct ligation (2-DL) for drooling in neurodisabilities. After excluding 4 patients due to missing or unreliable primary outcomes, fifty children with moderate to severe drooling were left for analyses. The average age at the time of surgery was 12 years. Outcomes in this retrospective observational cohort study were DQ (Drooling Quotient) and VAS (Visual Analog Scale). Predictors were assessed for treatment success, defined as ≥50% VAS and/or DQ reduction from baseline to 32 weeks follow-up. Measurements were obtained at baseline, 8 and 32 weeks. Age (more mature), adequate posture (no anteflexion), and normal speech are predictors for treatment success. DQ was significantly lower at 8 (difference 18.6%, 95% CI 12.3 – 24.9%) and 32 weeks (difference 10.1%, 95% CI 3.9 – 16.4%) compared to baseline. Eight weeks VAS (difference 45.0, 95% CI 37.0 – 52.9) and 32 weeks VAS (difference 32.9, 95% CI (25.0 – 40.7) were significantly lower compared to baseline VAS. Age, adequate posture, and normal speech are predictors for treatment success, are easily accessible pre-operatively, and help the clinician providing the patient-specific probability of treatment success to decide when to advocate 2-DL and when there is limited chance for treatment success so to refrain from 2-DL. This study confirms a significant subjective and objective decrease of drooling after 2-DL. Chapter 5 Submandibular Botulinum Neurotoxin Type A (BoNT-A) injections and submandibular duct ligation (2-DL) are used to treat drooling in children and adolescents with severe drooling. Even though the interventions significantly reduce drooling, patients are rarely dry after salivary reducing surgery. To date, it remains unclear whether these interventions positively influence the quality of life and impact of drooling on daily life and care, social interaction, and self-esteem. The fifth chapter evaluates the impact of drooling on everyday life and care, social interaction, and self-esteem after 2-DL compared to BoNT-A. The study design was similar to the methodology reported in chapter 2; patients were randomly assigned to BoNT-A or 2-DL. Both interventions were performed in an outpatient
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