67 Submandibular Duct Ligation After Botulinum Neurotoxin A Treatment of Drooling in Children With Cerebral Palsy 3 nerve. In addition, SMDR is unsuitable in children with posterior drooling (saliva aspiration). Bilateral submandibular gland excision is another surgical procedure that can provide a longer-lasting solution to drooling. Potential disadvantages include a small risk of damage to the lingual, hypoglossal, and mandibular branches of the facial nerve. Additionally, an external incision is required. This leaves a scar that is generally cosmetically acceptable to children and their caregivers.13 In the recent decade, bilateral submandibular duct ligation has arisen as a potential minimally invasive surgical procedure to treat drooling. In contrast to SMDR and bilateral submandibular gland excision, bilateral submandibular duct ligation is performed as part of day care with a shorter surgery that is safe and effective.14–16 However, due to a lack of comparative studies, the relevance of bilateral submandibular duct ligation is yet to be determined among the range of surgical treatment options open to families who choose not to continue with repeated BoNT-A injections or patients in whom BoNT-A is not effective. Since both treatment modalities aim to reduce submandibular salivary flow, we might expect treatment success after submandibular BoNT-A injections to have a predictive value with regard to treatment success derived from bilateral submandibular duct ligation. This within-participant retrospective observational study aimed to compare subjective and objective drooling severity after bilateral submandibular duct ligation in children with severe drooling first treated with BoNT-A and evaluate if BoNT-A treatment success is a predictor for treatment success after bilateral submandibular duct ligation.
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