73 Submandibular Duct Ligation After Botulinum Neurotoxin A Treatment of Drooling in Children With Cerebral Palsy 3 There were no missing data at baseline and no missing VAS scores at follow-up for either intervention. The drooling quotient follow-up rate 8 weeks (mean 8wks 6d; SD 2wks 5d) after BoNT-A injection was 100%. The drooling quotient 32 weeks after BoNT-A injection was not measured in one child, while in another patient the drooling quotient was omitted due to an unreliable measurement (the patient put her hands in her mouth during the measurement); this resulted in a 93.1% follow-up rate (mean 34wks 1d; SD 5wks 4d). There were no missing drooling quotient measurements 8 weeks (mean 8wks 6d; SD 1wks 1d) after bilateral submandibular duct ligation. The drooling quotient follow-up rate 32 weeks after bilateral submandibular duct ligation (mean 34wks 1d; SD 5wks 5d) was 97%; one patient did not attend the appointment due to personal circumstances. However, subjective assessment of this patient was made through a phone call. The average age at the time of BoNT-A administration was 9 years 6 months (SD 2y 5mo; range 6–15y) and 10 years 11 months (SD 2y 4mo; range 8–16y) at the time of surgery. Postoperative submandibular swelling was seen in all children after bilateral submandibular duct ligation. This was temporary and self-limiting within 2 weeks in all patients. Transient swallowing difficulties were reported by two patients after BoNT-A injection. One child was admitted to hospital with pneumonia after BoNT-A injection and developed another bout of pneumonia after bilateral submandibular duct ligation, which was treated at home. Another child was treated with oral antibiotics for mild pneumonia after bilateral submandibular duct ligation. One child mentioned temporary, self-limiting nasal regurgitation after bilateral submandibular duct ligation. One patient underwent bilateral excision of the ranula, excision of the sublingual glands, and repeated ligation of the submandibular ducts 2 years after the initial bilateral submandibular duct ligation. There were no cases of wound infection. The linearmixedmodel showed a significant difference inmean VAS for both BoNT-A and bilateral submandibular duct ligation at follow-up (Fig. 1). VAS was significantly lower 8 weeks after treatment (mean 40.3) compared to 32 weeks after treatment (mean 60.7) (mean difference −20.4, F[1,113]=16.449, p≤0.001; 95% CI=−10.7 to −31.1). Even though both interventions were effective, VAS was significantly lower at follow-up after bilateral submandibular duct ligation (mean 34) compared to BoNT-A
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