80 CHAPTER 3 for bilateral submandibular duct ligation should be carefully considered because bilateral submandibular duct ligation interferes with SMDR, which is currently the most effective therapeutic option to treat drooling in our experience. Yet, SMDR is contraindicated in cases of posterior drooling; therefore, bilateral submandibular duct ligation could be indicated as the first surgical step after BoNT-A treatment. Future studies should focus on bilateral submandibular duct ligation in a larger patient population with a longer follow-up period to further define the long-term effect and externally validate predictors for treatment success or failure32, thereby establishing the place of bilateral submandibular duct ligation within the current spectrum of treatment modalities for the treatment of drooling.
RkJQdWJsaXNoZXIy MjY0ODMw